Cardiac history

Question 1

Order of the history

Answer 1

Presenting complaints
History of PC
Past medical history
DH and allergies
Family history
Social history and smoking
SE and risk factors

Question 2

Main cardiac symptoms

Answer 2

Chest pain
Breathlessness
Palpitation
Syncope or presyncope
Fluid retention

Question 3

How to investigate chest pain

Answer 3

SOCRATES

Question 4

Types of cardiac chest pain

Answer 4

Ischaemic and non ischaemic

Question 5

Causes of ischaemic chest pain

Answer 5

Angina pectoris and ACS

Question 6

Causes of non ischaemic chest pain

Answer 6

Pericarditis, myocarditis, aortic dissection and others

Question 7

Causes of gastro oesophageal non cardiac chest pain

Answer 7

GORD/Spasm and peptic ulcer

Question 8

Causes of non gastro oesophageal non cardiac pain

Answer 8

Pulmonary, musculoskeletal and psychosomatic

Question 9

Factors pointing towards ischaemic cardiac pain

Answer 9

Character of pain
Location of pain
Provoking factors
Relieving factors
Associated symptoms
Associated risk factors

Question 10

Cardiac causes of breathlessness

Answer 10

IHD, LVF, valves

Question 11

Pulmonary causes of breathlessness

Answer 11

Airway disease, PE, Others

Question 12

Questions for breathlessness

Answer 12

When did it start?
How quickly did it come on?
Circumstances?
Relieving or exacerbating factors?
Associated features?

Question 13

Circumstances of breathlessness

Answer 13

Exertional
Postural, orthopnoea
Nocturnal. paroxysmal nocturnal dyspnoea

Question 14

Relieving factors for breathlessness

Answer 14

Position
Rest
Oxygen, nebulisers or other medication

Question 15

Features associated with breathlessness

Answer 15

Wheeze, cough, fever, pain

Question 16

Define orthopnoea

Answer 16

Shortness of breath on lying flat that is relieved by sitting upright

Question 17

Define paroxysmal nocturnal dyspnoea

Answer 17

Acute dyspnoea that wakes the patient from sleep

Question 18

Cardiac causes of fluid retention

Answer 18

Congestive heart failure
Right heart fialure
Pericardial

Question 19

Protein loss causes of fluid retention

Answer 19

Hepatic
Renal
GI

Question 20

Questions for fluid retention

Answer 20

Onset and duration

Location

Question 21

Peripheral oedema specific considerations

Answer 21

Unilateral/bilateral
Onset
PMH
Medications
Associated symptoms

Question 22

Peripheral oedema PMH of significance

Answer 22

Malignancy, heart and lung disease, diabetes

Question 23

Peripheral oedema drug history of significance

Answer 23

Dihydropyridine calcium channel blockers

Question 24

Peripheral oedema associated symptoms

Answer 24

Pain and SOB

Question 25

Causes of palpitations

Answer 25

``` Cardiac arrythmias Structural heart diseases Psychosomatic disorders Systemic causes Drugs: medical, recreational ```

Question 26

Palpitation questions

Answer 26

``` Onset and duration Nature -what does it feel like -tap out rhythm -regular or erratic Relieving or exacerbating factors Associated symptoms ```

Question 27

Palpitation associated symptoms

Answer 27

``` Nausea and vomitting Sweaty or clammy Short of breath Light headed Loss of consciousness ```

Question 28

Palpitation special considerations

Answer 28

``` Age of patient Onset Duration Frequency and timing Associated activity Diet Drugs ```

Question 29

Define syncope

Answer 29

Sudden and brief loss of consciousness associated with a deficit of postural tone, from which recovery is spontaneous

Question 30

Define presyncope

Answer 30

The feeling of imminent loss of consciousness but not progressing to loss of consciousness

Question 31

Cardiovascular causes of syncope

Answer 31

``` Hypovolaemia Postural hypotension Cardioneurogenic syncope Carotid sinus hypersensitivity Arrythmias Aortic stenosis, LVOT obstruction ```

Question 32

What is cardioneurogenic syncope

Answer 32

Faint - vasodepressor - cardiodepressor

Question 33

Neurological causes of syncope

Answer 33

Epilepsy | CVA (not often)

Question 34

Other causes of syncope

Answer 34

Metabolic | Drugs

Question 35

Questions for syncope

Answer 35

Onset and duration Nature Associated features Witnesses

Question 36

Associated features of syncope

Answer 36

``` Sick Sweaty or clammy Chest pain Incontinence Injuries Memory of the event ```

Question 37

Cardiac PMH

Answer 37

Cardiac history Cardiovascular risk factors Cardiac procedures

Question 38

IHD risk factor assessment

Answer 38

``` Age Smoking Hypertension Dyslipidaemia DM Family history of IHD Physical inactivity and obesity Vascular disease ```

Question 39

Drug history

Answer 39

Cardiac medication Other medication Allergies Interactions

Question 40

Family history

Answer 40

Ischaemic heart disease Sudden cardiac death Risk factors

Question 41

Social history

Answer 41

Smoking- IHD Drinking- arrhythmias, cardiomyopathy Occupation

Question 42

Breathless lying down, relieved by sitting up

Answer 42

Orthopnoea