What is the first step in evaluating a patient with chest pain?
The clinical examination is the key first step in evaluating a patient with chest pain and should include a detailed assessment of symptoms, including quality, location, severity, and duration of pain; radiation; associated symptoms; provocative factors; and alleviating factors. Adjectives often used to describe anginal pain include squeezing, grip-like, suffocating, and heavy, but it is rarely sharp or stabbing and typically does not vary with position or respiration. On occasion the patient might demonstrate the classic Levine’s sign by placing a clenched fist over the precordium to describe the pain. Many patients do not, however, describe angina as frank pain but as tightness, pressure, or discomfort.