Cardiac history Flashcards
Order of the history
Presenting complaints History of PC Past medical history DH and allergies Family history Social history and smoking SE and risk factors
Main cardiac symptoms
Chest pain Breathlessness Palpitation Syncope or presyncope Fluid retention
How to investigate chest pain
SOCRATES
Types of cardiac chest pain
Ischaemic and non ischaemic
Causes of ischaemic chest pain
Angina pectoris and ACS
Causes of non ischaemic chest pain
Pericarditis, myocarditis, aortic dissection and others
Causes of gastro oesophageal non cardiac chest pain
GORD/Spasm and peptic ulcer
Causes of non gastro oesophageal non cardiac pain
Pulmonary, musculoskeletal and psychosomatic
Factors pointing towards ischaemic cardiac pain
Character of pain Location of pain Provoking factors Relieving factors Associated symptoms Associated risk factors
Cardiac causes of breathlessness
IHD, LVF, valves
Pulmonary causes of breathlessness
Airway disease, PE, Others
Questions for breathlessness
When did it start? How quickly did it come on? Circumstances? Relieving or exacerbating factors? Associated features?
Circumstances of breathlessness
Exertional
Postural, orthopnoea
Nocturnal. paroxysmal nocturnal dyspnoea
Relieving factors for breathlessness
Position
Rest
Oxygen, nebulisers or other medication
Features associated with breathlessness
Wheeze, cough, fever, pain
Define orthopnoea
Shortness of breath on lying flat that is relieved by sitting upright
Define paroxysmal nocturnal dyspnoea
Acute dyspnoea that wakes the patient from sleep
Cardiac causes of fluid retention
Congestive heart failure
Right heart fialure
Pericardial
Protein loss causes of fluid retention
Hepatic
Renal
GI
Questions for fluid retention
Onset and duration
Location
Peripheral oedema specific considerations
Unilateral/bilateral Onset PMH Medications Associated symptoms
Peripheral oedema PMH of significance
Malignancy, heart and lung disease, diabetes
Peripheral oedema drug history of significance
Dihydropyridine calcium channel blockers
Peripheral oedema associated symptoms
Pain and SOB
Causes of palpitations
Cardiac arrythmias Structural heart diseases Psychosomatic disorders Systemic causes Drugs: medical, recreational
Palpitation questions
Onset and duration Nature -what does it feel like -tap out rhythm -regular or erratic Relieving or exacerbating factors Associated symptoms
Palpitation associated symptoms
Nausea and vomitting Sweaty or clammy Short of breath Light headed Loss of consciousness
Palpitation special considerations
Age of patient Onset Duration Frequency and timing Associated activity Diet Drugs
Define syncope
Sudden and brief loss of consciousness associated with a deficit of postural tone, from which recovery is spontaneous
Define presyncope
The feeling of imminent loss of consciousness but not progressing to loss of consciousness
Cardiovascular causes of syncope
Hypovolaemia Postural hypotension Cardioneurogenic syncope Carotid sinus hypersensitivity Arrythmias Aortic stenosis, LVOT obstruction
What is cardioneurogenic syncope
Faint
- vasodepressor
- cardiodepressor
Neurological causes of syncope
Epilepsy
CVA (not often)
Other causes of syncope
Metabolic
Drugs
Questions for syncope
Onset and duration
Nature
Associated features
Witnesses
Associated features of syncope
Sick Sweaty or clammy Chest pain Incontinence Injuries Memory of the event
Cardiac PMH
Cardiac history
Cardiovascular risk factors
Cardiac procedures
IHD risk factor assessment
Age Smoking Hypertension Dyslipidaemia DM Family history of IHD Physical inactivity and obesity Vascular disease
Drug history
Cardiac medication
Other medication
Allergies
Interactions
Family history
Ischaemic heart disease
Sudden cardiac death
Risk factors
Social history
Smoking- IHD
Drinking- arrhythmias, cardiomyopathy
Occupation
Breathless lying down, relieved by sitting up
Orthopnoea
