Cardiac History taking

Question 1

Main symptoms to think about in cardiology

Answer 1

• CP
• SOB
• Palpitations
• Oedema
• Syncope & Dizzinesss
• Claudication

Question 2

What is the patient like

Answer 2

• Are they well or ill- may need rapid treatment
• Keep quiet and let them speak
• Use their words
• Ask them what they think has happened
• Repeat back the information to confirm with the patient
• Stories change (don’t worry about it)

Question 3

Asking about chest pain

Answer 3

• 12 lead ECG, is time critical have an ECG done whilst doing the Hx
• Nature of pain- how do they describe it
• Sit and radiation-
• Onset and duration
• Severity of pain
• Associated symptoms
• Provoking factors
• Relieving

Question 4

What could be the cause of CP

Answer 4

• Ischaemic- need to rule out an ACS or angina (Angina tends to be caused by an provoking factor (e.g. Exercise) <20 mins and releived by GTN whereas ACS >20 mins and can come on with rest)
• Differential diagnosis: pericarditis (worse when lying flat and on deep breathing, often will have had a recent viral illness), MSK, Pleuritic, PE, gastric
• May be non-specific with no identifiable cause

Question 5

Asking about SOB

Answer 5

• Can they speak in full sentences
• When did the symptoms start
• Effort, exercise tolerance
• Orthopneoa- SOB when lying flat (paroxysmal, nocturnal, dyspnoea), how many pillow do people sleep with

Question 6

NYHA SOB classification

Question 7

SOB what could be the problems

Answer 7

• HF
• Secondary to ACS or valvular issues
• If acutely unwell call for help stat
• Differential diagnosis: PE, Respiratory disorders, anxiety

Question 8

Palpitations

Answer 8

• How do they feel (do they feel the palpitations)
• 12 lead ECGs
• Mode of onset
• Frequency
• Duration of attacks
• Patients awareness and regularity
• Get the patient to tap out of rhythm- physically tap on the desk or hand
• Associated Sx
• Precipitating factors- Alcohol, caffeine, drugs

Question 9

Palpitations what could the problem be

Answer 9

• could be ectopics (extra beats), AF, SVT, VT
• Differential diagnosis- Anxiety, ?underlying causes e.g. sepsis

Question 10

Asking about syncope

Answer 10

• Pre-syncope symptoms- dizziness, light headed, nausea
• Previous episodes
• Previous medical history of fits
• Full LOC
• Loss of bladder control
• Length of time to become fully conscious
• Flushing after syncope
• Medications- anti-arrhythmics can be cause bradycardia/pauses/heart block

Question 11

Syncope- what could it be

Answer 11

• Rhythm disturbance- brady or tacharrhythmia
• Differential diagnosis: vasovagal, neurological attacks, TIA

Question 12

Oedema

Answer 12

• Do their ankles swell
• how far does the oedema extend to
• What drugs are they taking
• Can they get their shoes/trousers on

Question 13

Oedema- what could the problems be

Answer 13

• Heart failure
• Cardiac drugs- amlodipine
• Differential diagnosis
• Hypoalbuminaemia- liver failure, nephrotic syndrome, malnutritiion
• Venous insufficiency- Prolonged sitting (elderly patients)
• Pelvic mass
• Pregnancy
• Unilateral swelling + redness= DVT

Question 14

Claudication

Answer 14

• Pain on walking
• Calf, thigh, buttuck
• More commonly seen in men than women
• More common in smokers

Question 15

What could be the issue

Answer 15

• Acute: arterial occlusion- cold white, painful, pulseless limbs
• Chronic: Arterial insufficiency more common in the lower limb presents as intermediate claudication
• Chronic: Pain worse at night, symptomatically eased by putting legs over the side of the bed which worsens perfusion

Question 16

Previous medical history

Answer 16

• PMH: risk factors, HTN, high cholesterol, diabetes, Other CVD (stroke, PVD etc)
• FHx
• Shx: Smoking, illicits, EtOH, social circumstances
• Exercise ability
• DHx