Comms: Cardiovascular and respiratory histories

Question 1

What questions should be asked when determining if a respiratory condition specifically?

Answer 1

Cough
Sputum
Cough up blood
Wheeze (whistling sound)

Question 2

What questions should be asked when determining a CV disease specifically?

Answer 2

Palpitations
Shortness of breath with lying flat
Wake up feeling short of breath
Swelling of feet or lower legs
Crampy pain in lower legs when walking a distance - relieved by stopping

Question 3

What questions overalp between cardiovascular and respiraotroy histories?

Answer 3

Loss of consciousness or faiting
Lightheadedness or dizziness
walked up feeling shortness of breath
Shortness of breath on exertion or rest
Weight change

Question 4

What potential questions should be asked to consider an upper GI disease?
Differentiate from a respiratory or cardiovascular condition

Answer 4

Difficulty swallowing - food getting stuck
Heartburn
Nausea or vomiting
Abdominal pain

Question 5

What conditions tend to have ann acute onset in resp and cardio system?

Answer 5

PE
MI
Aortic dissection
Pneuomothorax

Question 6

What is Levine’s sign?

Answer 6

Sign of ischemic heart pain, holding a clenched fist over the central chest, often also leaning forward slightly.

Question 7

What is the difference in the description of pain between the respiratory and cardiovascular system?

Answer 7

Cardiovascular - crushing or tightening pain = MI
Sharp or stabbing = pericarditis
Ripping - aortic disection
Respiratory - Pleuritic pain worse on inspiration or cough.

Question 8

How can we rule out an aortic dissection diagnosis?

Answer 8

Radial-radial delay
Collapsing pulse

Question 9

How does the radiation of pain differ between cardio and respiratory?

Answer 9

Respiratory - shoulders
Cardio - left neck, arm, jaw.

Question 10

How does lying down affect cardio v resp pain?

Answer 10

Cardio - tends to be worse lying down
Resp - better lying down as aortic preload increases.

Question 11

What is the medical research council dyspnoea scale?

Answer 11

Used to guide severity of breath
Remember tip: happy, Hill, horizontal, hundred, housebound

grade 1: not troubled or only during strenuous exercise
grade 2: troubled when hurrying on the level fo walking up a slight hill
grade 3: walk slower then people of same age on level or needs to stop because of breathlessness
grade 4; SOB after 100 yards or few minutes needs to stop
grade 5: too breathless to leave the house or when dressing or undressing.

Question 12

What should you ask about palpitations?

Answer 12

Duration and frequency
Tap out the rhythm
Onset at rest or exertion
Associated: chest pain, syncope, dizziness.
When palpitations stop - coughing, breath holding.
History: heart failure, MI, CHF.