How to interview a patient with chest pain
Other platforms explain it with text and video. In VMS you practice it on the patient.
Chest pain can be harmless or life-threatening, so the interview has two goals: catch the dangerous causes fast and describe the pain well enough to guide the work-up. In an emergency, the ECG and the first questions happen at the same time.
Step by step
Check stability first
Look at the patient: pale, sweaty, short of breath or confused means call for help, get vital signs and an ECG before a long interview. [1]
Introduce yourself and get consent
Say your name and role, confirm the patient, explain what you will do and ask for permission. [2]
Describe the pain
When it started and what they were doing, where it is (ask them to point), pressure, tightness, sharp or tearing, how long it lasts, what makes it worse (exertion, breathing, position, eating) or better (rest, nitroglycerin), and severity 0 to 10. [3]
Ask where it spreads
Arm, jaw, neck, back or between the shoulder blades. Pain that tears through to the back is a red flag. [3]
Associated symptoms
Shortness of breath, sweating, nausea, palpitations, fainting, cough, fever, leg swelling and heartburn. [1]
Risk factors
High blood pressure, diabetes, high cholesterol, smoking, family history of early heart disease, cocaine use, recent surgery, long trips or immobility, and prior clots. [1]
Medications and allergies
Ask about nitrates, erectile dysfunction drugs, blood thinners and aspirin allergy: they change what can be given next. [1]
Summarize and act
Repeat the story in one sentence, say what you think is most likely and what must be ruled out, and explain the next tests. [2]
Common errors
- Long interview before the ECG in an unstable patient.
- Expecting classic pain in women, older adults and people with diabetes, who often have atypical symptoms.
- Forgetting pulmonary embolism and aortic dissection when the pain is not typical of the heart.
Practice it in VMS
In VMS you do this on the patient, not on paper: every step goes on the checklist with a score, and in Teach mode Blocky tells you what comes next.
VMS cases that train this skill
Sources
- NCCPA PANCE Content Blueprint
- AAMC Core Entrustable Professional Activities (Core EPAs)
- NBOME COMLEX-USA clinical presentations
Facts and steps follow NBOME COMLEX-USA clinical presentations; NCCPA PANCE Content Blueprint; AAMC Core Entrustable Professional Activities (Core EPAs). VMS is not affiliated with these organizations. Updated: 2026-10-11.