Cardiovascular History Flashcards
What are the key symptoms that you should be asking about in a cardiovascular history?
i. Shortness of Breath
a) Exertional – how much can you do?
b) Laying down – orthopnoea
c) Waking the patient at night - paroxysmal nocturnal dyspnoea
ii. Palpitations – feeling your heartbeat – regular or irregular – ask them to tap out the beat
iii. Chest pain (most common) - SOCRATES
iv. Syncope (fainting)/pre-syncope – Rapid onset LOC – postural, exertional or random
v. Oedema – peripheral or central oedema (sacral)
Extra
Intermittent claudication: muscle pain, typically in the calf, that develops during mild exertion and resolves upon resting. Intermittent claudication is caused by inadequate arterial supply secondary to peripheral vascular disease.
What systemic symptoms should you ask about?
Systemic symptoms – feeling unwell generally, fatigue, loss of appetite, fever and weight loss or weight gain
When performing an systemic enquiry what other systems could you be thinking about?
i. Respiratory – SOB, cough, wheeze, sputum, haemoptysis, pleuritic chest pain
ii. GI - indigestion or pain after eating (dyspepsia), nausea, vomiting, dysphagia and abdominal pain
iii. Musculoskeletal - muscle strain or injuries – pain with movement
What things should you be looking for when taking a past medical history?
Past Medical History
Do you have any other medical conditions associated with the heart? – hypertension, diabetes, hyperlipidaemia, obesity, chronic kidney disease, atrial fibrillation and stroke
Have you previously undergone any operations or procedures?
What medications are commonly perscribed for cardiovascular disease?
What are some examples of OTC drugs that could impact the cardiovascular system?
What should you ask when enquiring for a family history?
Any family history of heart problems? – clarify the ages when these conditions impacted their relatives.
What points should you touch on for the social history?
General
i. Accommodation they currently reside.
ii. Who else the patient lives with and their personal support network
iii. What tasks they are able to carry out independently and what they require assistance with
iv. If they have any carer input
v. Occupation – Are you currently working?
More Health Related
i. Smoking – how many packs/day and for how long
ii. Alcohol – Frequency and quantity
iii. Recreational drugs
iv. Average Diet
v. Exercise
What is angina?
- Angina is a pain that comes from the heart
- Caused by narrowing of the heart’s blood vessels - the (coronary) arteries – reduced flow of blood to the heart.
- Normal occurs when exerting oneself/perform more vigorous exercise – heart is unable to keep up with demands.
- Can progress to heart pain symptoms when no engaging in physical activity – unstable angina
What are the clinical features/presentation of angina?
Clinical Features/Presentation
- Pain/discomfort/tightness/heaviness across the chest
- Pain the gets worse upon exertion
- Radiating pain to the jaw, neck, arm or stomach
- Breathlessness
- Symptoms ease within 10 minutes of stopping physical exertion.
- Symptom relief in 1-2 minutes of administering GTN spray.
- Less common - pain that develops when bending or eating
- Timeline – acute
What are the risk factors for angina?
Non-modifiable
* Male sex
* Age
* Family history of CVD
* Previous history of CVD
* Diabetes
Modifiable
* Smoking
* Hypertension
* Hypercholesteremia – elevated cholesterol
* Obesity & Sedentary lifestyle
What is a myocardial infarction?
- Myocardial infarction (Heart attack) – caused by a sudden loss of blood flow to a part of your heart muscle – usually caused by coronary heart disease.
- Most common cause is coronary artery disease – build up of fatty deposits (atheroma), which blocks blood flow in the heart, which may become unstable and burst leading to a clotting response that can ultimately block the artery, preventing the heart muscle from receiving sufficient oxygen
Results in tissue injury/death
What are the clinical features for an MI?
Clinical Features/Presentation
* Central chest pain/discomfort – heaviness or sometimes as a burning pain – last longer than 15min
* Radiation of pain to the jaw, neck, arm, back and stomach
* Autonomic disturbance – feeling sick, sweaty, lightheaded and SOB
* Hemodynamic instability – abnormal or unstable blood pressure
* Can occur when exerting oneself but also with little to no exertion
* Timeline – acute
What are the risk factors for a MI?
Non-modifiable
* Male sex
* Age
* Family history of CVD
* Previous history of CVD
* Diabetes
Modifiable
* Smoking
* Hypertension
* Hypercholesteremia – elevated cholesterol
* Obesity & Sedentary lifestyle
What is the difference between an ST-elevation (STEMI) and Non-ST-elevation (NSTEMI) MI?
- ST-elevation - In the case of ST-elevation myocardial infarction (STEMI) this is caused predominantly by complete atherothrombotic occlusion of a coronary artery.
- Non-ST-elevation - Usually caused by a partial or near-complete occlusion of a coronary artery resulting in compromised blood flow to myocardium with subsequent myocardial injury or infarction as demonstrated by elevation in troponin.
