cardiovascular assessment Flashcards
Examples of history questions you could ask relating to chest pain
How is the patient normally? • Is this acute / chronic / acute on chronic? • Level of pain based on previous episodes? • Breathing? • Colour? Onset, timing, duration, variability • What were they doing at the time? • Exertion or at rest? Exacerbating factors • Movement / exercise Relieving factors • Rest • Medication – GTN • Position Associated symptoms • SOB / DIB? Pertinent Negatives • TLOC/LOC, diaphoretic, diabetic, HTN Severity • At rest, on exertion? • Level of pain based on previous episodes?
what are the symptoms of cardio related illnesses ?
- Chest pain
- Shortness of breath
- Palpitations
- Oedema
- Syncope & dizziness
- Claudication (pain in your calf, leg or bum when you walk)
questions to ask about shortness of breath
Can they speak in full sentences
When did symptoms start
Effort, (Exercise tolerance)
orthopnoea (how does the sensation of breathlessness feel laying down)
questions to ask about palpitations
How does the patient feel 12 lead ECG Mode of onset Frequency Durations of attacks Patients awareness and regularity Get the patient to tap out the rhythm Did the patient check his pulse? Associated symptoms Precipitating factors, alcohol, caffeine, drugs
asking about syncope ( fainting episode)
Pre-syncope symptoms - dizziness Previous episodes Previous medical history of fits Full loss of conciousness? Loss of bladder control? Length of time to become fully conscious? Flushing after syncope? Remember to ask what drugs do they take?
questions to ask about oedema
Do their ankles swell?
How far does the oedema extend to?
What drugs are they taking?
Can they get their shoes on?
what is claudication
pain on walking
calf, thigh or buttock
more common in men than women
more common in smokers than non-smokers
what are common cardiovascular conditions that cause chest pain
Cardiovascular • Angina • Stable • Unstable • Myocardial infarction • Aortic dissection • Myocarditis
Chest wall • Coughing • Intercostal muscle strain • Shingles • Rib fracture • Rib tumour • Costochondritis
what are gastrointestinal causes of chest pain
Gastrointestinal
• Gastro-oesophageal reflux
• Oesophageal spasm
acid reflux
on inspection what are you looking for
- Colour – Pale, Sweating, Clammy,
- Body type - Cachexia, Obesity? Congenital abnormality?
- How’s their breathing? – Dyspnoea
- Patient behaviour – pain / discomfort
what can patients behaviour show you about chest pain
depending on how they are holding/ describing chest pain can tell you the type
e.g: clenched fist oesophagal pain radiation chest wall pain
what is a myocardial infarction
blockage of the blood flow in the heart
what is the management of an mi
Emergency PPCI (or consider thrombolysis if unavailable)
• Oxygen if needed
• Aspirin 300 mg (4 x 75mg) chewed
• GTN 400mcg to 5mg (depending on drug preparation)
• Clopidogrel 600mg (in conjunction with aspirin)
• Morphine Sulphate if needed up to 20mg max
what are the 3 types of angina
stable angina
unstable angina
variant angina
how to mange angina
- GTN 400mcg – 5mg (may need to repeat)
- Aspirin – 300mg
- Consider further pain relief if needed:
- Morphine first line choice
