Focused Exam: Chest Pain, Brian Foster Shadow health transcript

Focused Exam: Chest Pain, Brian Foster Shadow health transcript

Transcript

Hello

Greet
04/15/23 1:09 PM EDT

Good morning.
What brings you in today?

Question
04/15/23 1:09 PM EDT

I have been having some troubling chest pain in my chest now and then for the past month.
Sorry for the chest problem

Empathize
04/15/23 1:10 PM EDT

Thanks. I appreciate that.
When did the chest pain start?

Question
04/15/23 1:11 PM EDT

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

Question
04/15/23 1:13 PM EDT

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?

Question
04/15/23 1:13 PM EDT

When the pain happens, I feel it mostly in the middle of my chest, over my heart.
Does the chest pain radiate?

Question
04/15/23 1:14 PM EDT

The pain doesn’t radiate anywhere. It’s mostly just right in the middle of my chest.
Do you have back pain?

Question
04/15/23 1:15 PM EDT

I haven’t had back pain, no.
How frequent are the chest pains?

Question
04/15/23 1:16 PM EDT

Well, it has happened three times the past month. It usually goes away after about a couple of minutes.
What relieves the chest pain?

Question
04/15/23 1:17 PM EDT

I’m not sure. I think lying still seems to help a little.
What makes the pain worse

Question
04/15/23 1:17 PM EDT

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

Question
04/15/23 1:18 PM EDT

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

Question
04/15/23 1:20 PM EDT

No, not yet.
Which medications do you take currently (Clarified to What medications do you take?.)

Question
04/15/23 1:21 PM EDT

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

Educate
04/15/23 1:22 PM EDT

Good to know. Thank you. Focused Exam: Chest Pain, Brian Foster Shadow health transcript
Any allergies

Question
04/15/23 1:23 PM EDT

No, well . . . I’ve had a bad reaction to codeine before, but that is all I know of.
Any history of chronic illness?

Question
04/15/23 1:24 PM EDT

Besides a little high blood pressure and cholesterol, no.
Have you done EKG test recently?

Question
04/15/23 1:24 PM EDT

I had one about three months ago. They usually put one on me at my annual physical.
What were the results of the EKG?

Question
04/15/23 1:25 PM EDT

I don’t remember the actual results, but as far as I know, it was normal.
Do you have a primary care provider?

Question
04/15/23 1:25 PM EDT

Dr. Melinda Smith.
Great

Educate
04/15/23 1:26 PM EDT

Good to know. Thank you.
When did you last visit your care provider

Question
04/15/23 1:26 PM EDT

I had a physical about 3 months ago.
Any palpitations?

Question
04/15/23 1:27 PM EDT

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?.)

Question
04/15/23 1:27 PM EDT

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?

Question
04/15/23 1:28 PM EDT

Not usually, but I’m feeling pretty anxious not knowing what’s going on with my chest.
I’m sorry about that

Empathize
04/15/23 1:28 PM EDT

Thanks. I appreciate that.
Do you have hypertension?

Question
04/15/23 1:29 PM EDT

Yes, I supposedly have moderately high blood pressure.
Do you exercise?

Question
04/15/23 1:29 PM EDT

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

Empathize
04/15/23 1:29 PM EDT

Thanks. I appreciate that.
What is your typical diet

Question
04/15/23 1:30 PM EDT

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?

Question
04/15/23 1:30 PM EDT

I usually drink water all day at work. At least four glasses, probably more.
Do you smoke cigarette?

Question
04/15/23 1:31 PM EDT

Nope, I had a lot of friends who did but I never started.
Smoking is bad for the health

Educate
04/15/23 1:32 PM EDT

Good to know. Thank you.
Do you take alcohol? Focused Exam: Chest Pain, Brian Foster Shadow health transcript

Question
04/15/23 1:32 PM EDT

Sure, but never more than two or three beers on a weekend.
Do you feel fatigued?

Question
04/15/23 1:33 PM EDT

I’m not more tired than normal.
Any dizziness?

Question
04/15/23 1:33 PM EDT

No, I haven’t felt dizzy.
Do you have Angina?

Question
04/15/23 1:33 PM EDT

I’ve never been diagnosed with angina.
Do you have edema?

Question
04/15/23 1:34 PM EDT

I haven’t noticed any swelling.
Have you has blood clots?

Question
04/15/23 1:34 PM EDT

Not that I know of.
Any fever?

Question
04/15/23 1:35 PM EDT

I haven’t had a fever, no.
Do you cough?

Question
04/15/23 1:35 PM EDT

I don’t have a cough.
Any difficulty breathing?

Question
04/15/23 1:35 PM EDT

My breathing’s fine.
Any sore throat?

Question
04/15/23 1:35 PM EDT

I haven’t had a sore throat in a long time.
Do you have diarrhea?

Question
04/15/23 1:36 PM EDT

I have, but it is very rare for me.
Do you have constipation?

Question
04/15/23 1:37 PM EDT

I haven’t had problems with that. I wish it were only that.
Any heartburn?

Question
04/15/23 1:37 PM EDT

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?

Question
04/15/23 1:37 PM EDT

No, nobody had that.
Have you been monitoring your blood pressure?

