Cardiovascular Histories

1. Cardiovascular Histories

2. Session Plan The Cardiovascular System and its Presenting Complaints Role Play 1 The History Role Play 2 Investigations and Management

3. The Cardiovascular System Heart Peripheral Vasculature

4. The Heart Ischaemia Angina MI Heart Failure Cardiomyopathies Pericarditis Disturbances in rhythm and rate Etc.

5. Ischaemia Atherosclerosis causing narrowing of coronary arteries Stable Angina Chest pain on exertion Unstable Angina Chest pain without exertion Questions to ask: SOCRATES How far did you walk before the pain started? What were you doing at the time the pain started? Do you feel pain anywhere else in your body after exertion? Has this happened to you before? Drugs (GTN Spray)

6. Ischaemia Myochardial Infarction Cardiac tissue insufficiently perfused due to occluded artery. Chest Pain, sweating, grey, breathless, nausea, vomiting Are all MIs painful? Questions to ask: Same as Angina, but focus on PMH and FH

7. Chest Pain Non-Cardiac Differential Diagnoses GORD Does the pain come on when you lie down? What were you doing when you had the pain? (Gardening!) History of dispepsia Pulmonary Embolism Does it hurt when you breathe? Have you coughed up anything? (Pink frothy sputum) Have you had any leg pain? Have you travelled anywhere recently?

8. Chest Pain Non-Cardiac Differential Diagnoses Tietze’s Syndrome Where is the pain? Does it hurt when you push on the area? Does it hurt when you breathe?

9. Chest Pain Cardiac Differential Diagnoses Pericarditis What makes the pain better? (Leaning forward) Have you been ill recently? (Viral infections) Have you had an MI recently? (Dressler’s) Aortic Dissection Where does the pain radiate? (Straight through the back, a tearing pain) Have you experienced any changes to your vision? (Blurring) Aortic Stenosis Age HOCM Age

10. Heart Failure Valvular Disease Mitral and Aortic Regurgitation, Stenosis Have you ever had Rheumatic fever or infective endocarditis? Have you had your tonsils removed or had any oral surgery? Have you fainted? Do you have palpitations?

11. Heart Failure Dilated Cardiomyopathy Ventricle dilates and cannot function adequately. Alcohol, Genetics, Valvular disease Cor Pulmonale Cardio-respiratory failure Do you suffer from COPD? Do you smoke?

12. Heart Failure Questions to ask: LHF Do you get Breathless? (Dyspnoea) How many pillows do you sleep on? (Orthopnea) Do you wake up breathless at night? (Paroxysmal Nocturnal Dyspnoea) RHF Have you noticed any swelling in your legs? Differentials?

13. Rate and Rhythm Disturbances Rate: Bradychardia (Sick Sinus syndrome) Tachycardias (Hyperthyroidism, SVTs, VTs, etc.) Rhythm: Atrial fibrillation (Hyperthyroidism, Mitral Stenosis) The rest are difficult to ask about Thyroid Questions Dizzy spells or fainting? Stroke? Temporary Blindness? (Amaurosis Fugax) Anxious?

14. Palpitations Questions to ask: When do you get them? Do you feel short of breath when you get them? Do you get any chest pain when you get them? How long does each episode last? Is it regular or irregular? Can you tap out the rhythm? Are all the beats the same? Probe differentials: Thyroid, Heart, Anaemia and Endocrine

15. The History PC HPC PMH FH SH DH SR

16. History of Presenting Complaint ALWAYS ASK: Fever, Weight Loss, Change in appetite Write 3 questions you would ask for each differential: MI Palpitations Congestive Heart Failure

17. Past Medical History MITJTHREADS Write 2 questions you would ask for each differential: MI Palpitations Congestive Heart Failure

18. FH Are your parents alive and well? Do you have any siblings? Do you have a relative with a heart condition?

19. SH Do you smoke? Do you drink? Do you take recreational drugs or have you taken any? Who do you live with? ICE

20. DH Name 8 different drugs that can be mentioned in a Cardiovascular history Don’t forget to probe about inhalers!

21. SR Write down 10 things to ask in SR related to a cardiovascular PC

22. Contact me! Mohammed Latif (Find me on Facebook!) Maa307 if ya wanna email me. I’m actually obsessed with teaching. If you want any and you’re around Mary’s...facebook me or email me!