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Cardiovascular History Taking - Geeky Medics
Cardiovascular History Taking - Geeky Medics
Cardiovascular History Taking - Geeky Medics
3/4/15, 7:23 PM
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Pain if pain is a symptom, clarify the details of the pain using SOCRATES
Site where exactly is the pain / where is the pain worst
Onset when did it start? / did it come on suddenly or gradually?
Character what does it feel like? (sharp stabbing / dull ache / burning?)
Radiation does the pain move anywhere else? (e.g. chest pain with left arm
radiation)
Associations any other symptoms associated with the pain (e.g. chest pain with
SOB)
Time course does the pain have a pattern (e.g. worse in the mornings)
Exacerbating / Relieving factors anything make it particularly worse or better?
Severity on a scale of 0-10, with 0 being no pain & 10 being the worst pain
youve ever felt
Associated symptoms dyspnoea, chest pain, orthopnea, PND, palpitations,
syncope, sweating, nausea, leg swelling, reduced exercise tolerance, fever, loss
of consciousness, cough
Cardiovascular Risk Factors:
Hypertension if patient unsure, check their medications
Smoking very important risk factor, establish how many a day for how long
Hypercholesterolaemia patients often dont know ask if their on a statin or
check
Diabetes establish how long theyve had it & how good their glycaemic control
is (HBA1C useful)
Ideas, Concerns & Expectations
Ideas what are the patients thoughts regarding their symptoms?
Concerns explore any worries the patient may have regarding their symptoms
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Expectations gain an understanding of what the patient is hoping to achieve from the
consultation
Summarising
Summarise what the patient has told you about their presenting complaint.
This allows you to check your understanding regarding everything the patient has
told you.
It also allows the patient to correct any inaccurate information & expand further
on certain aspects.
Once you have summarised, ask the patient if theres anything else that youve
overlooked.
Continue to periodically summarise as you move through the rest of the history.
Signposting
Signposting involves explaining to the patient;
What you have covered Ok, so weve talked about your symptoms & your
concerns regarding them
What you plan to cover next - Now Id like to discuss your past medical history
and your medications
Past Medical History
Medical conditions - AF, hypertension, hypercholesterolaemia, ischaemic heart
disease, etc
Any operations? CABG, Stents, valve replacements, Fem-Pop bypass, Amputation,
etc
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http://geekymedics.com/2010/09/05/cardiovascular-history/
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Drug use Cocaine causes coronary artery vasospasm can present as young
person with chest pain
Diet - Overweight? Fatty foods? Salt intake? significant cardiovascular risk factors
Exercise levels gives an idea regarding baseline level of patients activity
Living Situation:
House/bungalow? the presence of stairs is important will the patient manage?
Who lives with the patient? are they a source of support?
Any carer input? - what level of care do they receive?
Activities of Daily Living - Does illness impact patients ADLs? e.g. stairs, going to
shop, cooking
Occupation? those with sedentary jobs are at increased cardiac risk e.g. Lorry
Driver
Systemic Enquiry
Systemic enquiry involves performing a brief screen for symptoms in other body
systems.
This may pick up on symptoms the patient failed to mention in the presenting
complaint.
Some of these symptoms may be relevant to the diagnosis e.g. reduced urine output in
fluid overload
Choosing which symptoms to ask about depends on the presenting complaint & your
level of experience
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Comments
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