Cardiovascular History Taking

Question 1

What are the five aspects to the Roger Neighbour - the inner consolation 1987

Answer 1

1) connecting (build rapport and get to know them)
2) summarising (reword what the patient has said to ensure you have the information right which allows for correction)
3) handing over (put some of the discussion in the patients hands
4) safety netting (what if you’re wrong, plan another appointment)
5) housekeeping (taking care of yourself)

Question 2

Presenting Complaint /

History of Presenting Complaint

Answer 2

• description of symptoms
• patients own words
• allow patient the time to speak
• don’t interupt
• you need to establish a timeline
• use a relevant systems enquiry when you have been communicated their issue

Question 3

Past Medical History

Answer 3

• previous/present medical conditions
• have they visited the GP hospital before
• are they undergoing nay investigations
• have they had any operations or procedures
• are these problems ongoing or are have they been resolved with meds etc?

Question 4

what conditions should you look for in a cardiovascular PMH

Answer 4

History of vascular disease 
diabetes 
hyperthyroidism 
renal disease
hypertension 
hypercholesteroloaemia

Question 5

Drug history AND allergies

Answer 5

prescribed medications 
over the counter medications 
why are they taking it?
are they actually taking it effectively? 
allergies and what the side effects are

Question 6

family history

Answer 6

any family diseases
premature death ? ho did they die?
any cardiovascular disease at a young age?

Question 7

what counts as a young age for cardiovascular disease in males and females

Answer 7

younger than 55 in males

younger than 65 in females

Question 8

social history headlines

Answer 8

• upbringing
• home life
• occupation
• finance
• relationships
• house
• community support
• sexual history
• leisure acitviites
• exercise
• substance misuse

Question 9

how do you calculate pack years of smoking

Answer 9

20 cigs = 1 packet

the number of cigs they smoke per day x the number of years they have been smoking

divided by 20

Question 10

general systems enquiry

Answer 10

chest pain 
breathessness 
palpitations 
dizziness
oedema 
peripheral vascular symptoms 
intermittent claudication (muscle pain on mild exertion)

Question 11

non-modifiable risk factors to cardiovascular diseases

Answer 11

ethnicity
age
gender
family history

Question 12

modifiable risk factors for cardiovascular disease

Answer 12

weight 
high blood pressure 
smoking 
type 2 diabetes 
high cholesterol 
psychosocial factors 
stress

Question 13

what meds can effect dyspnoea

Answer 13

beta blockers in patients with asthma, NSAIDS, exacerbation of heart failure by beta blockers, some calcium channel antagonists

Question 14

what meds can effect dizziness

Answer 14

vasodilators

Question 15

what meds can effect angina

Answer 15

aggravated by thyroxine pr drug induced anaemia

Question 16

what drugs can effect oedema

Answer 16

from steroids, NSAIDS, calcium channel antagonists

Question 17

meds that can effect palpitations

Answer 17

thyroxine, B2 stimulants

Question 18

cardio causes of chest pain

Answer 18

stable angina, acute coronary syndromes, pericarditis, aortic dissection

Question 19

respiratory causes of chest pain

Answer 19

pulmonary embolism 
pneumothorax 
pneumonia 
lung cancer 
mesothelioma

Question 20

upper GI causes of chest pain

Answer 20

oesophageal disease

Question 21

Musculoskeletal causes of chest pain

Answer 21

trauma - muscle or rib injury, costochondritis

Question 22

Angina

Answer 22

A clinical syndrome of chest pain or pressure precipitated by activities such as exercise or emotional stress which increase
myocardial oxygen demand

Question 23

Differentiating oesophageal disease from angina pectoris

Answer 23

Those individuals with typical anginal pain who have normal multistage exercise tests or normal coronary arteriograms and any person with atypical chest pain should be thoroughly evaluated for oesophageal disease.

