CVS History Flashcards
Describe how you would take a cardiovascular history
Presenting complaint, Past history of presenting complaint, past medical history, Drug history and allergies, Family history (History of cardiovascular
disease at a young age
• 1st degree male relative <55
years.
• 1st degree female relative
<65 years), social history, systems enquiry
How can you calculate pack years
(No. ciggs smoked per day x No. years smoking) / 20
Name some non-modifiable risk factors for cardiovascular disease
Race and ethnicity, biological sex, Genetics and age
Name some modifiable risk factors
Obesity, smoking, high blood pressure, psychosocial factors, high cholesterol and diabetes
What symptoms can be worsened with medication?
Dysponea - Beta blockers. Dizzieness - vasodilators. Angina - NSAIDS Oedema - Steroids Palpitations - Beta2 stimultents
What are some of the causes of chest pain?
CV - Aortic dissection, preicarditis, stable angina, acute coronary syndromes.
R- PE, pneumothorax, pneumonia, lung cancer
GI- oesophageal disease
MS - trauma
Shingles (herpes zoster)
Indigestion and acid reflux is more common in younger patients
Where is the pain of aortic dissection felt? and what does the pain feel like?
Between scapula, tends to be a sudden and severe tearing or ripping feeling. No pain relief manoeuvres and radiates to left shoulder/back
Describe the differences between Angina and Myocardial Infarction
Similar site (retrosternal which radiates to arm and neck) AG - Brought on by exercise/emotion MI - Spontaneous AG- relived by rest and nitrates MI - not relived by rest or nitrates AG - nausea or vomiting is uncommon MI- Nausea and vomiting are common
Describe features of pericarditis
- inflammation of the pericardium
- Acute onset of chest pain; classically pleuritic, and is commonly retrosternal but can be anywhere on anterior chest, may radiate to arm but a characteristic feature is the pain can radiate to trapezius ridge
If patient complains about Dysponea (shortness of breath) what should you ask?
Acute or chronic? How disabling? can you exercise? response to a diutetic? associated symptoms?
Orthoponea/PND?
What is paroxysmal nocturnal dysponea?
Sensation of shortness of breath that awakes a patient, it is often relived when they stand in an upright position. Indication of left sided heart failure.
What are the causes of dysponea?
CV - cardiac failure, associated with angina or MI.
R - Asthma, COPD, Pneumothorax, pneumonia
others - anxiety, anemia, obesity.
What is orthopnea?
Breathlessness in the recumbent position, relived by sitting or standing
What should you ask a patient with palpitations?
Ask patient to tap it out, onset and termination, precipitate/relieving factors, frequency and duration, associated symptoms, PMH
What are some of the causes of dizziness and syncope
Postural hypotension, neurocardiogenic (vasovagal), micturition syncope and cardiac arrythmias, hypoglycaemic.
What questions should you ask when a patient complains of dizziness of syncope?
Try establish what happened/witness, frequency and duration? loss of consciousness? and associated symptoms?
What questions should you ask if a patient presents with oedema?
Localised or general? unilateral or bilateral? Is it getting better or worse? aggravating or relieving factors?
What is pitting oedema?
If you press on the swollen area and then release, it will leave an indent in the skin as you moved the fluid, can be due to increased venous pressure.
Name some of the causes of unilateral oedema
DVT, chronic venous insufficiency and compartment syndrome
Name some of the causes for bilateral oedema?
Congestive cardiac failure, cirrhosis, acute renal failure, meds. sepsis and pregnancy.
Name some of the cardiovascular causes of fatigue
Inadequate systemic perfusion in cardiac failure or potentially side effects of medication
Name some important characteristics of left sided heart failure
Paroxysmal noctural dysponea, orthoponea, cyanosis and pulmonary congestion
Name some of the key characteristics of right sided heart failure
Peripheral venous pressure, ascites, enlarged liver and spleen, dependent oedema and distended jugular veins
How useful is taking the medical history in terms of making a diagnosis?
The medical history provides sufficient information in about 75% of patient encounters for the doctor to be able to make a diagnosis before physically examining a patient or sending off tests
What are the 3 elements of personal communication and their percentages?
7% spoken word
38% voice + tone
55% body language
What other 5 secondary components are important in CVS history taking
- Connecting with the patient, building a rapport and identifying their views, beliefs & expectations (use ICE)
- Summarising! (Allows for correction or mutual understanding of patient history)
- Handing over by agreeing on a doctors and patients agenda, negotiating and giving ownership and responsibility of management to patient as if there not on board they won’t do what you’ve asked
- Safety netting - consider what else could happen to the patient, can arrange check up appointment - works for benefit of patient and doctor. E.g you think patient has flu but say if gets worse or get these symptoms get back in touch
- Housekeeping - doctor looks after themselves and knows important of this and is in good enough shape for next patient
What points should you consider in past medical history?
History of vascular disease (coronary artery, cerebrovascular, peripheral vascular), Diabetes, hypertension, hyperthyroidism, renal disease, hypercholesterolaemia.
What specific CVS questions do you want to ask in a CVS systems enquiry ?
Systems enquiry. • Chest pain? • Breathlessness (including Orthopnoea and Paroxysmal Nocturnal Dyspnoea)? • Palpitations? • Syncope / dizziness? • Oedema? • Peripheral vascular symptoms? • Intermittent claudication etc.
Describe the differences between Oesophageal disease and Angina Pectoris chest pain?
AG = Retrosternal; radiates to arm and jaw
OP = Reterosternal or epigastric; sometimes radiates to arm of back
AG = Usually by exertion
OP = Can be worse by exertion but often present at other times
AG - rapidly relived by rest, nitrates
OP - Not rapidly relived by rest, often relieved by nitrates
AG - wakes patient in sleep seldomly
OP - often wakes patient
AG - No relation to heartburn
OP - sometimes get heart burn
AG = lasts 2 - 10 mins
OP - variable
