Cardiac History Flashcards
Name 10 symptoms of cardiac problems?
- Chest pain
- Dyspnoea (shortness of breath)
- Orthopnoea (SOB on lying flat that is relieved by sitting upright)
- Paroxysmal nocturnal dyspnoea (acute dyspnoea that wakes the patient from sleep)
- Ankle oedema
- Cough, sputum & haemoptysis
- Dizziness
- Light-headedness
- Presyncope & syncope
- Palpitations
- Nausea & sweating
- Claudication
- Systemic symptoms e.g. fatigue, weight loss, anorexia, fever
What are the risk factors for IHD?
- Male sex
- Age
- Smoking
- Hypertension
- Diabetes mellitus
- Family history of IHD
- Hypercholesterolaemia
- Physical inactivity and obesity
What are the key elements of SOCRATES for chest pain?
site: Central substernal, across mid-thorax anteriorly, in both arms/shoulders, in the neck/cheeks/teeth, in the forearms/ fingers, in the interscapular region
Onset: Acute
Character: Crushing, tight, constricting, squeezing, burning,
‘heaviness’
Radiation: Neck, jaw, left arm
Associated Symptoms: Sweating, nausea, shortness of breath, palpitations
timing: On exertion? At rest?
Exacerbating Factors: Exercise, excitement, stress, cold weather, after meals,
smoking,
lying flat (decubitus angina 2° to left heart failure)
Alleviating Factors: Rest, medication, oxygen
Severity: Pain scale 1-10
What are the socrates features of shortness of breath?
S-
O- Acute, chronic, acute-on-chronic
C-
A-Sweating, nausea (due to hepatic/gastric congestion),
pain, cough, sputum (watery/frothy? Blood-tinged?),
swollen ankles, palpitations, nocturnal micturition, rapid
weight gain (could be due to oedema)
T-On exertion? At rest? Constant? At night (paroxysmal
nocturnal dyspnoea)?
E-Position (number of pillows – orthopnoea)?
Alleviating- Rest, medication, oxygen, sitting up straight
S-How debilitating? Effect on activities of daily life?
Exercise tolerance
Questions about exercise tolerance for dyspnoea?
‘How far can you walk on the flat before you need to stop and rest?’
• ‘What is it that limits how far you can walk?’
• ‘Do you feel short of breath when you walk, such as walking up hills or stairs?’
• ‘Do you have any discomfort or tightness in your chest when you walk?’
• ‘How long ago did you notice a problem when you are walking…did it get worse suddenly
or gradually…. how far were you able to walk a year/month ago?’
What are the Factors against cardiac ischaemia as the cause of pain?
Character of pain: ‘knife-like’, sharp, stabbing, aggravated by respiration
• Location of pain: left submammary area, left hemithorax
• Exacerbating factors: pain after completion of exercise, specific body motion
What are the questions to ask about palpitations?
• ‘Have you had any palpitations or awareness of your heart racing?’
• ‘Does anything seem to provoke this?’
• ‘Does it start suddenly or build up gradually?’ ‘Does it stop suddenly or gradually?’ ‘How
long does it last?’
• ‘Do you have any other symptoms with the palpitations?’
• ‘Can you can tap the rhythm?’ (Is it regular, irregular or regularly irregular? Is it fast or
slow?)
What are the questions to ask about syncope?
Sudden and brief loss of consciousness associated with a deficit of postural tone, from
which recovery is spontaneous (not requiring electrical or chemical cardioversion)
• Usually results from sudden transient hypotension, which results in impairment of cerebral
perfusion
• Presyncope – the feeling of imminent loss of consciousness but not progressing to loss
of consciousness e.g. faintness
What are the questions to ask about the medical history in a cardiac exam?
- Similar episodes, previous diagnoses, treatments and responses to treatment.
- Previous cardiac surgery
- Hypertension
- Hypercholesterolaemia
- Anaemia
- Diabetes
- Angina
- Myocardial infarction
- Cerebrovascular accident / Transient ischaemic attack
- Peripheral vascular disease e.g. intermittent claudication
- Cardiac failure
- Rheumatic fever
What are the questions to ask about drug history and allergies in a cardiac history?
Particularly relevant drugs include:
Antihypertensive drugs
All cardiac drugs
Other drugs with cardiac side effects e.g. corticosteroids (hypertension and fluid retention),
and drugs that can cause sinus tachycardia (e.g. salbutamol, theophylline, nifedipine,
thyroxine)
Over-the-counter drugs e.g. aspirin, NSAIDs
What are the social history questions to ask in a cardiac history?
Occupation, smoking (number of pack years), alcohol (can cause atrial fibrillation,
cardiomyopathy, hypertension and tachycardia), diet, stress
What are the family history questions to ask in a cardiac history?
Family history of ischaemic heart disease or cerebrovascular accident before the age of 65.
