Cardiovascular Histories Flashcards
What PCs might you see in a CVS hx?
Chest pain
Dyspnoea
Orthopnoea (SOB on lying flat that is relieved by sitting upright)
PND (acute dyspnoea that wakes the patient from sleep)
Ankle oedema
Cough, sputum & haemoptysis
Dizziness
Light-headedness
Presyncope & syncope
Palpitations
Nausea & sweating
Claudication
Systemic symptoms
What are the risk factor for IHD?
Male sex
Age
Smoking
HTN
DM
FHx of IHD
Hypercholesterolaemia
Physical inactivity and obesity
Give the Potential SOCRATES for Chest pain
Site: Central substernal / Across mid-thorax anteriorly /
In both arms/shoulders / In the neck/cheeks/teeth / In the forearms/ fingers / In the interscapular region
Onset: Acute
Character: Crushing / Tight / Constricting / Squeezing / Burning / ‘heaviness’
Radiation: Neck / Jaw / Left arm
Asso sx: Sweating / Nausea / SOB / Palpitations
Timing: On exertion? At rest?
E / R factors:
(E) Exercise / Excitement / Stress / Cold weather / After
meals / Smoking / Lying flat (decubitus angina 2° to
LHF)
(R) Rest / Medication / Oxygen
Severity: Pain scale (1 – 10)
What factors act against cardiac ischaemia as the cause of chest pain?
Character of pain: ‘knife-like’, sharp, stabbing, aggravated by respiration
Location of pain: left submammary area, left hemithorax
Exacerbating factors: pain after completion of exercise, specific body motion
What questions do you want to ask about SOB in a CVS hx?
Onset: Acute / Chronic / Acute-on-chronic
Asso sx: Sweating / Nausea (due to hepatic/gastric congestion) / Pain / Cough / Sputum (watery/frothy? Blood-tinged?) / Swollen ankles / Palpitations / Nocturnal micturition / Rapid wt gain (?due to oedema)
Timing: On exertion? At rest? Constant? At night (paroxysmal nocturnal dyspnoea)?
E /R factors:
(E) Position (number of pillows – orthopnoea)?
(R) Rest, medication, oxygen, sitting up straight
Severity: How debilitating? Effect on activities of daily life? Exercise tolerance
Ask about resp conditions
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 it that limits how far you can walk?’
‘Do you feel short of breath when you walk, such as walking up hills or stairs?’
‘Do you have any discomfort or tightness in your chest when you walk?’
‘How long ago did you notice a problem when you are walking…did it get worse suddenly or gradually…. how far were you able to walk a year/month ago?’
What questions would you ask about palpitations?
‘Have you had any palpitations or awareness of your heart racing?’
‘Does anything seem to provoke this?’
‘Does it start suddenly or build up gradually?’
‘Does it stop suddenly or gradually?’
‘How long does it last?’
‘Do you have any other symptoms with the palpitations?’
‘Can you can tap the rhythm?’
- Is it regular, irregular or regularly irregular?
- Is it fast or slow?
What is syncope?
Sudden and brief loss of consciousness associated with a deficit of postural tone, from which recovery is spontaneous (not requiring electrical or chemical cardioversion)
What causes syncope?
Usually results from sudden transient hypotension, which results in impairment of cerebral perfusion
What is presyncope?
The feeling of imminent loss of consciousness but not progressing to loss of consciousness e.g. faintness
What is INTERMITTENT CLAUDICATION?
A reproducible discomfort of a defined group of muscles that is induced by exercise and relieved with rest.
This disorder results from an imbalance between
supply and demand of blood flow that fails to satisfy ongoing metabolic requirements.
Give the classic SOCRATES for INTERMITTENT CLAUDICATION
Site = Depends on the site of arterial occlusion, e.g.
occlusion of the superficial femoral artery often
causes pain in the calf muscles
Onset = Acute -> ?after acute thrombosis
Chronic -> atherosclerotic stenosis/occlusion
Character = Gripping / Cramping / Burning / Tightness
Radiation = N/A
Asso sx = (For example, chest pain) May suggest
atherosclerotic vascular disease elsewhere
e.g. ischaemic heart disease, cerebrovascular
disease, erectile dysfunction
Timing = Intermittent?
E / R factors = (E) Exercise (“How far can you walk?”,
“Does the pain limit your walking, or
something else e.g. SOB?”)
(R) Rest (“How long before the pain
subsides?”) – Usually minutes
Severity = Pain scale (1-10).
Give the SOCRATES for REST PAIN
Site = Foot/toes
Onset = Usually progresses from intermittent
Claudication to rest pain
Character = Sharp, burning, usually severe
Radiation = N/A
Asso sx = (For example, chest pain) May suggest
atherosclerotic vascular disease elsewhere
e.g. ischaemic heart disease, cerebrovascular
disease, erectile dysfunction
Timing = At rest (Worse at night)
E / R factors = (E) Elevation of leg / (R) Lowering legs
What are the sx of acute limb ischaemia?
6PS
Pain
Pallor
Pulselessness
Paralysis (loss of function)
Paraesthesia (loss of sensation)
Perishing cold
Give the sx of the following types of AAA
a) Symptomatic
b) Ruptured
a) In this situation patients may complain of back pain
b) These present as an emergency with back pain and
collapse
