Quick Way to Write Chest Pain SOAP Notes for Healthcare Providers

Chest Pain SOAP Notes

It's 2 AM in the ED, you've just evaluated your fifth chest pain patient of the shift, and you need to document why you sent one home, admitted another, and kept the third for observation.

Each decision could be scrutinized later, and you need your documentation to clearly show your clinical reasoning.

The stakes are high. Miss something and you're facing a lawsuit. Over-document and you'll never leave the hospital.

Sound familiar? If you've ever found yourself in these shoes, keep on reading.

We've all been here.

Quick Tip:

SOAP Notes Doctor is our product that transforms recordings, audios, and text into industry-standard SOAP notes.

You can let it listen to your patient encounters and do the work.

You can add, edit, review, and add more context later.

Head over to soapnotes.doctor now.

Let's dive in.

SOAP Notes: The Quick Story

Back in the day, chest pain documentation was all over the place.

One provider might write "chest pain - negative workup, discharged" while another would document every single detail from birth history to shoe size.

There was no middle ground, no consistency, and absolutely no way to defend your clinical decision-making when the lawyers came knocking.

Then in the late 1960s, Dr. Lawrence Weed revolutionized medical documentation with the Problem-Oriented Medical Record and SOAP notes.

His brilliant idea was simple: give everyone the same structure so your clinical reasoning is crystal clear to anyone reviewing the chart.

Here's what Dr. Weed came up with:

• S (Subjective): What the patient tells you about their chest pain and associated symptoms
• O (Objective): What you observe, measure, and test
• A (Assessment): Your clinical judgment about what's causing the pain and the risk level
• P (Plan): What you're going to do about it and why

This format became essential for chest pain because it forces you to systematically evaluate cardiac risk, document your reasoning, and justify your disposition decision.

For chest pain specifically, this structure is your best friend and your best legal protection. It shows you asked the right questions, did the right exam, ordered appropriate tests, and made a reasonable decision based on all the data.

How to Write Chest Pain SOAP Notes: My Recommended Approach

When I started working with ED docs and cardiologists, I noticed something interesting.

The best clinicians had a mental checklist they ran through for every chest pain patient, and their documentation reflected that systematic approach.

Then I discovered the golden rule:

"Document what you found AND what you ruled out."

For chest pain, it's not enough to say what you think it is. You need to show why you don't think it's the scary stuff.

I built soapnotes.doctor around this principle - capturing both the positive findings and the critical negatives.

There are technically two ways you can approach chest pain SOAP notes. You can write them manually, or you can use soapnotes.doctor.

Use soapnotes.doctor

I'll choose soapnotes.doctor every single time because chest pain documentation is too important to rush or forget critical elements.

Here's how to streamline the whole process:

1. Head over to soapnotes.doctor to get started. Complete the onboarding process if you're new to the platform.

2. Click on the record button to either record the patient encounter or dictate your findings after the evaluation.

3. Wait 1-3 minutes.

4. Review and save.

One beauty of soapnotes.doctor is that it doesn't just document what you found - it prompts you to include the critical negatives that protect you legally. Chest pain documentation isn't just about being thorough; it's about being smart and defensible.

And if you need to add specific risk scores or additional context, you have the tailorr feature at your disposal. Edit, approve, add details, and copy straight to your EHR.

Write Manually

Maybe you prefer the control of writing it yourself. Here's how to do it systematically without missing anything important.

1. S - Subjective

This is where you capture the patient's chest pain story in detail.

This section should thoroughly document the character, location, timing, and associated symptoms of the chest pain.

Purpose: Paint a complete picture of the patient's symptoms and risk factors.

What to include:

• OPQRST of the pain:
  • Onset (sudden vs gradual, what were they doing)
  • Provocation/Palliation (what makes it better or worse)
  • Quality (sharp, dull, pressure, burning, tearing)
  • Region/Radiation (location and any radiation patterns)
  • Severity (0-10 scale)
  • Timing (duration, constant vs intermittent)
• Associated symptoms (SOB, diaphoresis, nausea, palpitations, syncope)
• Cardiac risk factors
• Previous cardiac history
• Medications (especially cardiac meds, recent changes)
• Critical negatives (no syncope, no diaphoresis, etc.)

