History Taking Cardiovascular System Flashcards
According to Dr Bernard Lown what percentage of patient encounters can be diagnosed by the medical history?
75%
What are the 5 steps of Roger Neighbour’s consultation model?
- Connecting
- Summarising
- Handing over
- Safety netting
- Housekeeping
What conditions may you specifically ask for in a cardiovascular examination ?
- History of vascular disease
- Diabetes
- Hyperthyroidism
- Renal disease
- Hypertension
- Hypercholesterolaemia
How do you calculate pack years?
(No. of cigarettes smoked per day X No. of years smoking) / 20
What should you include in a systems enquiry?
- Chest pain
- Breathlessness (including orthopnoea and paroxysmal nocturnal dyspnoea)
- Palpitations
- Syncope / dizziness
- Oedema
- Peripheral vascular symptoms
- Intermittent claudication
What are modifiable cardiovascular risk factors?
- High BP
- Smoking
- Diabetes melitus
- Physical inactivity
- Obesity
- High blood cholesterol
What are non-modifiable cardiovascular risk factors?
- Age
- Gender
- Genetic factors
- Race and ethnicity
What are the cardiovascular causes of chest pain?
- Stable angina
- Acute coronary syndromes
- Pericarditis
- Aortic dissection
What are the respiratory causes of chest pain?
- Pulmonary embolus
- Pneumothorax
- Pneumonia
- Lung cancer
- Mesothelioma
What GI disease can cause chest pain?
Oesophageal disease
What are the musculoskeletal causes of chest pain?
- Trauma - muscular or rib injury
- Chostochondritis
What conditions are included in as an acute coronary syndrome?
- STEMI
- NSTEMI
- Unstable angina
How do you differentiate oesophageal disease from angina pectoris
- Angina can radiate pain to jaw
- Angina is usually precipitated by exertion but oesophageal pain can be worsened but is usually present at other times
- Angina is rapidly relieved by rest
- Oesophageal disease often wakes patient from sleep angina rarely does
- Angina is typically 2-10 mins
- Oesophageal disease is related to heartburn
What percentage of percarditis is idiopathic?
80 -90%
How is aortic dissection pain usually described?
- Sudden and severe
- Tearing and deep
- Radiating to left shoulder / back
What is dyspnoea
Difficulty or trouble breathing
What are the cardiac causes of dyspnoea?
- Cardiac failure
- Associated with angina or MI
What are the causes of respiratory dyspnoea?
- Asthma
- COPD
- Pneumothorax
- Pneumonia
- Bronchitis
- Bronchiectasis
- Pulmonary fibrosis
What are the causes of dyspnoea that are not cardiac or respiratory related?
- Anaemia
- Obesity
- Hyperventilation
- Anxiety
- Metabolic acidosis
How can you differentiate dyspnoea?
- Acute, chronic or acute-onchronic
- At rest / on exertion / exercise tolerance?
- Orthopnoea / paroxysmal nocturnal dyspnoea (PND)
- Response to diuretic?
- Associated symptoms (e.g cough / sputum / chest pain /palpitations)
What is Paroxysmal nocturnal dyspnea (PND)?
A sensation of shortness of breath that awakens a patient often after 1 or 2 hours of sleep.
What underlying conditions can cause PND?
- (Heart failure)
- Ischaemic heart disease
- Aortic valve disease
- Hypertension
- Cardiomyopathy
- Atrial fibrilation
- Mitral valve disease
- Atrial tumours
What is orthopnea?
The sensation of breathlessness in the recumbent position, relieved by sitting or standing. Often a symptom of left ventricular heart failure and/or pulmonary oedema.
What is a heart palpitation?
An unexpected awareness of heart beating in chest.
What is postural/orthostatic hypotension?
When systolic blood pressure decreases by at least 20 mg Hg when going from lying down to flat
What conditions can cause dizziness and syncope?
- Postural hypotension
- Neurocardiogenic (vasovagal)
- Micturition syncope
- Cardiac arrhythmias
What is micturition syncope?
Fainting after urination
What factors should you consider when assessing oedema?
- Localised or generalised
- Are the legs unilateral or bilateral
- Duration
- Are there any aggravating or relieving factors
What is the most common cause of pitting oedema?
- Increased venous pressure (can also result from reduced oncotic pressure or may be idiopathic)
What conditions can cause bilateral oedema?
- Congestive cardiac failure
- Cor pulmonale
- Cirrhosis
- Acute renal failure
- Medication, for example, calcium-channel blockers
- Sepsis
- Myxoedema
- Pregnancy
- Idiopathic
What conditions can cause unilateral oedema?
- DVT
- Chronic venous insufficiency
- Compartment syndrome
- Retroperitoneal mass
What is micturition syncope?
Fainting shortly after urination
