Focused Exam: Chest Pain, Brian Foster Shadow health transcript

Focused Exam Chest Pain, Brian Foster Shadow health transcript Hello Greet Good morning. What brings you in today? I have been having some troubling chest pain in my chest now and then for the past month. Sorry for the chest problem Thanks. I appreciate that. When did the chest pain start? I first noticed it earlier this month. I thought it might just be heartburn and it passed after a couple of minutes. How is the pain like Well, it doesn’t hurt right now, but I have been having chest pain now and then for the past month. Where is the pain located? When the pain happens, I feel it mostly in the middle of my chest, over my heart. Does the chest pain radiate? The pain doesn’t radiate anywhere. It’s mostly just right in the middle of my chest. Do you have back pain? I haven’t had back pain, no. How frequent are the chest pains? Well, it has happened three times the past month. It usually goes away after about a couple of minutes. What relieves the chest pain? I’m not sure. I think lying still seems to help a little. What makes the pain worse Well, I think it’s when I’m doing something physical most of the time. The first time it happened, my chest started hurting after I was doing some yard work. The second time happened when the elevator broke at work so I had to take the stairs. My office is on the 5th floor. can you rate the pain on a scale I’d say maybe a . . . 5? It’s just really uncomfortable . . . like there’s nothing I can do about it. Right now it’s like a zero though. Have you taken any medications for the chest pain No, not yet. Which medications do you take currently (Clarified to What medications do you take?.) Yeah, let’s see, I take atorvastatin for cholesterol, lisinopril for blood pressure. . . Oh yeah, and I take fish oil too. I hear that’s good for your cholesterol. (Clarified to what medications I am taking.) Thats good for your cholesterol, continue taking it Good to know. Thank you. Focused Exam: Chest Pain, Brian Foster Shadow health transcript Any allergies No, well . . . I’ve had a bad reaction to codeine before, but that is all I know of. Any history of chronic illness? Besides a little high blood pressure and cholesterol, no. Have you done EKG test recently? I had one about three months ago. They usually put one on me at my annual physical. What were the results of the EKG? I don’t remember the actual results, but as far as I know, it was normal. Do you have a primary care provider? Dr. Melinda Smith. Great Good to know. Thank you. When did you last visit your care provider I had a physical about 3 months ago. Any palpitations? I don’t think so. I haven’t noticed any. Any history of heart illness? (Clarified to Do you have a history of heart problems?.) All I know is I have high blood pressure and cholesterol, but that’s pretty well-controlled by medicine as far as I know. (Clarified to if I have a history of heart problems.) Do you feel stressed? Not usually, but I’m feeling pretty anxious not knowing what’s going on with my chest. I’m sorry about that Thanks. I appreciate that. Do you have hypertension? Yes, I supposedly have moderately high blood pressure. Do you exercise? Well I used to ride my bike a lot but it got stolen a couple years ago. I guess I haven’t had much regular exercise since then. I want to get a new bike if the doctor says it is OK to exercise with this chest pain I’ve been having. I’m sorry you’ve not been able to exercise Thanks. I appreciate that. What is your typical diet I try to stay conscious of my diet. You know, I watch the fat. I watch the sodium . . . but I’m a dyed-in-the-wool carnivore too. Steaks and burgers find their way in there every once in a while. Do you drink water regularly? I usually drink water all day at work. At least four glasses, probably more. Do you smoke cigarette? Nope, I had a lot of friends who did but I never started. Smoking is bad for the health Good to know. Thank you. Do you take alcohol? Focused Exam: Chest Pain, Brian Foster Shadow health transcript Sure, but never more than two or three beers on a weekend. Do you feel fatigued? I’m not more tired than normal. Any dizziness? No, I haven’t felt dizzy. Do you have Angina? I’ve never been diagnosed with angina. Do you have edema? I haven’t noticed any swelling. Have you has blood clots? Not that I know of. Any fever? I haven’t had a fever, no. Do you cough? I don’t have a cough. Any difficulty breathing? My breathing’s fine. Any sore throat? I haven’t had a sore throat in a long time. Do you have diarrhea? I have, but it is very rare for me. Do you have constipation? I haven’t had problems with that. I wish it were only that. Any heartburn? No, I’ve never had problems with heartburn. I sure hope that’s all this is, but it’s pretty intense if it’s heartburn. Any family history of hear attack? No, nobody had that. Have you been