Cardiovascular History

Presenting Symptoms

1.  Chest pain

Site - Where is the pain? Onset - When did the pain start, and was it sudden or gradual? Character - What is the pain like? An ache? Stabbing? Radiation - Does the pain radiate anywhere? Associations - Any other signs or symptoms associated with the pain? Time course - Does the pain follow any pattern? Exacerbating/Relieving factors - Does anything change the pain? Severity - How bad is the pain? Causes/ Ddx Characteristic Angina heaviness/dull, left-sided, radiate to jaw/arms, occurs with exertion, relief with rest /sublingual nitrates MI comes on at rest, more severe, last longer than angina(>30min), associated with dyspnoea, sweating, anxiety. nausea. Pleurisy/pericarditis worse by inspiration (pleuritic pain), usually relieved by sitting up and leaning forward, caused by inflamed pleural/pericardial surface on one another Disease  of cervical/thoracic spine Pain associated with movement, radiate from back towards chest Aortic dissection/aneurysm Severe, tearing, greatest at onset, radiates to back, hx of HTN, Marfan, Ehlers-Danlos Massive pulmonary embolism sudden onset, retrosternal, associated with collapse, dyspnoea, cyanosis. Spontaneous pneumothorax sharp pain, severe dypsnoea Gastro-oesophageal reflux retrosternal, after eating/drinking hot/cold fluids, may be associated with dysphagia

2.  Dyspnoea -SOB

chronic, occurs with exercise, caused by failure of the left ventricular output to rise with exercise Orthopnoea - dyspnoea when patient is supine. Oxygenation better in an upright position- upper zones of the lungs are better due to redistribution of interstitial oedema. It is a symptom of LVF. Non-cardiac causes: Massive ascites, pregnancy, bilateral diaphragmatic paralysis, large pleural effusion severe pneumonia Paroxysmal nocturnal dypsnoea (PND) -severe dypsnoea that wakes the patient, gasping for breath. Caused by sudden failure of left ventricular output

3.  Ankle swelling

May notice weight + >3kg a symptom of RHF or binventricular failure Cardiac origin; symmetrical, worst in the evenings, improved at night can be caused by vasodilating drug (CCB)

4.  Palpitation

- unexpected awareness of the heartbeat. Ddx Artrial/ventricular premature contraction - sensation of a missed beat followed by heavy beat Cardiac arrhytmias - instantaneous onset sinus tachycardia - gradual onset Atrial fibrillation - rapid irregular rhythm Ventricular tachycardia - rapid palpitation followed by syncope Supraventricular tachycardia - suddenly terminated by increasing vagal tone with Valsava manoever, carotid massage, coughing, swallowing cold water or ice cubes

5.  Syncope

-transient loss of consciousness resulting from cerebral anoxia     Presyncope - transient sensation of weakness without loss of consciousness     Type of syncope: Postural syncope - standing for prolonged period or standing up suddenly, may be induced by antihypertensive drugs micturition syncope - while passing water tussive syncope - coughing vasovagal syncope - sudden emotional stress, precipated by unpleasant things (blood, crowded, hot room) Epilepsy Exertional syncope - obstruction to left ventricular outflow or hypertrophic cardiomyopathy

6.  Intermittent claudication

pain in one/both calves, thighs or buttocks when walking more than a certain distance. Suggest PVD

Risk Factors for Coronary Artery Disease (CAD)

1. Previous IHD 2. Hypercholesterolaemia, low HDL 3. Alcohol consumption 4. Smoking 5.  Hypertension 6.  Family hx of CAD - 1st degree relatives (parents/siblings), affected people <60 y.o 7. Diabetes melitus 8. Renal failure

History of Presenting Complaint

History of angina Previous myocardial infarction History of palpitations Previous cardiac investigations Previous cardiac surgery/interventional procedures Recent dental work [endocarditis] Rheumatic fever in past

Past Medical/Surgical History

1.  Dental decay/infection - risk of infective endocarditis 2.  angioplasty, CABG, stent, rheumatic fever.

Medication , Allergy

Social History

Marital status, Children, Employment, Home situation Alcohol intake (count units) Smoking (quantity of cigarettes per day, and duration of smoking must be documented)

Review of System