Chest pain
In a chest pain workup, gather and document the character and timing of the pain, cardiovascular risk factors, ECG and troponin results with times, and the red flags you asked about.
Heart and lungs: In these presentations, you often have an ECG, a troponin or a chest X-ray in the sources already.
Key takeaways
- Record whether the pain comes on with exertion and settles with rest.
- Quote every troponin with its value, unit and the time it was taken.
- Document the red flags you asked about, including the negatives.
What this presentation is
Chest pain has cardiac, respiratory, gastrointestinal, musculoskeletal and psychological causes. The history decides which matter most for this patient.
Many doctors classify the pain as typical angina, atypical angina or non-anginal from three features: constricting discomfort, brought on by exertion, and relieved by rest or nitrates. Record which features are present so the reader can see the classification.
Gather these sources first
- The referral and the question it asks
- Current and previous ECGs, so you can compare them
- Troponin results with the times they were taken
- Lipids, HbA1c, renal function and complete blood count
- Previous cardiology letters and echocardiogram reports
- The current medication list
Document these history questions
- Onset, duration and how often episodes occur
- Site, character and radiation of the pain
- Relation to exertion, meals, breathing and posture
- What relieves it, including rest or nitrates
- Associated breathlessness, palpitations, sweating or syncope
- Smoking in pack-years, hypertension, diabetes and lipids
- Family history of premature coronary disease, with the relative's age
Record these findings
- Blood pressure, heart rate and rhythm
- Heart sounds and signs of heart failure
- ECG rhythm and any ST or T wave changes
- Troponin values, units and timing
- Lipid profile and HbA1c
Ask about these red flags
Record each one as present or absent. Your local pathway decides what happens when one is present.
- Pain at rest or lasting longer than a few minutes
- Pain with syncope, breathlessness or sweating
- Tearing pain radiating to the back
- Pleuritic pain with breathlessness or hemoptysis
- Hemodynamic instability or a new arrhythmia
Put these in the assessment draft
- The pain classified, with the features that support it
- A ranked differential with cardiac causes weighed against the history
- The results that bear on it, quoted with dates
- The red flags asked about and the answers
- A plan with investigations, referral and safety-netting advice
How Workup Desk helps
Add the referral, the ECG reports, the lab results and your visit notes to the patient's workspace. Ask which risk factors the sources record and which results are missing a date.
Draft the assessment in the structure above and edit it. Check each answer in the chat against the source it names before it goes into the letter.
Frequently asked questions
Does a normal ECG and troponin exclude a cardiac cause?
Not on their own. A normal resting ECG and troponin in someone with weeks of exertional symptoms do not exclude stable coronary disease. Record the results and weigh them against the history.
Why record pack-years rather than smoker or non-smoker?
Pack-years quantify exposure, and an ex-smoker with 25 pack-years carries a different risk from someone who smoked briefly. The pack-year calculator does the arithmetic.
General guidance on what to gather and document, not advice about any individual patient. Local guidelines and your clinical judgment govern.