How to take a cardiovascular history Flashcards
How to take the cardiovascular history?
Presenting Complaint
History of PC
Past Medical History
DH and allergies
Family History
Social History and smoking
SE and risk factors
AOQ
Main cardiac symptoms
Chest pain
Breathlessness
Palpitation
Syncope or pre-syncope
Fluid retention
What is the pneumonic for chest pain?
OPQRST
What does OPQRST stand for?
Onset
Position (site)
Quality (nature / character)
Relationship (with exertion, posture, meals, breathing and with other symptoms)
Radiation
Relieving or aggravating factors
Severity
Timing
Treatment
Chest pain can 2 types.. what are they
Cardiac and Non - cardiac
Diff types of Cardiac chest pain
Ischaemic - Angina pectoris, ACS
Non - ischaemic - Pericarditis/ Myocarditis, Aortic dissection, others
Non - cardiac chest pain examples
Gastro oesophageal - GORD/ spasm, peptic ulcer
Non - Gastro oesophageal - Pulmonary, MSK, psychosomatic
What are the factors pointing towards ischemic cardiac pain?
Character of pain
Location of pain
Provoking factors
Relieving factors
Associated symptoms
Associated risk factors
Questions to ask patient suffering from breathlessness?
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)
Relieving or exacerbating factors of breathlessness questions
Does anything make it better?
- Position
- Rest
- Oxygen, nebulisers or other medication
Does anything make it worse?
- Exertion
What are the associated features of breathlessness?
Wheeze, Cough, Fever, Pain
What is orthopnea?
shortness of breath on lying flat that is relieved by sitting upright - pericarditis trait
What is Paroxysmal nocturnal dyspnoea (PND)
acute dyspnoea that wakes the patient from sleep
What are the cardiac causes of breathlessness?
IHD, LVF, Valves
What are the pulmonary causes of breathlessness?
Airway disease, PE, Others
Cardiac causes of fluid retention
CHF
RHF
Pericardial
Protein loss causes of fluid retention
Hepatic
Renal
GI
Onset and duration questions for fluid retention
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
What are the specific considerations for peripheral oedema?
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
What are the causes of palpitations?
Cardiac arrhythmias
- Ectopic beats
- AF
- SVT and VT
Structural heart diseases
Psychosomatic disorders
Systemic causes
Drugs: medical, recreational
Questions to ask about palpitations
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’)
What are the relieving or exacerbating factors of palpitations?
Does anything make it better?
Rest
Exercise
Does anything make it worse?
Exertion
How much tea, coffee, coke, alcohol do you drink?
What are the associated symptoms of palpitations?
Nausea, vomiting
Sweaty or clammy
Short of breath
Light headed
Loss of consciousness
What are the specific considerations to think about for palpitations?
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
