Cardiovascular Flashcards
What are some risk factors for ischemic heart disease?
Male, age, smoking, HTN, DM, FHx, hypercholesterolaemia, physical inactivity and obesity
What would you expect on taking a history of someone with chest pain?
Site – central, substernal, anterior, in both arms/shoulders/neck/cheeks/teeth/forearms/fingers/interscapular region
Onset –acute
Character – crushing, tight, constricting, squeezing, burning, ‘heaviness’
Radiation – neck, jaw, left arm etc
Associated symptoms – sweating, nausea, dyspnoea, palpitations
Timing – on exertion or at rest?
Exacerbating factors – exercise, excitement, stress, cold weather, after meals, smoking
Alleviating factors – rest, medication, oxygen
Severity - high
What are some factors against ischemia being the cause of chest pain?
Character – ‘knife like’/sharp/stabbing/worse on respiration (PE/pneumothorax/pneumonia)
Exacerbating factors – pain AFTER the completion of exercise, specific body motions
What would you expect on taking a history of someone with dyspnoea?
Onset – acute or chronic? Acute-on-chronic?
Associated symptoms – cough (productive? Haemoptysis), wheeze, chest pain, weight loss/gain, leg swelling, palpitations, sweating, nausea
Timing – at rest or on exertion? How much exertion? Constant? After a particular event? At night? Lying down?
Exacerbating factors – exercise, cold weather, position (no. pillows?)
Alleviating factors – rest, medication, oxygen, sitting up
You would also take a focused respiratory history from them
What questions would you ask about exercise tolerance?
How far can you walk on the flat before you need to stop and rest? What is the limit of how far you can walk? Do you have any shortness of breath or chest pain/tightness when you walk? How long ago did you notice the problem and is it developing over time?
What questions would you ask about palpitations?
Have you had any palpitations or awareness that your heart is racing?
Timing - provoked/at rest, frequency, duration progression, triggers - caffeine/alcohol/activity, ending - sitting/spontaneous/compulsion
Can you tap the rhythm? Is it fast/slow/regular/irregular?
Cardiac symptoms - CP, SOB, polyuria
Hyperthyroid symptoms - weight loss, sweating diarrhoea, heat intolerance
Hyperglycaemic symptoms - hunger, sweating
Anxiety symptoms - tingling, nausea
Current life stress?
What questions would you ask about PMH?
Similar episodes/previous diagnoses/treatments + response to treatments
Previous cardiac surgery
HTN/hypercholesterolaemia/anaemia/diabetes/angina/MI/CVA or TIA/ PVD/cardiac failure/rheumatic fever?
DH + A?
Antihypertensives, all cardiac drugs, drugs with cardiac side effects i.e. corticosteroids (HTN + fluid retention), drugs that can cause a sinus tachyc. I.e. salbutamol, theophylline, nifedipine, thyroxine
OTC medications?
SH?
Smoking (pack years)? Occupation? Alcohol (AF, cardiomyopathy, HTN, tachyc.)? Diet? Stress?
FH?
IHD or CVA before age of 65?
Sudden death?
Arrhythmias?
Thyroid issues?