Question
04/15/23 1:38 PM EDT

Not usually. They check it when I get checkups. My doctor has never seemed overly concerned about it.
 Measured vitals

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04/15/23 1:39 PM EDT

 Tested blood pressure in left arm with cuff

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 Tested blood pressure in right arm with cuff

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 Measured vitals

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 Inspected face

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 Inspected for jugular venous distension: No jugular venous distention; JVP 3 cm above sternal angle

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04/15/23 1:40 PM EDT

 Inspected anterior chest wall

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 Inspected right side chest wall

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 Inspected posterior chest wall

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 Inspected left side chest wall

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 Inspected left side of abdomen

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 Inspected front of abdomen

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 Inspected right hand: no visible abnormal findings

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04/15/23 1:41 PM EDT

 Inspected left hand: no visible abnormal findings

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 Inspected fingernails of left hand Focused Exam: Chest Pain, Brian Foster Shadow health transcript

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 Inspected right hand: no visible abnormal findings

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 Inspected left hand: no visible abnormal findings

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 Inspected fingernails of right hand

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 Inspected left leg

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 Inspected right leg Focused Exam: Chest Pain, Brian Foster Shadow health transcript

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 Inspected toenails on left foot

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 Inspected toenails on right foot

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 Inspected left leg

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 Inspected right leg

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 Inspected right leg for edema: No edema

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04/15/23 1:42 PM EDT

 Inspected left leg for edema: No edema

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 Checked capillary refill in fingernails

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 Checked capillary refill in fingernails

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 Checked capillary refill in fingernails

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 Auscultated right carotid pulse: Bruit present

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04/15/23 1:43 PM EDT

 Auscultated left carotid pulse

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 Auscultated aortic area with the bell

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 Auscultated aortic area with the diaphragm

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 Auscultated pulmonic area with the diaphragm

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 Auscultated pulmonic area with the bell

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 Auscultated Erb’s point with the bell

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 Auscultated Erb’s point with the diaphragm

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 Auscultated tricuspid area with the diaphragm

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 Auscultated tricuspid area with the bell

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 Auscultated tricuspid area with the diaphragm

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 Auscultated mitral area with the diaphragm

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 Auscultated mitral area with the bell

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 Auscultated breath sounds in anterior right upper lobe

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 Auscultated breath sounds in anterior left upper lobe

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 Auscultated breath sounds in anterior right middle lobe

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 Auscultated breath sounds in anterior left mid-chest (upper lobe)

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 Auscultated breath sounds in anterior right lower lobe

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 Auscultated breath sounds in anterior left lower lobe

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 Auscultated breath sounds in posterior left upper lobe

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 Auscultated breath sounds in posterior right upper lobe

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 Auscultated breath sounds in posterior left mid-back (lower lobe)

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 Auscultated breath sounds in posterior right mid-back (lower lobe)

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 Auscultated breath sounds in posterior left lower lobe

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 Auscultated breath sounds in posterior right lower lobe

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 Auscultated breath sounds in posterior left lower lobe on side

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 Auscultated breath sounds in posterior right lower lobe on side

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 Auscultated aorta in abdomen

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04/15/23 2:12 PM EDT

 Auscultated right renal pulse

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 Auscultated left renal pulse

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 Auscultated right iliac pulse

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 Auscultated left iliac pulse

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 Auscultated right femoral pulse

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 Auscultated left femoral pulse

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 Auscultated right upper quadrant

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 Auscultated left upper quadrant

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 Auscultated right lower quadrant

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 Auscultated left lower quadrant

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 Auscultated over liver Focused Exam: Chest Pain, Brian Foster Shadow health transcript

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 Auscultated over spleen

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 Palpated right carotid pulse: Thrill, 3+

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04/15/23 2:14 PM EDT

 Palpated right carotid pulse: Thrill, 3+

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 Palpated PMI: Displaced laterally; brisk and tapping; less than 3 cm

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 Palpated right brachial pulse: No thrill, 2+

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 Palpated left brachial pulse: No thrill, 2+

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 Palpated right radial pulse: No thrill, 2+

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 Palpated left radial pulse: No thrill, 2+

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 Palpated right femoral pulse: No thrill, 2+

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 Palpated left femoral pulse: No thrill, 2+

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 Palpated right popliteal pulse: No thrill, 1+

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 Palpated left popliteal pulse: No thrill, 1+

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 Palpated right tibial pulse: No thrill, 1+

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 Palpated left tibial pulse: No thrill, 1+

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 Palpated right dorsalis pedis pulse: No thrill, 1+

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04/15/23 2:17 PM EDT

 Palpated left dorsalis pedis pulse: No thrill, 1+

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 Palpated right upper quadrant with light pressure: No tenderness reported; no masses, guarding, or distension

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 Palpated left upper quadrant with light pressure: No tenderness reported; no masses, guarding, or distension

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 Palpated right lower quadrant with light pressure: No tenderness reported; no masses, guarding, or distension

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 Palpated left lower quadrant with light pressure: No tenderness reported; no masses, guarding, or distension

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 Palpated right upper quadrant with deep pressure: No masses

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 Palpated left upper quadrant with deep pressure: No masses

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 Palpated right lower quadrant: with deep pressure: No masses

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 Palpated left lower quadrant with deep pressure: No masses

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 Palpated liver: Palpable 1 cm below right costal margin

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 Palpated for spleen: Not palpable

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04/15/23 2:19 PM EDT

 Palpated for right kidney: Not palpable

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 Palpated for left kidney: Not palpable

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 Tested skin turgor

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 Percussed right upper quadrant

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 Percussed left upper quadrant

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 Percussed right lower quadrant

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 Percussed left lower quadrant

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 Percussed spleen

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04/15/23 2:21 PM EDT

 Percussed for liver span: 7 cm in the mid-clavicular line Focused Exam: Chest Pain, Brian Foster Shadow health transcript

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