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.