Cardiac- PMH, Dhx, FHx, SHx

Question 1

Cardiac PMH

Answer 1

• conditions associated with increased risk of vascular disease such as HTN, diabetes mellitus and hyperlipidaemia
• rheumatic fever or heart murmurs during childhood
• potential causes of bacteraemia in patients with suspected infective endocarditis, such as skin infection, recent dental work, intravenous drug use or penetrating trauma
• systemic disorders with cardiovascular manifestations such as connective tissue diseases (pericarditis and Raynaud’sphenomenon), Marfan’s syndrome (aortic dissection) and myotonic dystrophy (atrioventricular block).

Question 2

Cardiac- DHx

Answer 2

• Drugs may cause or aggravate symptoms such as breathlessness, chest pain, oedema, palpitation or syncope
• Ask about ‘over-the-counter’ purchases, such as (NSAIDs) and alternative and herbal medicines, as these may have cardiovascular actions.

Question 3

Cardiac- FHx

Answer 3

• Many cardiac disorders such as cardiomyopathies have a genetic component.
• Ask about premature coronary artery disease in first-degree relatives (<60 years in a female or <55 years in amale);
• sudden unexplained death at a young age may raise thepossibility of a cardiomyopathy or inherited arrhythmia.
• Patients with venous thrombosis may have inherited thrombophilia, such as a factor V Leiden mutation.
• Familial hypercholesterolaemia is associated with premature arterial disease.
• Aortic disease can be inherited and a FHX of aortic aneurysm or dissection may be relevant

Question 4

Cardiac- SHx

Answer 4

• Smoking is the strongest risk factor for coronary and peripheral arterial disease (PAD).
• Take a detailed smoking history
• Alcohol can induce atrial fibrillation and, in excess, is associated with obesity, HTN and dilated cardiomyopathy.
• Recreational drugs such as cocaine and amphetamines can cause arrhythmias, chest pain, occlusive and aneurysmal PAD and even myocardial infarction.
• Heart disease may have important consequences for employment.
• Patients with limiting exertional symptoms may struggle to perform jobs that entail a high degree of physical activity.
• In addition, some diagnoses such as ischaemic heart disease or cardiac arrhythmia may impact on eligibility for certain occupations that have implications for public safety, such as commercial drivers and pilots.
• Finally, ask about undue stress or anxiety as these are commonly associated with cardiac type symptoms including chest pain, dyspnoea and palpitation.