Cardiovascular histories should focus on key system-specific symptoms related to the heart, cardiovascular risk factors, medications, lifestyle factors & relevant family history.
Chest pain can be described using the SOCRATES mnemonic. It is particularly important to determine the nature of the pain (i.e. central, crushing chest pain) in addition to the presence of any associated symptoms (i.e. nausea, sweating, clammy).
The key symptoms to determine in a cardiovascular history include:
The presence of breathlessness, orthopnoea and ankle swelling should make you think about heart failure as a possible diagnosis. It is important to determine whether palpitations are associated with features of dizziness, syncope or chest pain, which suggest a more sinister arrhythmia.
There are five critical cardiovascular risk factors that should be determined in every history.
It is important to ascertain any previous cardiovascular history such as a myocardial infarction (heart attack), arrhythmias (e.g. atrial fibrillation), or previous treatments (e.g. pacemaker, stenting).
When discussing previous medical problems always establish:
It is important to determine which medications the patient is taking related to their condition and whether they are experiencing any side-effects?
The critical things to pick up in the family history are underlying genetic conditions, heart disease at a young age (i.e. < 60) or sudden cardiac death (SCD).
Genetic conditions may include familial hyperlipidaemias. The presence of sudden cardiac death may be concerning for an underlying condition like long-QT syndrome or hypertrophic cardiomyopathy.
Enquire about the functional impact of their cardiovascular complaint on their life.
This could be angina (chest pain) limiting them from working, heart failure causing significant breathlessness or intermittent claudication limiting their exercise.
Always end by discussing the patient's ideas, concerns & expectations
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