Cardiovascular History

Question 1

What are the key CVS symptoms? Differentiating questions? (7)

Answer 1

Chest pain – SOCRATES
Dyspnoea – exertional / orthopnea / paroxysmal nocturnal dyspnoea
Palpitations – ask patient to tap out the rhythm
Syncope / dizziness – postural / exertional / random
Oedema – peripheral oedema (e.g. lower limbs) / sacral oedema
Intermittent claudication – e.g. leg pain worsened on exertion / improved at rest
Systemic symptoms – fatigue / fever / weight loss / weight gain

Question 2

What are the key CVS RFs?

Answer 2

Hypertension
Smoking
Hyperlipidaemia
Diabetes
Family history of cardiac disease

Question 3

What PMHx should you be asking about in a CVS history?

Answer 3

Angina
Myocardial infarction – bypass grafts / stents
Atrial fibrillation
Stroke
Peripheral vascular disease
Hypertension
Hyperlipidaemia
Rheumatic fever
Other medical conditions – e.g. hyperthyroidism 

Surgical history – bypass graft / stents / valve replacements

Acute hospital admissions? – when and why?

Question 4

What DHx should you be asking about in a CVS history?

Answer 4

Beta blockers
Calcium channel blockers
ACE inhibitors
Diuretics
Statins
Antiplatelets
Anticoagulants
Glyceryl trinitrate spray (GTN spray)
Other regular medications

Contraceptive pill – increased risk of thromboembolic disease

Over the counter drugs – NSAIDS / Aspirin

Herbal remedies – e.g. St John’s Wort – enzyme inducer (can affect Warfarin levels)