monitoring your blood pressure? Not usually. They check it when I get checkups. My doctor has never seemed overly concerned about it. Measured vitals Tested blood pressure in left arm with cuff Tested blood pressure in right arm with cuff Measured vitals Inspected face Inspected for jugular venous distension: No jugular venous distention; JVP 3 cm above sternal angle Inspected anterior chest wall Inspected right side chest wall Inspected posterior chest wall Inspected left side chest wall Inspected left side of abdomen Inspected front of abdomen Inspected right hand: no visible abnormal findings Inspected left hand: no visible abnormal findings Inspected fingernails of left hand Focused Exam: Chest Pain, Brian Foster Shadow health transcript Inspected right hand: no visible abnormal findings Inspected left hand: no visible abnormal findings Inspected fingernails of right hand Inspected left leg Inspected right leg Focused Exam: Chest Pain, Brian Foster Shadow health transcript Inspected toenails on left foot Inspected toenails on right foot Inspected left leg Inspected right leg Inspected right leg for edema: No edema Inspected left leg for edema: No edema Checked capillary refill in fingernails Checked capillary refill in fingernails Checked capillary refill in fingernails Auscultated right carotid pulse: Bruit present Auscultated left carotid pulse Auscultated aortic area with the bell Auscultated aortic area with the diaphragm Auscultated pulmonic area with the diaphragm Auscultated pulmonic area with the bell Auscultated Erb’s point with the bell Auscultated Erb’s point with the diaphragm Auscultated tricuspid area with the diaphragm Auscultated tricuspid area with the bell Auscultated tricuspid area with the diaphragm Auscultated mitral area with the diaphragm Auscultated mitral area with the bell Auscultated breath sounds in anterior right upper lobe Auscultated breath sounds in anterior left upper lobe Auscultated breath sounds in anterior right middle lobe Auscultated breath sounds in anterior left mid-chest (upper lobe) Auscultated breath sounds in anterior right lower lobe Auscultated breath sounds in anterior left lower lobe Auscultated breath sounds in posterior left upper lobe Auscultated breath sounds in posterior right upper lobe Auscultated breath sounds in posterior left mid-back (lower lobe) Auscultated breath sounds in posterior right mid-back (lower lobe) Auscultated breath sounds in posterior left lower lobe Auscultated breath sounds in posterior right lower lobe Auscultated breath sounds in posterior left lower lobe on side Auscultated breath sounds in posterior right lower lobe on side Auscultated aorta in abdomen Auscultated right renal pulse Auscultated left renal pulse Auscultated right iliac pulse Auscultated left iliac pulse Auscultated right femoral pulse Auscultated left femoral pulse Auscultated right upper quadrant Auscultated left upper quadrant Auscultated right lower quadrant Auscultated left lower quadrant Auscultated over liver Focused Exam: Chest Pain, Brian Foster Shadow health transcript Auscultated over spleen Palpated right carotid pulse: Thrill, 3+ Palpated right carotid pulse: Thrill, 3+ Palpated PMI: Displaced laterally; brisk and tapping; less than 3 cm Palpated right brachial pulse: No thrill, 2+ Palpated left brachial pulse: No thrill, 2+ Palpated right radial pulse: No thrill, 2+ Palpated left radial pulse: No thrill, 2+ Palpated right femoral pulse: No thrill, 2+ Palpated left femoral pulse: No thrill, 2+ Palpated right popliteal pulse: No thrill, 1+ Palpated left popliteal pulse: No thrill, 1+ Palpated right tibial pulse: No thrill, 1+ Palpated left tibial pulse: No thrill, 1+ Palpated right dorsalis pedis pulse: No thrill, 1+ Palpated left dorsalis pedis pulse: No thrill, 1+ Palpated right upper quadrant with light pressure: No tenderness reported; no masses, guarding, or distension Palpated left upper quadrant with light pressure: No tenderness reported; no masses, guarding, or distension Palpated right lower quadrant with light pressure: No tenderness reported; no masses, guarding, or distension Palpated left lower quadrant with light pressure: No tenderness reported; no masses, guarding, or distension Palpated right upper quadrant with deep pressure: No masses Palpated left upper quadrant with deep pressure: No masses Palpated right lower quadrant: with deep pressure: No masses Palpated left lower quadrant with deep pressure: No masses Palpated liver: Palpable 1 cm below right costal margin Palpated for spleen: Not palpable Palpated for right kidney: Not palpable Palpated for left kidney: Not palpable Tested skin turgor Percussed right upper quadrant Percussed left upper quadrant Percussed right lower quadrant Percussed left lower quadrant Percussed spleen Percussed for liver span: 7 cm in the mid-clavicular line Focused Exam: Chest Pain, Brian Foster Shadow health transcript