• not relieved by rest if OD
• often wakes them
• they may relate to heartburn

Question 24

Pericarditis

Answer 24

Pericarditis is inflammation of the pericardium

Question 25

clinical presentation of pericarditis

Answer 25

acute onset of chest pain, classically this is pleurtici in nature and is eased by sitting up and leaning forward - the pain may be anywhere over the anterior chest wall, but it is usually retrosternal, may radiate to the arm like ischaemic pain - radiation to the trapezius ridge

Question 26

Aortic dissection symptoms

Answer 26

sudden and severe pain tearing and deep radiating to the left shoulder/back

Question 27

Dyspnoea

Answer 27

shortness of breath: - is there anything that relieves the symptoms - anymore associated symptoms? - their response to the administration of a diuretic

Question 28

cardiac causes of dyspnoea

Answer 28

cardiac failure | associated with angina or MI

Question 29

respiratory causes of dyspnoea

Answer 29

``` asthma COPD pneumothorax pneumonia bronchitis pulmonary fibrosis ```

Question 30

other causes of dyspnoea

Answer 30

anaemia, obesity, hyperventilation, anxiety

Question 31

Paroxysmal nocturnal dyspnea (PND)

Answer 31

``` is a sensation of shortness of breath that awakens the patient, often after 1 or 2 hours of sleep, and is usually relieved in the upright position. CAUSES: - Atrial fibrillation - mitral valve disease - hypertension ```

Question 32

Orthopnea

Answer 32

Orthopnea is the sensation of breathlessness in the recumbent position, relieved by sitting or standing

Question 33

Palpitations

Answer 33

* Unexpected awareness of heart beating in chest. * Fast / slow / regular / irregular. * May occur in: * Sinus rhythm e.g. anxiety. * Intermittent irregularities of heartbeat e.g. Ectopic beats (extrasystoles). * Abnormal rhythm (arrhythmia). * Not all patients with arrhythmia experience palpitations

Question 34

what to do if a patients says they have an arrhythmia

Answer 34

``` Ask the patient to tap it out! • Onset and termination. • Precipitating/relievingfactors. • Frequency and duration. • Associated symptoms: • Chest pain / collapse / sweating / dyspnea. • Past medical history. • e.g. Cardiovascular/thyroid disease ```

Question 35

"my heart misses a beat or jumps or flutters"

Answer 35

ventricular or atrial extrasystoles

Question 36

"my heart is racing and jumping about" I also have breathlessness

Answer 36

atrial fibrillation

Question 37

"my heart is racing and fluttering and I need to urinate a lot"

Answer 37

supra ventricular tachycardia with polyuria

Question 38

"my heart is racing or fluttering and im breathless and I've lost conciseness

Answer 38

ventricular tachycardia presenting with syncope

Question 39

dizziness - syncope

Answer 39

postural hypotension neurocardiogenic (vasovagal) cardiac arrhythmias

Question 40

what to ask if a patients says they have dizziness

Answer 40

• Try to establish what actually happened. • History from a witness if possible. • Frequency / duration? • Loss of consciousness? • Associated symptoms- before, during and after - Chest pain, sweating, palpitations, dyspnoea, convulsions, tongue biting, incontinence, drowsiness afterwards etc.

Question 41

Oedema

Answer 41

Localised or generalized? • Legs - unilateral or bilateral? • Duration? Is it getting better or worse? • Aggravating or relieving factors?

Question 42

Pitting oedema.

Answer 42

* Most commonly, pitting oedema develops secondary to increased venous pressure but it can also result from reduced oncotic pressure or it may be idiopathic. * Oedema of rapid onset or deterioration, or with marked associated symptoms, such as dyspnoea, suggests serious underlying pathology and warrants immediate investigation.

Question 43

unilateral causes of oedema

Answer 43

DVT. • Chronic venous insufficiency. • Compartment syndrome. • Retroperitoneal mass.

Question 44

bilateral causes of oedema

Answer 44

* Congestive cardiac failure. * Cor pulmonale. * Cirrhosis. * Acute renal failure. * Medication, for example, calcium- channel blockers. * Sepsis. * Myxoedema. * Pregnancy. * Idiopathic.

Question 45

CV causes of Fatigue.

Answer 45

* May be inadequate systemic perfusion in Cardiac Failure. | * Consider side-effects of medication e.g. β-blockers.

Question 46

Left sided heart failure

Answer 46

- paroxysmal nocturnal dyspnoea - orthopnea - pulmonary congestion

Question 47

right sided heart failure

Answer 47

``` peripheral venous pressire distended jugular veins ascites (fluid build up in the abdomen) enlarges liver and spleen dependant edema ```