Examples:

"55-year-old male presents with acute onset chest pain that started 2 hours ago while at rest watching TV. Describes pain as 'pressure-like, like an elephant sitting on my chest,' rated 8/10 severity, located substernally with radiation to left arm and jaw. Pain constant since onset, not relieved by position change or antacids. Associated with shortness of breath, diaphoresis, and nausea. Denies syncope, palpitations, or prior episodes. Cardiac risk factors include hypertension, hyperlipidemia, 30-pack-year smoking history, and family history of MI in father at age 52. Takes lisinopril and atorvastatin daily. No prior cardiac workup."

"28-year-old female presents with sharp left-sided chest pain for 3 days, worse with deep breathing and lying flat. Rates pain 6/10, located over left 4th intercostal space without radiation. Pain reproducible with palpation. Started after heavy lifting at gym. Denies shortness of breath, diaphoresis, palpitations, syncope, or cough. No cardiac risk factors, non-smoker. No prior cardiac history. Takes oral contraceptive pills only."

2. O - Objective

This is where you document your physical exam findings and test results.

The objective section records measurable data and clinical findings that support or refute serious causes.

Purpose: Document evidence for or against life-threatening causes of chest pain.

What to include:

• Complete vital signs (including orthostatics if relevant)
• General appearance and distress level
• Cardiac exam (heart sounds, murmurs, rubs)
• Lung exam (breath sounds, equality)
• Vascular exam (peripheral pulses, blood pressure in both arms if concerning)
• Extremity exam (edema, calf tenderness)
• Abdominal exam if relevant
• EKG findings (be specific)
• Cardiac biomarkers (troponin timing is critical)
• Chest X-ray findings
• Other relevant labs or imaging

Examples:

"Vitals: BP 168/95 (equal in both arms), HR 102 regular, RR 22, O2 sat 94% on RA, Temp 98.4°F. General: Anxious-appearing male in moderate distress, diaphoretic. Cardiac: Tachycardic, regular rhythm, normal S1/S2, no murmurs/rubs/gallops, no JVD. Lungs: Clear bilaterally, no crackles or wheezes. Extremities: No edema, peripheral pulses 2+ and equal. EKG: Sinus tachycardia at 102 bpm, 2mm ST elevation in leads V2-V5, reciprocal ST depression in inferior leads. Troponin I: 2.8 ng/mL (elevated). CXR: Normal cardiac silhouette, no infiltrates or effusions."

"Vitals: BP 118/72, HR 76 regular, RR 14, O2 sat 99% on RA, Temp 98.6°F. General: Well-appearing female, comfortable at rest, no distress. Cardiac: Regular rate and rhythm, normal S1/S2, no murmurs/rubs/gallops. Lungs: Clear bilaterally. Chest wall: Point tenderness over left 4th-5th ribs, pain reproduced with palpation. Extremities: No edema, pulses intact. EKG: Normal sinus rhythm, no ST changes, no Q waves, normal intervals. Troponin I: less than 0.01 ng/mL (normal)."

3. A - Assessment

This section is your critical clinical judgment about what's happening.

Purpose: Synthesize all data to determine the likely diagnosis and risk level.

Key Principle: Always address cardiac causes first, then explain why you think it is or isn't cardiac.

What to include:

• Differential diagnosis with most likely cause
• Why serious causes are included or excluded
• Risk stratification (HEART score, TIMI score if applicable)
• Assessment of stability and urgency

Examples:

"55-year-old male with acute coronary syndrome, likely STEMI given classic presentation: acute onset substernal chest pressure with arm/jaw radiation, associated diaphoresis and nausea, significant cardiac risk factors, ST elevation in anterior leads V2-V5 with reciprocal changes, and elevated troponin. HEART score 8 (high risk). Time from symptom onset: 2 hours, within window for reperfusion therapy. Patient hemodynamically stable but requires urgent intervention. No contraindications to anticoagulation or catheterization noted."

