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CARDIOVASCULAR HISTORY

Most likely cases:


Syncope (cardio: secs to minutes, sudden if arrhythmia related, neuro (neuro deficit
before like aura or tingling, OR postictal confusion or fatigue or disorientation) or
idiopathic
ACS (angina, NSTEMI, STEMI)
CCF
Fast AFIB
Infective Endocarditis
VT or SVT rarely
Pre or post cardiac transplant (in the Mater hospital)

Most likely symptoms


Chest pain
Dyspnea
Palpitations
Syncope
Fatigue

Dont leave out any questions For ex.


Dyspnea
-Onset: sudden (acute resp) or gradual?
-Progressively better, worse (CCF, resp), or same (ACS)
-When at home and well, how often are you breathless??
-Breathless on a daily basis?
-Sitting in a chair?
-Going up stairs?
-Walkinug to the shop?
-How far can you walk before getting breathless?

Associated symptoms
Cardio: orthopnea, PND, pedal edema, palpitations, chest pain, syncope
(Resp: fever, cough, sputum, wheeze)

Palpitations
-Onset?
-Constant or do they come and go?
-Did it start at the same time as the other symptoms?
-Progressively better, worse, or same?
-A/w dizziness or LOC?

Cardiac RISK FACTORS (You can do checklist here, but ask details in MHx)
1. HTN
When was it dx?
Last BP reading?
How many tablets do you take for it?

2. Cholesterol
When was it dx?
Last cholesterol level?
How many tablets do you take for it?

3. Family hx:
Did your mom have a heart attack, stroke, or bleeding aneurysm? Age?
Did your dad have a heart attack, stroke, or bleeding aneurysm? Age?
Did your brother/sister have a heart attack, stroke, or bleeding aneurysm? Age?
Age <65 years old is important

4. Personal hx:
Have you ever been told youve had a heart attack? Stroke? Mini stroke?
Problem with a circulation in your legs?

5. Diabetes
When were you dx adult or younger?
When you were dx, did you start on tablets (DM2) or injections(DM1)?
What was your highest blood sugar last week?
What was your lowest blood sugar last week?
Do you know your HbA1C?
Have you ever been brought to the hospital because your blood sugar was too high?
Have you ever been brought to the hospital because your blood sugar was too low?
Ever had to go to the ICU because of your blood sugars?
Do you see a kidney doctor for your diabetes? Tablets?
Do you see an eye doctor for your diabetes? Are they keeping an eye on it or have
they had laser surgery? (proliferative vs non proliferative disease)
Do you see a doctor for your legs? Any loss of feeling in your legs?

6. Smoking
Do you smoke?
Have you ever smoked?
When did you stop?
When you did smoke, how many did you smoke at your most?
How many years did you smoke for?

INVESTIGATIONS since they came in? (So that you look like you know what you are
talking about, ask the following)
-Did you have a heart tracing since you came in?
-Did they put jelly on your chest and do an U/S of your heart?
-Did they make you run for a while while you had your heart tracing on?
-Bloods to look at cholesterol and sugars?
-Did you have the test where they put a hole in the thigh, then used a camera up the
hole to look at the arteries in your heart?

Medical Hx
Arthritis? If it is unrelated to PC, just write it down (dont need details)

Surgical Hx
CABG?
This is related. So ask:
When was it?
Did you tolerate GA okay?
How many vessels?
Any complications after?
Ever had a blood transfusion?
When was your most recent stress test?
Because if CABG done 10 years ago, may need angio or re-stent.

Medications
Kardex will be there some examiners will show you, some wont.
What medications are you on?
Have you missed any doses in the last week? Do you miss doses regularly? Why?
Side effects?
Are you on any tablets for your blood pressure? Spray to take away pain? Aspirin?
Any other tablets that thin your blood out? (pts will know Plavix or warfarin)
If theyre on warfarin: AFIB w CHADSVASC >2, or prosthetic valves
Are you on any tablets for your cholesterol?
Are you on any tablets for your diabetes? Are you on insulin? Do you take your
insulin at every meal? Morning and night? Every meal AND morning and night?

Allergies
Any allergies to any medications?
Which one? What happened?
Did you have a rash or did you have trouble breathing?
Timeline (was this within two hours? Can be 5-6 in GI, if 2 days later rash is ADR).
(Rash or vomit? Cant say for sure it is an allergy. Could be a side effect or ADR)
(Bronchospasm/severe urticarial or wheeze, LOC >> allergy)

Family Hx
Parents and siblings (ages)
Children healthy? Sudden adult death? Collapse? (HOCM/arrhythmia), Older: ACS?
Social Hx
Where do you live?
Do you live on your own or is anyone else there? Partner? Children?
Whos living nearby?
Do you have a mobile phone? Panic button?
ELDERLY only (or as appropriate):
Do you feed yourself?
Wash yourself?
Can you drive? (after cardiac event, cant drive for 3 months)
How many stairs are there up to your house?
Is your bedroom/bathroom on the bottom floor or do you have to take stairs?
Do you have home help?
Meals on wheels? How often?
Have physio/OT/public health nurse ever come to your house?
What is your occupation? / Do you still work?
Do you smoke?
Do you drink alcohol?
Have you ever drank?
How many glasses or pints would you have each day?
NB: pint = 2 units, wine = 1.5 units, spirits = 1 unit

Systems Review (say it like this)


Theres a few questions I need to ask you now.
They are usually yes or no answers.
Most of them will be no.
Resp, GI, Neuro, Rheum.
systems review revealed no new details

Presenting the Hx
This is ________, a ____ year old patient who presented ___ days ago as a self/GP
referral (orbrought in by ambulance, elective admin, brought in from the OPD)
with X,Y, and Z (chest pain, dyspnea, and palpitations). This is on a background of.
X (ONLY use if cardio related). Of note, his/her RF are X and Y (HTN and smoking).
Previous investigations are X and Y (ECG, Echo).
(May not have risk factors or investigations).

His/Her main symptoms were X, Y and Z. To describe the (chest pain), it started five
days ago. Etc etc. With regards to his RF, he has the following

Questions at the end clarify if it is vague

DDX top three and REASONS (Differentials should be why they are in NOW. Ie. If
its a CF patient the DDx is acute exacerbation of CF)

Investigations and expected abnormalities?


Cardiac enzymes, cardiac function (ECHO), cardiac electrical activity (ECG)

Management? Ex. ACS


Symptomatic: Morphine, nitroglycerin
Therapeutic:
1. Reperfusion depends on the type of ACS. NSTEMI > PCI, STEMI >option of PCI
or thrombolysis, new LBBB > option of PCI or thrombolysis
2. Prevention of propagation (dont want the clot to get bigger): antiplatelet
(aspirin, clopidogrel), anticoagulant
3. O2: 100% O2 via a non re breather mask (unless they have COPD)
4. Prevent complications
ACEI prevents cardiac remodelling
BB prevents cardiac remodeling, reduces preload
Statin stabilize the plaques
5. Discharge plans: write a prescription for medications (all except
morphine/analgesia), F/U in OPD (1.5-3 months), tests day before or on the
day of F/U (ECG, CXR), or if they have diabetes glucose!

Complications?
Acute: Arrhythmias, CCF, ACS (They all cause eachother. Arrhythmias cause CCF, ACS,
ACS causes arrhythmias and CCF, etc).

Chronic: tachyarrhythmias or bradyarrhythmias, cardiogenic shock, Multiorgan


failure, cardiac arrest

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