Chest Pain Practice Sheet

Table of Contents


Mr Jones is a 55-year-old gentleman who is complaining of intermittent right-sided chest pain and shortness of breath. 

Please take a history from, and examine Mr Jones.

Presenting Complaint

Mr Jones felt feverish and developed a cough 8 days ago. He has come in today as he has now developed chest pain and shortness of breath and is worried that he may have something serious.

Chest pain

  • Site: Right side of chest

  • Onset: Symptoms started roughly 8 days ago; pain started 2 days ago

  • Character: Sharp pain

  • Radiation: No radiation

  • Associated symptoms: Shortness of breath and cough

  • Timing: Intermittent, pain only present when coughing or taking deep breath

  • Exacerbating / relieving factors: Pain is worse when breathing in or coughing

  • Severity of pain: 7/10


  • Productive

  • Green sputum

  • No haemoptysis

Shortness of breath

  • Intermittent

  • Caused by not being able to take full breath / catching pain in chest

  • Worse on exertion 

Systems Review

  • Cardio: No palpitations, no ankle swelling, no PND, no syncope

  • Resp: No wheeze, no stridor, current smoker, no asbestos exposure
  • GI: Reduced appetite, no vomiting, no epigastric pain, no change in bowel habit
  • Infective: Fevers, no coryzal symptoms, no sore throat, no rashes, no dysuria
  • Red flags: No weight loss, no lumps or bumps, no night sweats

Past Medical History

  • PMHx: Hypertension, no previous hospital admissions

  • DHx: Amlodopine
  • Allergies: NKDA, allergic to cats
  • Vaccinations status: Annual flu vaccine

Social History

  • Smoking: 15-20 cigarettes each day for past 30 years

  • Alcohol: Nil
  • Illicit drug use: Nil
  • Occupation: Social worker, sees a lot of people, uses public transport everyday primarily the bus
  • Home: Lives in flat with wife, she is not unwell, no mould or exposures
  • FHx: Mother has COPD, Father died from heart attack


  • Ideas: Caught a chest infection from someone at work.

  • Concerns: Could the chest pain be a heart attack?
  • Expectations: Medication to make him feel better so that he can get back to work.


  • End of bed: Increased work of breathing
  • General examination: Tar stains on fingers, no peripheral cyanosis, no skin changes, pulse regular, HR 106, BP 108/66, RR 30, Temp 38.6
  • Inspection: Even chest expansion, no chest deformities
  • Palpation: Trachea central, apex beat not displaced
  • Auscultation: HS I + II + 0, course crackles on right side from base to mid zone, no wheeze, no stridor
  • Percussion: Slight dullness of right base
  • Other: JVP not raised, calves SNT

VIVA Questions


Fever and productive cough make an infective cause more likely, unilateral crackles on auscultation are in keeping with pneumonia.


As above an infective respiratory cause is likely, and the patient has a significant smoking history and FHx.

PE / Influenza / Heart failure / Other: 

With appropriate justification.


ECG – To look for cardiac cause such as ischaemia

Flu Swab – Detection of viral cause of symptoms

ABG – Type one respiratory failure, respiratory alkalosis, raised lactate if septic


FBC – Raised WCC in infection, anaemia could also cause SOB

U&E’s – Urea for calculation of CURB-65 for severity

CRP – Increased in infection

D-dimer – Raised in PE

BNP – Raised in Heart Failure

Blood cultures: For detection of sepsis causing pathogens


Chest XR – Consolidation in pneumonia, pulmonary oedema in heart failure

CTPA – If suspecting PE

Special / Other:

Urinary antigen – For detection of specific pathogens that can cause pneumonia

Sputum MCS – specific pathogens that can cause pneumonia



AP plain film of a 55yr old male. Confirm correct patient.

Image quality:

Not rotated, adequate penetration.


Trachea central


Right lower zone consolidation.

Lung markings extend to chest wall, no costophrenic angle blunting.


No cardiomegaly, no widened mediastinum.


Slight elevation of right hemidiaphragm.

No pneumoperitoneum.


The above findings are consistent with a right lower lobe pneumonia.

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