"28-year-old female with musculoskeletal chest pain, most consistent with costochondritis. Pain sharp, pleuritic, reproducible on palpation, started after heavy lifting. No features concerning for ACS: young age with no cardiac risk factors, pain characteristics not typical for cardiac etiology, normal vital signs, normal cardiac exam, benign EKG, normal troponin. HEART score 0 (very low risk). Pulmonary embolism unlikely given lack of risk factors, no dyspnea, normal oxygen saturation, and lack of clinical signs. Patient appropriate for discharge with outpatient follow-up."

4. P - Plan

This final section outlines your treatment and disposition with clear justification.

Purpose: Document your management decisions and the reasoning behind them.

Length: Be specific about treatments given, consultations made, and why you chose your disposition.

What to include:

• Immediate treatments provided
• Consultations obtained
• Disposition decision (discharge, observation, admission, transfer)
• Discharge instructions or admission plan
• Follow-up arrangements
• Return precautions

Examples:

"Activated STEMI protocol. Administered aspirin 325mg, ticagrelor 180mg, heparin bolus. Obtained cardiology consultation - patient accepted for emergent cardiac catheterization. IV morphine for pain control, SL nitroglycerin with BP monitoring. Admitted to CCU under cardiology service. Patient and family informed of diagnosis, treatment plan, and catheterization risks/benefits. Will proceed to cath lab within 30 minutes. ICU bed arranged. Family present and updated."

"Administered ibuprofen 600mg PO for pain with good effect, pain decreased from 6/10 to 2/10. Educated patient on costochondritis, typical course, and appropriate use of NSAIDs. Advised against heavy lifting for 1-2 weeks. Discussed red flag symptoms warranting immediate return: chest pain different in character, shortness of breath, palpitations, syncope, or pain not relieved by ibuprofen. Discharged home in stable condition with ibuprofen 600mg TID for 5 days. Follow-up with PCP in 1 week if symptoms persist. Patient verbalized understanding of diagnosis, treatment plan, and return precautions."

Complete Chest Pain SOAP Note Examples

Now let's look at three complete examples that bring all these components together.

Example 1: STEMI - Emergency Department

Patient: 62-year-old male
Arrival: Via EMS, chest pain
Chief Complaint: Severe chest pain

S – Subjective:

62-year-old male brought in by EMS with acute onset chest pain that started 45 minutes ago while shoveling snow. Describes pain as "crushing pressure" across entire chest, rated 10/10 severity, radiating to both arms, neck, and jaw. Pain constant since onset, not relieved by rest. EMS administered sublingual nitroglycerin x3 with minimal relief. Associated symptoms include severe shortness of breath, profuse diaphoresis, nausea without vomiting. Denies syncope, palpitations, or recent trauma. Patient appears extremely anxious, states "I think I'm having a heart attack like my brother." Significant cardiac risk factors: Type 2 diabetes for 15 years, hypertension, hyperlipidemia, current smoker (1 PPD x 40 years), obesity (BMI 34). Family history strongly positive for CAD - brother had MI at age 58, father died of MI at age 61. Takes metformin, lisinopril, and atorvastatin daily. No previous cardiac workup, never had stress test or catheterization. Denies prior chest pain episodes. Last meal 3 hours ago.

O – Objective:

Vitals: BP 178/102 (right arm) 175/98 (left arm), HR 108 regular, RR 24, O2 sat 91% on RA (95% on 4L NC), Temp 98.8°F
General: Obese male in severe distress, diaphoretic, anxious, clutching chest
HEENT: Diaphoretic face, no JVD at 45 degrees
Cardiac: Tachycardic, regular rhythm, S1 and S2 normal, no murmurs or rubs, distant heart sounds due to body habitus
Lungs: Bilateral crackles in lower 1/3 of lung fields, no wheezes
Abdomen: Obese, soft, non-tender, normal bowel sounds
Extremities: No peripheral edema, pulses 2+ radially, 1+ in dorsalis pedis bilaterally, cool extremities
Skin: Pale, diaphoretic
EKG: Sinus tachycardia 108 bpm, 3-4mm ST elevation in leads II, III, aVF (inferior leads), 1-2mm ST depression in leads I, aVL (reciprocal changes), no prior EKG for comparison
Labs: Troponin I 4.2 ng/mL (markedly elevated, normal less than 0.04), BNP 180 pg/mL, BMP normal except glucose 198 mg/dL, CBC normal
CXR: Mild pulmonary vascular congestion, no infiltrates, normal cardiac silhouette

