MAAS-MI Review of Systems

1HEART: Chest Pain

• 1.1Complaint Heuristic

  1. Asks about the nature of the pain (acute and sharp, tearing and ripping, pressing and squeezing, burning);
  2. Asks about the intensity of the pain, use a scale of 1-10 where 10 is extremely painful;
  3. Asks about the localization (show me) and radiation (neck and cheek, breast, shoulder and back, down the arm).

• 1.2Time-Intensity Heuristic

  1. Asks about the unset (acute or slowly evolving) and course (minutes or hours, episodes, variable or persistent);
  2. Asks about chest pain in the past weeks;
  3. Asks whether the pain wakes the patient up at night.

• 1.3Triggering & Decreasing Factors Heuristic

  1. Asks whether the pain occurs during exercise, walking, climbing stairs, and carrying heavy groceries;
  2. Asks whether the pain increases with breathing, coughing, swallowing, lying down or sitting up, and a large meal;
  3. Asks whether the pain wanes with rest or with medication, or with a specific position.

• 1.4Accompanying Complaints Heuristic

  1. Asks whether the chest pain is accompanied by dyspnoe, nausea and vomiting, sweating, weakness.

2HEART: Chest Pain / Palpitations

• 2.1Complaint Heuristic

  1. Asks whether the patient is aware of their heartbeat and what it is like;
  2. Asks whether during episodes of palpitations the heartbeat is slower or faster, regular or irregular, and whether the episodes stop suddenly or gradually;
  3. Asks about the nature of any palpitations (skipping, racing, fluttering, pounding, stopping).

• 2.2Time-Intensity Heuristic

  1. Asks how long the episodes last, how many hours a day;
  2. Asks about episodes over the last month.

3HEART: Chest Pain / Shortness of Breath

• 3.1Complaint Heuristic

  1. Asks whether breathing feels uncomfortable and requires effort during rest.

• 3.2Time-Intensity Heuristic

  1. Asks whether the dyspnoe:
     • Changes during the day;
     • Is getting worse during the night.
  2. Asks:
     • When the dyspnoe started;
     • How it changed over time.

• 3.3Triggering & Decreasing Factors Heuristic

  1. Asks whether the dyspnoe occurs when the patient is lying down and improves while sitting or standing;
  2. Asks how many pillows the patient uses to sleep comfortable;
  3. Asks whether the dyspnoe occurs during rest, during exercise or after exercise.

• 3.4Accompanying Complaints Heuristic

  1. Asks about accompanying symptoms: wheezing and coughing.

4HEART: Chest Pain / Peripheral Edema

• 4.1Complaint Heuristic

  1. Asks about swelling anywhere, in feet and legs, in vingers and hand, around the eyes, around the middle;
  2. Asks about tightness with shoes, rings, belts, and clothes.

• 4.2Time-Intensity Heuristic

  1. Asks whether the swelling is worse in the morning or at night.

5HEART: Chest Pain / Loss of Consiousness

• 5.1Complaint Heuristic

  1. Asks about any dizziness or loss of consciousness followed by recovery.

• 5.2Time-Intensity Heuristic

  1. Asks how long the episode lasted;
  2. Asks about the number of episodes in the last month.

• 5.3Triggering & Decreasing Factors Heuristic

  1. Asks whether the episode occurred with or after exercise.

• 5.4Accompanying Complaints Heuristics

  1. Asks about accompanying symptoms: chest pain, palpitations.

   

• 6.1References & Further Reading

  • Bickley, L., Szilagy, P., Hoffman, R., & Soriano, R. (2021). Bates’ Guide to physical examination and history-taking. Wolters Kluwer, Philadelphia
  • de Jongh, T., Schijf, V., van ’t Spijker, A., Pellikaan-van der Veer, M., 2019). Handbook History-taking (Leerboek Anamnese). Bohn, Stafleu, van Lochum, Houten.