Last Updated on August 19, 2026
ACS evaluations account for 10 – 20% of chest pain in ED. Therefore, when patients present with chest pain, it must be clerked properly!
SOCRATES
• S: retrosternal / localized pain / left or right sided • When did you start to have chest pain? Duration ≥20 minutes ≈angina • What did you do when you have chest pain? • Always ask whether the chest pain is at rest / during exertion. Chest pain at rest highly suggestive of ACS instead of stable angina
• O:
when
• Time of onset important to determine urgency and type of management in the case of STEMI / NSTEMI!
• C: pressure / sharp
• R: jaw / left shoulder / arms
• A: relieved by nitrates within minutes?
• T:
how long
•
E
• What makes the pain worse?
• S: nausea / vomiting / palpitations / diaphoresis
Notes
• Always ask whether the pain is at rest / upon exertion (especially if suspecting ACS)
Relevant History
Patient’s background
•
Smoking
cardiovascular risk factor cardiovascular risk factor
•
Obesity
Co-morbidities
•
History of MI / PCI / CABG
cardiovascular risk factor cardiovascular risk factor cardiovascular risk factor cardiovascular risk factor cardiovascular risk factor cardiovascular risk factor
•
History of CVA / TIA
•
Hypertension
•
Diabetes mellitus
•
Dyslipidaemia
•
Peripheral vascular disease
Family history
•
Family Hx of premature cardiovascular disease
Parent / sibling, age <65 years old
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