A – Assessment:

62-year-old male with acute inferior ST-elevation myocardial infarction (STEMI). Diagnosis based on classic presentation: acute onset crushing substernal chest pain with radiation during exertion, associated dyspnea and diaphoresis, multiple cardiac risk factors (diabetes, hypertension, smoking, family history), inferior ST elevations with reciprocal changes on EKG, markedly elevated troponin, and symptom onset within 1 hour. TIMI risk score 5 (high risk). Patient hemodynamically stable though hypertensive with tachycardia likely from pain and anxiety. Mild pulmonary edema on exam and CXR suggests LV dysfunction. Door-to-balloon time critical - patient within window for emergent reperfusion. No contraindications to anticoagulation or PCI noted. Cardiogenic shock not present but patient requires close monitoring.

P – Plan:

STEMI protocol activated immediately. Aspirin 325mg chewed, clopidogrel 600mg loading dose administered, heparin 60 units/kg bolus given followed by infusion. Morphine 4mg IV for pain control and anxiety, decreased pain to 6/10. Sublingual nitroglycerin held due to inferior STEMI (concern for RV involvement). Metoprolol 5mg IV given x1 for heart rate control. Started on oxygen 4L NC with improvement in oxygen saturation to 95%. Cardiology consulted emergently - Dr. Smith at bedside, patient accepted for emergent cardiac catheterization. Estimated door-to-balloon time 45 minutes. ICU bed reserved, cath lab team assembled. Patient and wife informed of diagnosis, explained urgent need for catheterization, discussed risks/benefits of procedure. Patient consented for emergent PCI. Continuous telemetry monitoring, serial EKGs obtained every 30 minutes until cath. Admitted to CCU under cardiology service. Patient transferred to cath lab for emergent coronary angiography with plan for PCI of culprit lesion.

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Example 2: Low-Risk Chest Pain - Discharged from ED

Patient: 35-year-old female
Arrival: Walk-in to ED
Chief Complaint: Chest pain for 2 days

S – Subjective:

35-year-old female presents with left-sided chest pain that started 2 days ago after completing intense CrossFit workout. Describes pain as "sharp and stabbing," rated 5/10 at worst, located over left anterior chest wall around 3rd-5th ribs. Pain worse with deep breathing, coughing, and when lying on left side. Improved with ibuprofen and when sitting upright. No radiation of pain. Denies shortness of breath, palpitations, diaphoresis, nausea, vomiting, or syncope. No fever or cough. Never had similar pain before. No recent illness or trauma beyond the workout. Cardiac risk factors: none - non-smoker, no hypertension, normal cholesterol per PCP visit 6 months ago, no diabetes, no family history of premature CAD. Currently on oral contraceptive pills only. No history of blood clots or PE. Recent travel: none. No leg swelling or pain. Exercise regularly without previous chest discomfort. Concerned because mother told her "any chest pain needs to be checked out." Denies anxiety or panic disorder history.

O – Objective:

Vitals: BP 118/76, HR 72 regular, RR 14, O2 sat 99% on RA, Temp 98.4°F
General: Well-appearing female, comfortable at rest, no acute distress, conversing normally
HEENT: Normal, no JVD
Cardiac: Regular rate and rhythm, normal S1/S2, no murmurs, rubs, or gallops, PMI normal position
Lungs: Clear to auscultation bilaterally, symmetric breath sounds, no wheezes/rales/rhonchi
Chest wall: Tenderness to palpation over left 3rd, 4th, and 5th costochondral junctions, pain reproduced exactly with palpation at these sites, no swelling or erythema noted
Extremities: No edema, no calf tenderness, negative Homan's sign, peripheral pulses 2+ and equal bilaterally
Abdomen: Soft, non-tender
EKG: Normal sinus rhythm at 72 bpm, normal axis, normal intervals, no ST segment changes, no T wave inversions, no Q waves, normal R wave progression
Troponin I: less than 0.01 ng/mL (normal, drawn 48 hours after symptom onset)
D-dimer: Not indicated given Wells score 0 for PE

