CardiovascularHistory

PresentingComplaint
Concisedescriptionofsymptomsthepatientfeels(e.g.Imshortofbreath)
HistoryofPresentingComplaint
OnsetWhendiditallstart?
AcuteorgradualDiditcomeonsuddenly?
Duration?isthisanacuteorchronichealthproblem?
Progressionofsymptomshasitgottenworse/betterorstayedsameoverthattimeframe?
Intermittentorcontinuous?
PainSOCRATES

AssociatedsymptomsDyspnoea,chestpain,orthopnea,palpitations,syncope,sweating,nausea,leg
swelling,reducedexercisetolerance,fever,lossofconciousness

RiskFactors:
Hypertensionifpatientunsure,checktheirmedications
Smokingveryimportantriskfactor,establishhowmanyadayforhowlong
Hypercholesterolaemiapatientsoftendontknowaskiftheironastatinorcheck
Diabetesestablishhowlongtheyvehadit&howgoodtheirglycaemiccontrolis(HBA1Cuseful)
Ideas,Concerns&Expectations
PastMedicalHistory
Anyhospitaladmissions?when,where&why?

Anyoperations?CABG,Stents,CarotidEndarterectomy,FemPopbypass,Amputation
Dentalworkifsuspiciousofinfectiveendocarditis
Othermedicaldiagnosesatrialfibrillation,hypertension,hypercholesterolaemia,diabetes,
thyrotoxicosis,angina,previousMI,heartfailure,cardiomyopathy?
DrugHistory
Doyoutakeanyregularmedication?Betablockers,Ca+channelblockers,Antihypertensives
OTCdrugs?
Herbalremedies?
Contraceptivepill?increasedriskofthromboembolicdiseaseDVT/PE
Oxygen?patientmayhaveendstageCOPDwithCorpulmonale
ALLERGIES?somepatientsaresensitivetobetablockers&developbronchoconstriction/wheeze
FamilyHistory
Anyillnessesthatseemtoruninyourfamily?MIs,Clottingdisorders,Haemophilia
Areyourparentsstillingoodhealth?ifdeceaseddetermineage&causeofdeath
Anyunexplaineddeathsinyoungrelatives?LongQTsyndrome/Channelopathies
Hasanyoneeverhadanyproblemssimilartowhatyouareexperiencing?
SocialHistory
SmokingHowmanysmokedandforhowlong?
AlcoholHowmucheachweek(converttounits)
DruguseCocainecausescoronaryarteryvasospasmpresentasyoungpeoplewithchestpain
DietFattyfoods?Saltintake?significantcardiovascularriskfactor
Exerciselevelsgivesyouanideaofthispersonsbaseline&riskofcardiovasculardisease

LivingSituation:

House/bungalow?thepresenceofstairsisimportantwillthepatientmanage?
Wholiveswithyou?dotheyprovidesupport?
Anycarers?importantfactorwhendischargingapatient

ActivitiesofDailyLivingDoesillnessimpactpatientsADLs?e.g.stairs,goingtoshop,cooking
Occupation?thosewithsedentaryjobsareatincreasedcardiacriski.e.LorryDriver
SystemicEnquiry
CardiovascularChestpain,PND,Orthopnoea,SOB,Cough,Ankleswelling,Palpitations,Cyanosis
RespiratoryCough,Sputum,Haemoptysis,ChestPain,SOB,Tachypnoea,Hoarseness,Wheezing
GIAppetite,Diet,Nausea,Indigestion,Dysphagia,Pain,Bowelhabit,Haematemesis,Jaundice
UrinaryFrequency,Dysuria,Polyurea,Urgency,Hesitancy,Nocturia,Backpain,Incontinence
NervousSystemVisual/othersenses,Headache,Fits/Faints,LOC,Weakness,Numbness
MusculoskeletalPaininmuscles,bones&joints,swelling,gait
DermatologySkinchanges,dryness,ulcers,rashes

Introduction
Introduceyourself
Explainwhatyouwouldliketoexamine
Gainconsent
Placepatientat45withchestexposed
Askifpatienthasanypainanywherebeforeyoubegin!

General Inspection
BedsidefortreatmentsoradjunctsGTNspray,O2,Tablets,Wheelchair,Warfarin
Comfortableatrest?
SOB
MalarFlush
Chestforscars&visiblepulsations
Legsforharvestsitescarsandperipheraloedema
..

Hands
Temperaturepoorperipheralvasculature

Capillaryrefillshouldbe<2seconds
Colourcyanosis
Clubbing
Splinterhaemorrhages,Janewaylesions,OslersNodesinfectiveendocarditis
PalmarErythemahyperthyroidism,pregnancy,polycythaemia
NicotineStainingsmoker

Pulses

RadialPulserate&rhythm
RadialRadialDelayaorticcoarctation
CollapsingPulseaorticregurgitation
BPnarrowpulsepressure=AorticStenosis|widepulsepressure=AorticRegurgitation
Carotidcharacter&volume
JVPmeasureandalsopossiblycarryouthepatojugularreflex

Face

Eyesconjunctivalpallor,jaundice,cornealarcus,xanthelasma
Mouthcentralcyanosis,angularstomatitis
Dentalhygieneinfectiveendocarditis

Close Inspection Of Chest

Scarslateralthoracotomy(mitralvalve),midlinesternotomy(CABG),clavicular(pacemaker)
Apexbeatvisibleinaorticregurgitationandthyrotoxicosis
Chestwalldeformitiespectusexcavatum,pectuscarniatum

Palpation

Apexbeat5thintercostalspace,midclavicular
Heavesleftsternaledgeseeninleft&rightventricularhypertrophy
ThrillsPalpatablemurmursoveraorticvalve&apex

Auscultation

Listenover4valvesensurepalpationofcarotidpulsetodeterminefirstheartsound
Rollontoleftside&listeninmitralareamitralstenosis
Leanforward&listenoveraorticareaaorticregurgitation
Carotidsradiationofaorticstenosismurmurs&bruits
Lungbasespulmonaryoedema
SacralOedema&PedalOedema

To complete the examination

ThankPatient
Washhands
SummariseFindings

Sayyouwould
Assessperipheralpulses
CarryoutanECG
Dipstickurine

BedsideBloodGlucose
Fundoscopy