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Signs and Symptoms

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When you meet Mrs. Heart she appears to look somewhat pale and uncomfortable. She reports she is feeling short of breath and experiencing back pain. 

She tells you she was washing the dishes when she first started feeling short of breath. She sat down and waited a while and then began to feel nauseated. The nausea made her think she was having a digestive problem so she took an antacid. She did not experience any relief and began to feel anxious.

She called her husband, who was out in the garden. They decided to come to the emergency department. On arrival she began to have sharp pain in her back.

On questioning, she denies any chest pain but notes back pain that she says is 6/10. On further questioning she does relate that she feels some discomfort in her jaw.

This is not the first time she has had such pain, she has had many episodes like this, but they usually respond to antacids.

1.

What other history would you like to know at this point?

2.

What are you thinking about the most likely cause of her discomfort?

3.

What measures would you like to take at this point?

4.

What investigations would you like to order?