A – Assessment:

35-year-old female with musculoskeletal chest pain, most consistent with costochondritis secondary to strenuous exercise. Clinical presentation strongly supports benign etiology: young patient with zero cardiac risk factors, pain reproducible on palpation, pleuritic nature, clear temporal relationship to exercise, normal vital signs with excellent oxygen saturation, completely normal cardiac examination, benign EKG without any acute changes, and normal troponin 48 hours after symptom onset. HEART score 0 (very low risk for major adverse cardiac events). Acute coronary syndrome extremely unlikely given age, lack of risk factors, atypical pain characteristics, and negative workup. Pulmonary embolism unlikely: Wells score 0, no risk factors for VTE, no dyspnea, normal oxygen saturation, pain not consistent with PE presentation. No signs of pneumothorax, pneumonia, or pericarditis. Pain characteristics and exam findings classic for costochondritis. Patient hemodynamically stable, appropriate for discharge with conservative management.

P – Plan:

Prescribed ibuprofen 600mg PO three times daily with food for 7-10 days for anti-inflammatory effect. Educated patient on costochondritis: inflammation of cartilage connecting ribs to sternum, typically caused by overuse or strain, self-limited condition that usually resolves in 1-2 weeks though may take several weeks in some cases. Advised rest from upper body exercises and heavy lifting for 1-2 weeks, can resume gradually as pain allows. Ice packs to affected area 15-20 minutes several times daily may provide relief. Discussed red flag symptoms requiring immediate return to ED: chest pain different in quality or location, pain radiating to arms/jaw/back, shortness of breath, palpitations, lightheadedness, syncope, or fever. If pain persists beyond 2 weeks despite ibuprofen, follow up with PCP for reassessment. Patient expressed relief with explanation and understanding of benign nature. Verbalized clear understanding of diagnosis, treatment plan, and warning signs. Discharged home in stable condition with return precautions discussed. PCP follow-up as needed.

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Example 3: Non-Cardiac Chest Pain - Observation Unit for Serial Troponins

Patient: 48-year-old male
Arrival: Self-presented to ED
Chief Complaint: Chest discomfort

S – Subjective:

48-year-old male presents with intermittent chest discomfort that started this morning, approximately 6 hours ago. Describes sensation as "pressure and burning" behind sternum, rated 4-5/10 severity. Pain comes and goes in episodes lasting 5-15 minutes, occurring every 1-2 hours. Initially occurred after eating large breakfast, thought it was "heartburn." Pain does not radiate. Not clearly related to exertion - happened while sitting at desk. Relieved somewhat by antacids but keeps recurring. Denies shortness of breath, diaphoresis, palpitations, or syncope. No nausea though does report some indigestion and belching. Patient has history of GERD, takes omeprazole 20mg daily but admits has been non-compliant, ran out of medication 2 weeks ago. Cardiac risk factors present: borderline hypertension (controlled on medication, takes lisinopril 10mg daily), overweight (BMI 29), sedentary lifestyle. No diabetes, non-smoker (quit 5 years ago, 10-pack-year history), cholesterol "borderline" per patient. Family history: mother with hypertension, no early cardiac disease in family. No prior cardiac workup, never had stress test or echo. Presents today because wife insisted he get checked after telling her about the discomfort.

