Clinical skills: cardiovascular history

Question 1

In addition to the usual history questions, what are the 3 additional parts for cardiovascular history?

Answer 1

Systems review
Past medical/surgical history
Family history

Question 2

Systems review: what are the symptoms

Answer 2

Chest pain
Palpitations
Orthopnoea
Paroxysmal nocturnal dyspnoea
Intermittent claudication
Ankle swelling
Fatigue
Syncope

Question 3

How would you ask about:
- Palpitations
- Orthopnoea
- Paroxysmal nocturnal dyspnoea
- Intermittent claudication
- Syncope

Answer 3

• Have you noticed your heart beating harder or faster than before?
• Have you noticed SOB while lying down, which is relieved when you stand/sit up?
• Have you ever woken up gasping for air?
• Have you noticed any muscle pain when you’re active, which is relieved when you rest?
• Have you ever fainted or felt faint/dizzy?

Question 4

What is orthopnoea and why does it happen?

Answer 4

SOB when lying down, which is relieved by sitting/standing up.
A symptom of heart failure - where fluid builds up. Due to orthostatic pressures, when lying down, fluid is around the lungs - but it goes down due to gravity when upright.

Question 5

What is paroxysmal nocturnal dyspnoea?

Answer 5

SOB during sleep, that causes a person to wake up.

Question 6

What is intermittent claudication, and why does it occur?

Answer 6

Muscle pain during activity, which is relieved upon rest.
Due to inadequate muscle perfusion of oxygen (eg. due to artery blockage). Leads to pain. Rest –> meet oxygen demand –> pain goes away

Question 7

Past medical/surgical history: what to ask?

Answer 7

Any past history of cardiovascular/cerebrovascular conditions?
Any risk factors for these conditions?

Question 8

Family history: what to ask?

Answer 8

Any past history of cardiovascular/cerebrovascular conditions?
Any risk factors for these conditions?

Question 9

Risk factors: what are the 10?

Answer 9

Introduction:
- Age (older)
- Sex (male)

DASH
- Smoking

Social history
- Diet (high cholesterol)
- Exercise (sedentary behaviour)

Medical history
- Previous heart attack
- Blood pressure
- Cholesterol
- Diabetes

Surgical history
- Heart operations

Question 10

Risk factors: since many of these are covered elsewhere, which ones should you ask as part of past medical/surgical history?

Answer 10

Medical history
- Previous heart attack
- Blood pressure
- Cholesterol
- Diabetes

Surgical history
- Heart operations