Cardiovascular history Flashcards
what are the most common cardiovascular presenting complaints?
chest pain breathlessness palpitations syncope fluid retention
what is the most important differentiation in chest pain?
cardiac vs non-cardiac chest pain
what can cardiac chest pain be further divided into?
ischaemic or non-ischaemic
what in SOCRATES would be suggestive of ischaemic chest pain?
S - central, levine's sign, putting a fist infront of chest O - sudden C - crushing / pressure R -radiates down left arm or jaw A - nausea, vomiting, sweating T - prolonged E - made worse on exertion S - very severe
what would the onset of breathlessness suggest?
sudden - pneumothorax or PE
gradual - pneumonia or heart failure
what would the character of breathlessness suggest?
postural - orthopnoea (worse when lying flat) = HF
nocturnal - paroxysmal nocturnal dyspnoea = HF
what are some associated symptoms of breathlessness?
wheeze - COPD, asthma
cough - HF with pink frothy sputum, pneumonia with green sputum
fever - infection
pain - cardiac ischaemic pain vs pleuritic pain
what could cause palpitations?
Cardiac arrhythmias:
Ectopic beats (occasional thud in chest, not usually associated with symptoms, common)
AF (fast irregular pulse)
SVT (regular, very fast heart racing, blacking out but not syncope)
VT (dangerous, syncope)
Structural heart diseases
Psychosomatic disorders (anxiety)
Systemic causes (hyperthyroidism, anaemia)
Drugs: medical (beta blockers), recreational (caffeine, cocaine)
what could be the nature of palpitations?
Bumps and thumps Missed beats Extra beats Racing heartbeat Tap out the rhythm?
what could be exacerbating factors for palpitations?
Rest / exercise
Tea and coffee, alcohol
what would be more worrying signs of palpitations?
Age, older more worrying Rapid onset worse Duration, shorter better Frequency Activity, diet and drugs
what is syncope?
sudden and brief loss of consciousness associated with a deficit of postural tone, from which recovery is spontaneous
what is parasyncope?
the feeling of imminent loss of consciousness but not progressing to loss of consciousness
what would suggest syncope or pre-syncope was cardiac in cause?
Sudden drop, no warning, injury due to fall Hypovolaemia Postural hypotension Cardioneurogenic syncope (‘Faint’) Vasodepressor Cardiac Depressor Prodrome, position, provoking (hot rooms, bloods taken) Carotid sinus hypersensitivity Arrhythmias (fast and slow) Aortic stenosis/LVOT obstruction
what are some cardiac causes of fluid retention?
Congestive heart failure
Right heart failure
Pericardial
what are some protien loss causes of fluid retention?
Hepatic causes
Renal causes
GI causes
what could cause pitting oedema in the legs?
Cardiac more likely
Unilateral (DVT) vs bilateral (systemic causes)
Onset – rapid (acute kidney failure, acute heart failure) vs slow
Past history esp of malignancy, heart/lung disease, diabetes
Medications – eg dihydropyridine calcium channel blockers
Associated symptoms – Pain or dyspnea
what are cardiovascular risk factors?
Smoking HT Family history High cholesterol Age Obesity Cardiac procedures
