Assessing Chest Pain

The following is a good method of assessing chest pain based on the works of Newberry, Barnett and Ballard (2003, p84-5) mneumonic for assessing chest pain. Over the years there have been numerous mneumonics for assessing chest pain, including the commonly used OPQRST mneumonic used to assessing any pain type.

Chest Pain Assessment

C – Commenced when? This looks as the onset time and activity undertaken when the pain commenced.

H – History of heart disease or risk factors, such as smoking, age, sex, high blood pressure, high cholesterol, unstable BSL, obesity?

E – Extra symptoms – what other symptoms does the patient have, such as nausea, dizziness, sense of impending doom?

S – Stays or radiates? Where is the pain and where does it go?

T – Timing – when did it start, how long has it lasted? Is it continuous or intermittent?

P – Place – where is the pain exactly? Can you pinpoint the pain or is a non-specitific pain?

A – Alleviates/ aggravates – anything that makes the pain feel better? Anything that makes the pain feel worse?

I – Intensity. How intense is the pain – 0-10?

N – Nature – describe the pain – is is advised that you do not describe the types of pain, because this will likely just cause the patient to follow on with what you identify and not what he or she feels.

On top of these chest pain assessments, clinicians should perform a 12 lead ECG and assess it for any acute changes in the ST segment or arrythmias. In an emergency department, further 12 lead ECGs will be taken and blood tests will be collected to review blood electrolyte levels, creatinin kinase levels, troponin I and T levels and myoglobin levels, all of which may be elevated in the event of myocardial damage (a heart attack).