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Y2S1 CARDIO. > Cardiovascular History Taking > Flashcards

Cardiovascular History Taking Flashcards

1
Q

What are the five aspects to the Roger Neighbour - the inner consolation 1987

A

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)

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2
Q

Presenting Complaint /

History of Presenting Complaint

A
  • 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
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3
Q

Past Medical History

A
  • 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?
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4
Q

what conditions should you look for in a cardiovascular PMH

A 
History of vascular disease 
diabetes 
hyperthyroidism 
renal disease
hypertension 
hypercholesteroloaemia
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5
Q

Drug history AND allergies

A 
prescribed medications 
over the counter medications 
why are they taking it?
are they actually taking it effectively? 
allergies and what the side effects are
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6
Q

family history

A

any family diseases
premature death ? ho did they die?
any cardiovascular disease at a young age?

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7
Q

what counts as a young age for cardiovascular disease in males and females

A

younger than 55 in males

younger than 65 in females

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8
Q

social history headlines

A
  • upbringing
  • home life
  • occupation
  • finance
  • relationships
  • house
  • community support
  • sexual history
  • leisure acitviites
  • exercise
  • substance misuse
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9
Q

how do you calculate pack years of smoking

A

20 cigs = 1 packet

the number of cigs they smoke per day x the number of years they have been smoking

divided by 20

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10
Q

general systems enquiry

A 
chest pain 
breathessness 
palpitations 
dizziness
oedema 
peripheral vascular symptoms 
intermittent claudication (muscle pain on mild exertion)
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11
Q

non-modifiable risk factors to cardiovascular diseases

A

ethnicity
age
gender
family history

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12
Q

modifiable risk factors for cardiovascular disease

A 
weight 
high blood pressure 
smoking 
type 2 diabetes 
high cholesterol 
psychosocial factors 
stress
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13
Q

what meds can effect dyspnoea

A

beta blockers in patients with asthma, NSAIDS, exacerbation of heart failure by beta blockers, some calcium channel antagonists

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14
Q

what meds can effect dizziness

A

vasodilators

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15
Q

what meds can effect angina

A

aggravated by thyroxine pr drug induced anaemia

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16
Q

what drugs can effect oedema

A

from steroids, NSAIDS, calcium channel antagonists

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17
Q

meds that can effect palpitations

A

thyroxine, B2 stimulants

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18
Q

cardio causes of chest pain

A

stable angina, acute coronary syndromes, pericarditis, aortic dissection

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19
Q

respiratory causes of chest pain

A 
pulmonary embolism 
pneumothorax 
pneumonia 
lung cancer 
mesothelioma
20
Q

upper GI causes of chest pain

A

oesophageal disease

21
Q

Musculoskeletal causes of chest pain

A

trauma - muscle or rib injury, costochondritis

22
Q

Angina

A

A clinical syndrome of chest pain or pressure precipitated by activities such as exercise or emotional stress which increase
myocardial oxygen demand

23
Q

Differentiating oesophageal disease from angina pectoris

A

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
24
Q

Pericarditis

A

Pericarditis is inflammation of the pericardium

25
Q

clinical presentation of pericarditis

A

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
26
Q

Aortic dissection symptoms

A

sudden and severe pain
tearing and deep
radiating to the left shoulder/back

27
Q

Dyspnoea

A

shortness of breath:

  • is there anything that relieves the symptoms
  • anymore associated symptoms?
  • their response to the administration of a diuretic
28
Q

cardiac causes of dyspnoea

A

cardiac failure

associated with angina or MI

29
Q

respiratory causes of dyspnoea

A 
asthma 
COPD
pneumothorax
pneumonia 
bronchitis 
pulmonary fibrosis
30
Q

other causes of dyspnoea

A

anaemia, obesity, hyperventilation, anxiety

31
Q

Paroxysmal nocturnal dyspnea (PND)

A 
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
32
Q

Orthopnea

A

Orthopnea is the sensation of breathlessness in the recumbent position, relieved by sitting or standing

33
Q

Palpitations

A
  • 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
34
Q

what to do if a patients says they have an arrhythmia

A 
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
35
Q

“my heart misses a beat or jumps or flutters”

A

ventricular or atrial extrasystoles

36
Q

“my heart is racing and jumping about” I also have breathlessness

A

atrial fibrillation

37
Q

“my heart is racing and fluttering and I need to urinate a lot”

A

supra ventricular tachycardia with polyuria

38
Q

“my heart is racing or fluttering and im breathless and I’ve lost conciseness

A

ventricular tachycardia presenting with syncope

39
Q

dizziness - syncope

A

postural hypotension
neurocardiogenic (vasovagal)
cardiac arrhythmias

40
Q

what to ask if a patients says they have dizziness

A

• 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.

41
Q

Oedema

A

Localised or generalized?
• Legs - unilateral or bilateral? • Duration? Is it getting better
or worse?
• Aggravating or relieving factors?

42
Q

Pitting oedema.

A
  • 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.
43
Q

unilateral causes of oedema

A

DVT.
• Chronic venous insufficiency.
• Compartment syndrome.
• Retroperitoneal mass.

44
Q

bilateral causes of oedema

A
  • Congestive cardiac failure.
  • Cor pulmonale.
  • Cirrhosis.
  • Acute renal failure.
  • Medication, for example, calcium- channel blockers.
  • Sepsis.
  • Myxoedema.
  • Pregnancy.
  • Idiopathic.
45
Q

CV causes of Fatigue.

A
  • May be inadequate systemic perfusion in Cardiac Failure.

* Consider side-effects of medication e.g. β-blockers.

46
Q

Left sided heart failure

A
  • paroxysmal nocturnal dyspnoea
  • orthopnea
  • pulmonary congestion
47
Q

right sided heart failure

A 
peripheral venous pressire 
distended jugular veins 
ascites (fluid build up in the abdomen)
enlarges liver and spleen 
dependant edema

Y2S1 CARDIO. (47 decks)

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