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Fraser MD3001 > CVS History > Flashcards

CVS History Flashcards

1
Q

Describe how you would take a cardiovascular history

A

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

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2
Q

How can you calculate pack years

A

(No. ciggs smoked per day x No. years smoking) / 20

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3
Q

Name some non-modifiable risk factors for cardiovascular disease

A

Race and ethnicity, biological sex, Genetics and age

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4
Q

Name some modifiable risk factors

A

Obesity, smoking, high blood pressure, psychosocial factors, high cholesterol and diabetes

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5
Q

What symptoms can be worsened with medication?

A 
Dysponea - Beta blockers. 
Dizzieness - vasodilators. 
Angina - NSAIDS
Oedema - Steroids
Palpitations - Beta2 stimultents
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6
Q

What are some of the causes of chest pain?

A

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

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7
Q

Where is the pain of aortic dissection felt? and what does the pain feel like?

A

Between scapula, tends to be a sudden and severe tearing or ripping feeling. No pain relief manoeuvres and radiates to left shoulder/back

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8
Q

Describe the differences between Angina and Myocardial Infarction

A 
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
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9
Q

Describe features of pericarditis

A
  • 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
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10
Q

If patient complains about Dysponea (shortness of breath) what should you ask?

A

Acute or chronic? How disabling? can you exercise? response to a diutetic? associated symptoms?
Orthoponea/PND?

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11
Q

What is paroxysmal nocturnal dysponea?

A

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.

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12
Q

What are the causes of dysponea?

A

CV - cardiac failure, associated with angina or MI.
R - Asthma, COPD, Pneumothorax, pneumonia
others - anxiety, anemia, obesity.

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13
Q

What is orthopnea?

A

Breathlessness in the recumbent position, relived by sitting or standing

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14
Q

What should you ask a patient with palpitations?

A

Ask patient to tap it out, onset and termination, precipitate/relieving factors, frequency and duration, associated symptoms, PMH

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15
Q

What are some of the causes of dizziness and syncope

A

Postural hypotension, neurocardiogenic (vasovagal), micturition syncope and cardiac arrythmias, hypoglycaemic.

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16
Q

What questions should you ask when a patient complains of dizziness of syncope?

A

Try establish what happened/witness, frequency and duration? loss of consciousness? and associated symptoms?

17
Q

What questions should you ask if a patient presents with oedema?

A

Localised or general? unilateral or bilateral? Is it getting better or worse? aggravating or relieving factors?

18
Q

What is pitting oedema?

A

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.

19
Q

Name some of the causes of unilateral oedema

A

DVT, chronic venous insufficiency and compartment syndrome

20
Q

Name some of the causes for bilateral oedema?

A

Congestive cardiac failure, cirrhosis, acute renal failure, meds. sepsis and pregnancy.

21
Q

Name some of the cardiovascular causes of fatigue

A

Inadequate systemic perfusion in cardiac failure or potentially side effects of medication

22
Q

Name some important characteristics of left sided heart failure

A

Paroxysmal noctural dysponea, orthoponea, cyanosis and pulmonary congestion

23
Q

Name some of the key characteristics of right sided heart failure

A

Peripheral venous pressure, ascites, enlarged liver and spleen, dependent oedema and distended jugular veins

24
Q

How useful is taking the medical history in terms of making a diagnosis?

A

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

25
Q

What are the 3 elements of personal communication and their percentages?

A

7% spoken word
38% voice + tone
55% body language

26
Q

What other 5 secondary components are important in CVS history taking

A
  • 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
27
Q

What points should you consider in past medical history?

A

History of vascular disease (coronary artery, cerebrovascular, peripheral vascular), Diabetes, hypertension, hyperthyroidism, renal disease, hypercholesterolaemia.

28
Q

What specific CVS questions do you want to ask in a CVS systems enquiry ?

A 
Systems enquiry. 
• Chest pain? 
• Breathlessness (including Orthopnoea 
and Paroxysmal Nocturnal Dyspnoea)?
• Palpitations? 
• Syncope / dizziness? 
• Oedema? 
• Peripheral vascular symptoms? 
• Intermittent claudication etc.
29
Q

Describe the differences between Oesophageal disease and Angina Pectoris chest pain?

A

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

Fraser MD3001 (23 decks)

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