A squeezing clenched fist sign is characteristic of

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A squeezing “clenched fist” sign is characteristic of angina, but the symptoms below may be anginal equivalents in the absence of chest pain.10,14,33• Pain brought on by: activity—what type; rest; emotional upset;after eating; during sexual intercourse; with cold weather?• Any associated symptoms: sweating, ashen gray or pale skin, heart skips beat, shortness of breath, nausea or vomiting, racing of heart?Diaphoresis, cold sweats, pallor, grayness.Palpitations, dyspnea, nausea, tachycardia, fatigue.• Pain made worse by moving the arms or neck, breathing, lying flat?Try to differentiate pain of cardiac versus noncardiac origin.• Pain relieved by rest or nitroglycerin? How many tablets?2. Dyspnea.Any shortness of breath?• Which type of activity and how much brings on shortness of breath? How much activity brought it on 6 months ago?• Onset: Does the shortness of breath come on unexpectedly?• Duration: Constant or does it come and go?• Seem to be affected by position? Lying down?Dyspneaon exertion (DOE)—Quantify exactly (e.g., DOE after walking two level blocks).Paroxysmal.Constant or intermittent.Recumbent.• Awaken you from sleep at night?
• Does the shortness of breath interfere with activities of daily living?
.3. Orthopnea.How many pillows do you use when sleeping or lying down?
• Do you cough up mucus? Color? Any odor? Blood tinged?Sputum production, mucoid or purulent. Hemoptysis is often a pulmonary disorder but also occurs with mitral stenosis.• Associated with: activity, position (lying down), anxiety, talking?• Does activity make it better or worse (sit, walk, exercise)?• Relieved by rest or medication?5. Fatigue.Do you seem to tire easily? Able to keep up with yourfamily and co-workers?Unusual fatigue is a top prodromal MI symptom for women.14

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