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Phase 2B > How to take a cardiovascular history > Flashcards

How to take a cardiovascular history Flashcards

1
Q

How to take the cardiovascular history?

A

Presenting Complaint
History of PC
Past Medical History
DH and allergies
Family History
Social History and smoking
SE and risk factors
AOQ

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2
Q

Main cardiac symptoms

A

Chest pain
Breathlessness
Palpitation
Syncope or pre-syncope
Fluid retention

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3
Q

What is the pneumonic for chest pain?

A

OPQRST

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4
Q

What does OPQRST stand for?

A

Onset
Position (site)
Quality (nature / character)
Relationship (with exertion, posture, meals, breathing and with other symptoms)
Radiation
Relieving or aggravating factors
Severity
Timing
Treatment

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5
Q

Chest pain can 2 types.. what are they

A

Cardiac and Non - cardiac

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6
Q

Diff types of Cardiac chest pain

A

Ischaemic - Angina pectoris, ACS
Non - ischaemic - Pericarditis/ Myocarditis, Aortic dissection, others

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7
Q

Non - cardiac chest pain examples

A

Gastro oesophageal - GORD/ spasm, peptic ulcer
Non - Gastro oesophageal - Pulmonary, MSK, psychosomatic

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8
Q

What are the factors pointing towards ischemic cardiac pain?

A

Character of pain
Location of pain
Provoking factors
Relieving factors
Associated symptoms
Associated risk factors

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9
Q

Questions to ask patient suffering from breathlessness?

A

When did it start?
How quickly did it come on? Gradually, Suddenly, Immediately
Did it occur due to exertion?
Is it postural or due to your position?
Is it relieved by sitting or standing?
Does it occur at rest or whilst your trying to sleep? (Nocturnal)

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10
Q

Relieving or exacerbating factors of breathlessness questions

A

Does anything make it better?
- Position
- Rest
- Oxygen, nebulisers or other medication
Does anything make it worse?
- Exertion

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11
Q

What are the associated features of breathlessness?

A

Wheeze, Cough, Fever, Pain

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12
Q

What is orthopnea?

A

shortness of breath on lying flat that is relieved by sitting upright - pericarditis trait

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13
Q

What is Paroxysmal nocturnal dyspnoea (PND)

A

acute dyspnoea that wakes the patient from sleep

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14
Q

What are the cardiac causes of breathlessness?

A

IHD, LVF, Valves

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15
Q

What are the pulmonary causes of breathlessness?

A

Airway disease, PE, Others

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16
Q

Cardiac causes of fluid retention

A

CHF
RHF
Pericardial

17
Q

Protein loss causes of fluid retention

A

Hepatic
Renal
GI

18
Q

Onset and duration questions for fluid retention

A

When did it start?
Does it come and go?
Variation during the day and night
How long does it last?
How frequently does it happen
Where do you feel it most?
Feet, ankles, legs
Hands and arms
Face

19
Q

What are the specific considerations for peripheral oedema?

A

Unilateral vs bilateral
Onset – rapid vs slow
Past history esp of malignancy & heart/lung disease/diabetes
Medications – eg dihydropyridine calcium channel blockers
Associated symptoms – Pain/SOB

20
Q

What are the causes of palpitations?

A

Cardiac arrhythmias
- Ectopic beats
- AF
- SVT and VT

Structural heart diseases

Psychosomatic disorders

Systemic causes

Drugs: medical, recreational

21
Q

Questions to ask about palpitations

A

When does it start?
- Resting
- Exertion
How quickly does it come on?
How long does it last?
How frequently does it happen?

NATURE
What does it feel like?
- Bumps and thumps
- Missed beats
- Extra beats
- Racing heartbeat
How fast is it? Can you tap out the rhythm?
Regular or erratic (‘all over the place’)

22
Q

What are the relieving or exacerbating factors of palpitations?

A

Does anything make it better?
Rest
Exercise
Does anything make it worse?
Exertion
How much tea, coffee, coke, alcohol do you drink?

23
Q

What are the associated symptoms of palpitations?

A

Nausea, vomiting
Sweaty or clammy
Short of breath
Light headed
Loss of consciousness

24
Q

What are the specific considerations to think about for palpitations?

A

Age of patient
Onset – rapid vs. gradual
Duration – instant vs. seconds vs. minutes
Frequency & timing
Associated activity
Diet – coffee/energy drinks
Drugs – prescription vs recreational

25
Q

What is syncope?

A

sudden and brief loss of consciousness associated with a deficit of postural tone, from which recovery is spontaneous

26
Q

What is pre syncope?

A

the feeling of imminent loss of consciousness but not progressing to loss of consciousness

27
Q

Causes of syncope or pre - syncope?

A

Hypovolaemia
Postural hypotension
Cardioneurogenic syncope (‘Faint’)
- Vasodepressor
- Cardiodepressor
Carotid sinus hypersensitivity
Arrhythmias (fast and slow)
Aortic stenosis/LVOT obstruction
Epilepsy
Metabolic

28
Q

Questions to ask for syncope or pre- syncope

A

When does it happen?
- Resting
- Exertion
How quickly does it come on?
- Any warning?
How long does it last?
How frequently does it happen?
What does it feel like?
- Visual field changes
- Dizzy
- Light-headed
- Room spinning

29
Q

Associated features of syncope or pre - syncope

A

Sick
Sweaty or clammy
Chest pain
Incontinence
Injuries
Memory of the event?

30
Q

Questions to ask witnesses of syncope or pre - syncope

A

What does the patient look like?
How long is the LoC?
Convulsions?
How long to recover?

31
Q

Considerations for syncope or pre- syncope?

A

Onset – warning symptoms/signs
Frequency
Associated symptoms/signs – tongue biting, seizure, loss of bladder/bowel control
Duration – seconds vs minutes vs hours
Recovery – immediate vs gradual
Past history
Drug history

32
Q

What past medical history questions do you need to ask?

A

Cardiac history
Cardiovascular risk factors
Cardiac procedures

33
Q

RFs for IHD?

A

Age
Smoking
Hypertension
Dyslipidemia
Diabetes mellitus
Family history of IHD
Physical inactivity and obesity
Vascular disease in other territories

34
Q

Drug history questions to ask

A

Cardiac medication
Other medications
Allergies
Interactions

35
Q

Family history questions to ask

A

IHD

SCD

Risk factors

36
Q

Social history questions to ask?

A

Smoking history - IHD
Drinking history – Arrhythmias, cardiomyopathy
Occupation – Driving instructor etc

Phase 2B (16 decks)

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