Cardiac history and examination Flashcards
Name 10 symptoms of cardiovascular disease
Chest pain Dyspnoea Orthopnoea Paroxysmal nocturnal dysponea Ankle oedema Cough, sputum, haemoptysis Dizziness Lightheadedness Presyncope and syncope Palpitations Nausea Sweating Claudication Systemic symptoms - fatigue, weight loss, anorexia, fever
What are the risk factors for ischaemic heart disease?
Male Age Smoking Hypertension DM FHx of IHD Hypercholesterolaemia Sedentary lifestyle Obesity
What factors lead to you thinking that IHD is NOT the cause of chest pain?
Character - knife-like, sharp, stabbing, pleuritic (aggravated by respiration)
Location - L submammary area, L hemithorax
Exacerbating factors - pain after completion of exercise, specific body motion
What should you ask about in a SOB history specific to cardiac?
Timing - on exertion, at rest, constant, at night
Exacerbating factors - position (no. of pillows)
How debilitating?
Exercise tolerance
What questions are important to ask about palpitations?
Does anything seem to provoke them?
Does it start suddenly or build up gradually?
Any other symptoms?
Can you tap the rhythm?
What conditions are important to ask about in the past medical history?
Similar episodes Previous diagnoses, treatments and responses Previous cardiac surgery Hypertension Hypercholesterolaemia Anaemia Diabetes Angina MI Cerebrovascular accident/TIA PVD Cardiac failure Rheumatic fever
What drugs are important to ask about in the history?
Anti-hypertensives
All cardiac drugs
Other drugs with cardiac side effects
OTC eg NSAIDs
What drugs can have a cardiac side effect?
Corticosteroids - hypertension and fluid retention
Salbutamol, theophyilline, nifedipine, thyroxine - causes sinus tachycardia
What should you ask about in a social history?
Occupation Smoking Alcohol Diet Stress
Why is alcohol important to ask about?
It can cause
- AF
- Cardiomyopathy
- Hypertension
- Tachycardia
What is important to clarify in FHx?
At what age IHD or cerebrovascular accident occurred
ie before 65
What are the main steps in a cardiac examination?
Inspection
Palpation
Auscultation
Special tests
What should you inspect?
Around the bed space General appearance of patient Hands Eyes Face Mouth/lips JVP Chest
What should you look for in the general appearance of the patient?
Body habitus Colour Breathing Comfort Position Build
What cardiac signs should you look for in the hands?
Tar staining Vasodilatation/constriction Temperature Sweating Pallor of palmar creases (anaemia) Peripheral cyanosis (low cardiac output) Clubbing (low blood O2) Splinter haemorrhages Osler's nodes and Janeway lesions (infective endocarditis) Tendon xanthomas (hypercholesterolaemia)