O – Objective:

Vitals: BP 142/88, HR 78 regular, RR 16, O2 sat 98% on RA, Temp 98.6°F, BMI 29
General: Well-appearing male, no acute distress, comfortable during evaluation
HEENT: Normal, no JVD
Cardiac: Regular rate and rhythm, normal S1/S2, no murmurs/rubs/gallops, PMI normal
Lungs: Clear to auscultation bilaterally, equal breath sounds
Abdomen: Soft, mild epigastric tenderness to deep palpation, no guarding or rebound, positive bowel sounds
Extremities: No edema, pulses 2+ and equal bilaterally
EKG: Normal sinus rhythm at 78 bpm, normal axis, normal intervals, no ST changes, no T wave abnormalities, no Q waves, no prior EKG available for comparison
Troponin I (initial, drawn 6 hours after symptom onset): less than 0.01 ng/mL (normal)
BMP: Normal
CBC: Normal
CXR: Clear lung fields, normal cardiac silhouette, no acute findings

A – Assessment:

48-year-old male with chest discomfort, unclear etiology. Differential diagnosis includes: 1) GERD exacerbation (most likely given history of GERD, medication non-compliance, post-prandial timing, epigastric tenderness, response to antacids, burning quality), 2) Atypical angina cannot be completely excluded (has some cardiac risk factors including hypertension, prior smoking, overweight, though pain characteristics less typical for ACS), 3) Musculoskeletal pain less likely given no reproducibility on exam. HEART score 3-4 (low-moderate risk). Initial troponin normal but drawn only 6 hours from symptom onset. Patient does not meet criteria for very low risk discharge given: some cardiac risk factors present, no prior cardiac evaluation, intermittent symptoms, cannot definitively exclude ACS on initial evaluation alone. However, patient hemodynamically stable, pain currently resolved, no ongoing chest discomfort, normal EKG, and normal initial troponin. Appropriate candidate for observation unit with serial troponins to definitively rule out ACS before discharge with GERD treatment.

P – Plan:

Admit to ED observation unit for serial cardiac biomarkers. Troponin to be repeated at 3 hours (9 hours from symptom onset) and 6 hours (12 hours from symptom onset). Continuous telemetry monitoring. Nothing by mouth except medications until cardiac etiology excluded. If serial troponins remain negative and patient pain-free, will arrange outpatient stress test within 72 hours prior to discharge (stress test not performed acutely given patient currently asymptomatic). Administered GI cocktail (antacid and viscous lidocaine) with good effect, patient reports complete resolution of discomfort. Started omeprazole 40mg PO daily. Provided education on GERD management: medication compliance, dietary modifications (avoid large meals, fatty foods, caffeine, alcohol), elevate head of bed, avoid eating within 3 hours of bedtime. If troponins remain negative and stress test is negative or low-risk, will discharge on PPI therapy with GI follow-up. If any troponin elevation or positive stress test, will consult cardiology for further evaluation. Patient and wife agree with observation plan. Patient currently comfortable, resting in observation bed, will reassess in 3 hours or sooner if symptoms recur. Return precautions discussed: notify RN immediately if chest pain recurs, shortness of breath, palpitations, or any concerning symptoms develop.

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Additional Tips for Chest Pain SOAP Notes

Always Document the Time Course: Time of symptom onset, time of presentation, time of EKG, time of troponin draw. This is critical for interpretation and legal protection.

Be Explicit About Risk Stratification: Use validated tools like HEART score, TIMI score. Document your risk assessment clearly.

Document Critical Negatives: No diaphoresis, no syncope, no radiation - these negatives are as important as positive findings.

Record Exact EKG Findings: Don't just say "EKG normal." Document rate, rhythm, intervals, and specifically note presence or absence of ST changes, Q waves, T wave abnormalities.

Justify Your Disposition: Explain why you're admitting, observing, or discharging. Reference your risk assessment and clinical judgment.

Include What You Told the Patient: Document that you explained possible diagnoses, discussed red flags for return, and confirmed understanding.

Serial Measurements Matter: Document trends in vital signs, pain levels, and troponins - improvement or worsening guides decisions.

Consultant Input: If you called cardiology, document their recommendations and who you spoke with.

Chest pain documentation is high-stakes. Your SOAP note should clearly demonstrate systematic evaluation, appropriate risk stratification, and sound clinical reasoning. This protects both your patient and your license.