Cardiology — Chest Pain Evaluation Template
The Chest Pain Evaluation Template is designed for cardiologists, emergency physicians, and internists evaluating patients presenting with chest pain. This template documents the comprehensive workup required for risk stratification, including detailed pain characterization, cardiovascular risk factors, physical examination findings, and diagnostic test interpretation. The template supports appropriate billing for evaluation and management (E/M) services and includes sections for chief complaint characterization, cardiovascular history and risk factors, associated symptoms, physical examination with cardiac focus, ECG interpretation, troponin and biomarker results, risk stratification assessment, and disposition planning. Ideal for cardiology practices, emergency departments, hospitalist services, and urgent care settings evaluating chest pain.
Template
Chief Complaint
Chest pain, onset: [Date/time]
Duration: [Minutes/hours/days]
Current status: Ongoing / Resolved / Intermittent
Pain Characterization
Location: Substernal / Left chest / Right chest / Diffuse
Quality: Pressure / Sharp / Burning / Aching / Tearing
Radiation: None / Left arm / Jaw / Back / Shoulder
Severity: [X]/10 at onset, [X]/10 currently
Onset: Sudden / Gradual
Provocation: Exertion / Rest / Positional / Respiratory / Palpation
Palliation: Rest / Nitroglycerin / Antacids / Nothing
Associated symptoms: [See below]
Associated Symptoms
Dyspnea: Yes / No — at rest / exertional
Diaphoresis: Yes / No
Nausea/vomiting: Yes / No
Palpitations: Yes / No
Lightheadedness: Yes / No
Syncope: Yes / No
Cardiovascular Risk Factors
Hypertension: Yes / No — [controlled/uncontrolled]
Diabetes: Yes / No — Type [1/2], A1c: [X]%
Hyperlipidemia: Yes / No — on statin: Yes / No
Smoking: Current / Former / Never — [pack-years]
Family history CAD: Yes / No — [relationship, age of event]
Obesity: Yes / No — BMI: [X]
Prior cardiac history: [MI, PCI, CABG, CHF, arrhythmia]
Prior Cardiac Workup
Prior stress test: [Date, type, result]
Prior catheterization: [Date, findings]
Prior echo: [Date, EF, wall motion]
Current cardiac medications: [List]
Physical Examination
Vital signs: BP [X/X], HR [X], RR [X], SpO2 [X]%, Temp [X]
General: [Distress level, diaphoresis]
Cardiovascular:
- JVP: Normal / Elevated [cm]
- Carotid: Normal / Bruit
- Heart sounds: Regular / Irregular, S1, S2
- Murmurs: None / [Grade, location, radiation]
- S3/S4: Absent / Present
Lungs: Clear / Rales [location] / Wheezes
Extremities: No edema / Edema [grade, location]
- Pulses: 2+ / Diminished / Absent
Diagnostic Studies
ECG: [Rhythm, rate, intervals, ST changes, Q waves]
- Comparison to prior: [Changed / Unchanged / No prior]
Troponin: [Initial value] at [time]
- Serial: [Value] at [time]
BNP/NT-proBNP: [Value if obtained]
Chest X-ray: [Cardiomegaly, pulmonary edema, other]
Risk Stratification
HEART score: [0-10]
- History: [0-2]
- ECG: [0-2]
- Age: [0-2]
- Risk factors: [0-2]
- Troponin: [0-2]
TIMI score: [If applicable]
Assessment: Low risk / Intermediate risk / High risk
Assessment
1) Chest pain — [ACS ruled out / NSTEMI / Unstable angina / Non-cardiac]
Risk stratification: [Low/Intermediate/High]
2) [Secondary diagnoses: HTN, DM, etc.]
Plan
1) Disposition: Discharge / Observation / Admit telemetry / Admit ICU
2) Further workup:
- Stress test: [Type] — [Timing]
- Echocardiogram: [If indicated]
- Cardiac catheterization: [If indicated]
3) Medications:
- Aspirin: [Dose]
- Beta-blocker: [If indicated]
- Statin: [If indicated]
- Anticoagulation: [If indicated]
4) Follow-up: [Cardiology appointment, PCP]
5) Return precautions: Recurrent chest pain, dyspnea, syncope
Patient Education
Warning signs requiring immediate care, medication instructions, activity restrictions, follow-up appointments.
💡 Tip: Click anywhere to edit. Changes are temporary.
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