Cardiovascular History Taking Flashcards
What are the five aspects to the Roger Neighbour - the inner consolation 1987
1) connecting (build rapport and get to know them)
2) summarising (reword what the patient has said to ensure you have the information right which allows for correction)
3) handing over (put some of the discussion in the patients hands
4) safety netting (what if you’re wrong, plan another appointment)
5) housekeeping (taking care of yourself)
Presenting Complaint /
History of Presenting Complaint
- description of symptoms
- patients own words
- allow patient the time to speak
- don’t interupt
- you need to establish a timeline
- use a relevant systems enquiry when you have been communicated their issue
Past Medical History
- previous/present medical conditions
- have they visited the GP hospital before
- are they undergoing nay investigations
- have they had any operations or procedures
- are these problems ongoing or are have they been resolved with meds etc?
what conditions should you look for in a cardiovascular PMH
History of vascular disease diabetes hyperthyroidism renal disease hypertension hypercholesteroloaemia
Drug history AND allergies
prescribed medications over the counter medications why are they taking it? are they actually taking it effectively? allergies and what the side effects are
family history
any family diseases
premature death ? ho did they die?
any cardiovascular disease at a young age?
what counts as a young age for cardiovascular disease in males and females
younger than 55 in males
younger than 65 in females
social history headlines
- upbringing
- home life
- occupation
- finance
- relationships
- house
- community support
- sexual history
- leisure acitviites
- exercise
- substance misuse
how do you calculate pack years of smoking
20 cigs = 1 packet
the number of cigs they smoke per day x the number of years they have been smoking
divided by 20
general systems enquiry
chest pain breathessness palpitations dizziness oedema peripheral vascular symptoms intermittent claudication (muscle pain on mild exertion)
non-modifiable risk factors to cardiovascular diseases
ethnicity
age
gender
family history
modifiable risk factors for cardiovascular disease
weight high blood pressure smoking type 2 diabetes high cholesterol psychosocial factors stress
what meds can effect dyspnoea
beta blockers in patients with asthma, NSAIDS, exacerbation of heart failure by beta blockers, some calcium channel antagonists
what meds can effect dizziness
vasodilators
what meds can effect angina
aggravated by thyroxine pr drug induced anaemia
what drugs can effect oedema
from steroids, NSAIDS, calcium channel antagonists
meds that can effect palpitations
thyroxine, B2 stimulants
cardio causes of chest pain
stable angina, acute coronary syndromes, pericarditis, aortic dissection
respiratory causes of chest pain
pulmonary embolism pneumothorax pneumonia lung cancer mesothelioma
upper GI causes of chest pain
oesophageal disease
Musculoskeletal causes of chest pain
trauma - muscle or rib injury, costochondritis
Angina
A clinical syndrome of chest pain or pressure precipitated by activities such as exercise or emotional stress which increase
myocardial oxygen demand
Differentiating oesophageal disease from angina pectoris
Those individuals with typical anginal pain who have normal multistage exercise tests or normal coronary arteriograms and any person with atypical chest pain should be thoroughly evaluated for oesophageal disease.
- not relieved by rest if OD
- often wakes them
- they may relate to heartburn
Pericarditis
Pericarditis is inflammation of the pericardium
clinical presentation of pericarditis
acute onset of chest pain, classically this is pleurtici in nature and is eased by sitting up and leaning forward
- the pain may be anywhere over the anterior chest wall, but it is usually retrosternal, may radiate to the arm like ischaemic pain
- radiation to the trapezius ridge
Aortic dissection symptoms
sudden and severe pain
tearing and deep
radiating to the left shoulder/back
Dyspnoea
shortness of breath:
- is there anything that relieves the symptoms
- anymore associated symptoms?
- their response to the administration of a diuretic
cardiac causes of dyspnoea
cardiac failure
associated with angina or MI
respiratory causes of dyspnoea
asthma COPD pneumothorax pneumonia bronchitis pulmonary fibrosis
other causes of dyspnoea
anaemia, obesity, hyperventilation, anxiety
Paroxysmal nocturnal dyspnea (PND)
is a sensation of shortness of breath that awakens the patient, often after 1 or 2 hours of sleep, and is usually relieved in the upright position. CAUSES: - Atrial fibrillation - mitral valve disease - hypertension
Orthopnea
Orthopnea is the sensation of breathlessness in the recumbent position, relieved by sitting or standing
Palpitations
- Unexpected awareness of heart beating in chest.
- Fast / slow / regular / irregular.
- May occur in:
- Sinus rhythm e.g. anxiety.
- Intermittent irregularities of heartbeat e.g. Ectopic beats (extrasystoles).
- Abnormal rhythm (arrhythmia).
- Not all patients with arrhythmia experience palpitations
what to do if a patients says they have an arrhythmia
Ask the patient to tap it out! • Onset and termination. • Precipitating/relievingfactors. • Frequency and duration. • Associated symptoms: • Chest pain / collapse / sweating / dyspnea. • Past medical history. • e.g. Cardiovascular/thyroid disease
“my heart misses a beat or jumps or flutters”
ventricular or atrial extrasystoles
“my heart is racing and jumping about” I also have breathlessness
atrial fibrillation
“my heart is racing and fluttering and I need to urinate a lot”
supra ventricular tachycardia with polyuria
“my heart is racing or fluttering and im breathless and I’ve lost conciseness
ventricular tachycardia presenting with syncope
dizziness - syncope
postural hypotension
neurocardiogenic (vasovagal)
cardiac arrhythmias
what to ask if a patients says they have dizziness
• Try to establish what actually happened.
• History from a witness if possible.
• Frequency / duration?
• Loss of consciousness?
• Associated symptoms- before, during and
after - Chest pain, sweating, palpitations,
dyspnoea, convulsions, tongue biting,
incontinence, drowsiness afterwards etc.
Oedema
Localised or generalized?
• Legs - unilateral or bilateral? • Duration? Is it getting better
or worse?
• Aggravating or relieving factors?
Pitting oedema.
- Most commonly, pitting oedema develops secondary to increased venous pressure but it can also result from reduced oncotic pressure or it may be idiopathic.
- Oedema of rapid onset or deterioration, or with marked associated symptoms, such as dyspnoea, suggests serious underlying pathology and warrants immediate investigation.
unilateral causes of oedema
DVT.
• Chronic venous insufficiency.
• Compartment syndrome.
• Retroperitoneal mass.
bilateral causes of oedema
- Congestive cardiac failure.
- Cor pulmonale.
- Cirrhosis.
- Acute renal failure.
- Medication, for example, calcium- channel blockers.
- Sepsis.
- Myxoedema.
- Pregnancy.
- Idiopathic.
CV causes of Fatigue.
- May be inadequate systemic perfusion in Cardiac Failure.
* Consider side-effects of medication e.g. β-blockers.
Left sided heart failure
- paroxysmal nocturnal dyspnoea
- orthopnea
- pulmonary congestion
right sided heart failure
peripheral venous pressire distended jugular veins ascites (fluid build up in the abdomen) enlarges liver and spleen dependant edema
