Cardiac Screening Form Flashcards

1
Q

Cardiac Screening Form

A

Formulario para la detección de enfermedades cardiacas

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2
Q

Patient’s name

A

Nombre del paciente

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3
Q

Date

A

Fecha

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4
Q

Referring physician

A

Médico remitente

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5
Q

PCP

A

Médico de cabecera

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6
Q

Phone number

A

Número del teléfono

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7
Q

Screening provider’s name

A

Nombre del provedor que hace la prueba

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8
Q

Chief complaint or reason for referral

A

Síntoma principal o causa de la referencia

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9
Q

Cardiac history and diagnoses

A

Historia cardiaco y diagnósticos

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10
Q

Circle and explain with dates if possible

A

Circule y explique con fechas si es posible

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11
Q

CHF

A

Insuficiencia cardiaca, fall/o cardíaco/a

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12
Q

Myocardial infarction

A

Infarto de miocardio

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13
Q

Arrhythmia

A

Arritmia

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14
Q

Syncope/fainting/blackouts

A

Síncope/desvanecimiento/desmayo

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15
Q

Murmur

A

Soplo

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16
Q

Valve disease

A

Enfermedad de las válvulas

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17
Q

CHD

A

Enfermedad arterial coronaría

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18
Q

Cardiomyopathy

A

Cardiomiopatía

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19
Q

Past cardiac procedures and tests

A

Procedimientos cardiacos anteriores y exámenes

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20
Q

Angioplasty/stents

A

Angioplastia/stents..endoprótesis vascular

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21
Q

Type of stent and vessel

A

Tipo de stent y vasosanguíneo

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22
Q

Cardiac bypass surgery

A

Cirugía de baipás cardiaco

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23
Q

Heart valve o arrhythmia surgery

A

Cirugía de las válvulas del corazón o arritmia

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24
Q

Holter monitor

A

Monitor Holter

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25
Q

Defibrillator (ICD)

A

Desfibrilador cardioversor implantable o cardiodesfibrilador implantable

26
Q

Pacemaker

A

Marcopasos

27
Q

EP Study with ablation

A

Estudio electrofisiologia con ablación

28
Q

Surgical ablation

A

Ablación quirúrgica

29
Q

Most recent catheterization

A

Cateterismo mas reciente

30
Q

Most recent echo

A

Echo mas reciente

31
Q

Most recent ECG (EKG)

A

Electrocardiograma mas reciente

32
Q

Current symptoms

A

Síntomas actuales

33
Q

Chest pain or discomfort

A

Dolor del pecho o mal estar

34
Q

Location of pain

A

Ubicación del dolor

35
Q

Does it radiate?

A

Le corre?

36
Q

Describe the type of pain

A

Describa el tipo del dolor

37
Q

First time it was noticed and frequency

A

Primera vez que lo notó y su frecuencia

38
Q

Duration of each episode

A

Duración de cada episodio

39
Q

What makes it worse

A

Que lo empeora

40
Q

What makes it better

A

Que lo mejora

41
Q

Shortness of breath

A

Dificultad para respirar

42
Q

Dizziness, lightheadedness, fainting

A

Vahídos, mareos, desmayo

43
Q

Coughing or wheezing

A

Tos o sibilancia

44
Q

COPD/asthma

A

Enfermedad pulmonar obstructiva crónica/asma

45
Q

PND/orthopnea

A

Disnea paroxística nocturna/ortopnea

46
Q

Palpitations/missed or skipped heartbeats

A

Palpitaciones/perdidos de latidos del corazón

47
Q

Racing heartbeats

A

Latidos del corazón acelerados

48
Q

Fever/chills/night sweats

A

Fiebre/escalofríos/sudores nocturnos

49
Q

Peripheral vascular disease/ DVT

A

Enfermedad vascular periferica/Trombosis venosa profunda

50
Q

Aneurysm

A

Aneurisma

51
Q

Cardiac risk factors

A

Factores del riesgo cardiaco

52
Q

Tobacco use (Frequency)

A

Consumo del tobacco (Con que frecuencia)

53
Q

Alcohol use (Frequency)

A

Consumo de bebidas alcohólicas (Con que frecuencia)

54
Q

Hypertension

A

Hipertensión/presión alta

55
Q

Diabetes

A

Diabetes

56
Q

Elevated LDL

A

Nivel elevado de lipoproteínas de baja densidad

57
Q

Family history of heart disease (who)

A

Antecedentes familiares de enfermedades cardiacas (quien)

58
Q

Prior hospitalization and surgeries

A

Hospitalizaciones o cirugías previas

59
Q

Other medical diagnoses

A

Otros diagnósticos médicos

60
Q

Patient’s/Provider’s/Interpreter’s signature

A

Firma del paciente/provedor/interprete