Cardiovascular History Taking

• History of Presenting Complaint - Associated symptoms

  Other symptoms that might be associated with disease of a particular area, important CVS associated symptoms include nausea/vomiting, dizziness, blackouts, sweating, anxiety, fatigue/tiredness
• Presenting Complaint

  Presenting complaints in the cardiovascular system might include: Chest pain, Shortness of breath (dyspnoea), Feeling the heart beat in an abnormal way (stronger/harder, fast, irregular, skipping a beat - palpitations), Swelling of ankles or sacrum (oedema). A patient may have more than one symptom. Important to ask which symptom(s) brought them to see you this time.
• Communication Skills - Calgary Cambridge Consultation Model

  1. Initiating the session

  2. Gathering information

  3. Physical Examination

  4. Providing structure

  5. Building relationship

  6. Explanation and planning

  7. Closing the session
• History of Presenting Complaint

  Information about the current symptom(s), Associated symptoms, Previous similar episodes, Impact on daily living
• History of Presenting Complaint - Important areas to explore with each cardiac symptom

  Chest pain (using SOCRATES), Shortness of breath (association with activity, exercise tolerance, orthopnoea, paroxysmal nocturnal dyspnoea), Oedema (constant or transient, extent), Palpitations (speed, rhythm, onset, triggers, duration and frequency)
• History Taking Sequence

  1. Introduction and Consent

  2. Presenting Complaint

  3. History of Presenting Complaint

  4. Past History - Medical History, Surgical History

  5. Medications

  6. Allergies

  7. Social History

  8. Family History

  9. Systems Review

  10. Summary

  11. Differential Diagnosis

  12. Management Plan

  13. Initiating the Session

  14. Gathering Information
• Past History

  1. Open Questions: ‘How is your health generally?’ ‘Do you have any known medical conditions?’ ‘Are you attending a doctor or clinic regularly?’ ‘Have you had any previous operations or investigations done in the hospital?’ ‘Any previous heart problems?’

  2. Closed Questions: ‘Have you had high blood pressure? high cholesterol? heart disease? previous stroke? peripheral vascular disease? heart surgery? rheumatic fever?
• Associated symptoms in the History of Presenting Complaint


  • Other symptoms that might be associated with disease of a particular area
  • Important CVS associated symptoms: nausea/vomiting, dizziness, blackouts, sweating, anxiety, fatigue/tiredness
  • If patient presents with one major CVS symptom, important to ask if other CVS symptoms present e.g. patient with chest pain – ask about SOB, oedema, palpitations, as well as associated symptoms
  • Cardiac chest pain associated with breathlessness, nausea, and feeling anxious
• Allergies


  ‘Any known allergies to medication, latex, or other materials?’ If yes important to know the extent of allergy, what happened when exposed?
• Family History

  Parents/Siblings living or deceased chronic conditions Any known conditions that run in the family Any conditions that can occur frequently in families: diabetes, heart disease, stroke, or high blood pressure
• Medications


  ‘Are you currently taking any medications?’ ‘Prescribed or over the counter (OTC)?’ ‘Herbal remedies?’ ‘Recreational drug use?’ If medication list then: what are they for? when prescribed? compliance? tolerated/side effects?
• Social History - Occupation

  ‘Are you studying or working – either at home or elsewhere?’ ‘Is it stressful?’ ‘How do you manage?’ ‘Do you get to move much during the workday?’ (e.g. is it sedentary?)
• Social History - Alcohol History

  ‘Do you drink alcohol? Would you drink every day/week/month? How much, how often?’ 11 units/week female, 17 units/week male Glass of beer 1 unit Pint of beer 2 units Glass of wine 1-2 units 1 measure of spirits 1 unit
• Social History - Home


  ‘Who do you live with?’ e.g. partner/parents ‘Do you have any dependents/children?’ ‘Do you have good support from family and friends/neighbors?’
• Social History - Smoking History

  ‘Do you smoke? Have you ever smoked?’ ‘How many per day? For how long?’ *one pack year = 20 cigarettes/day/1 year
• Hand hygiene is important
• Factors to consider in a medical history

  • Speed (fast or slow)
  • Rhythm (regular or irregular)
  • Onset (sudden or gradual, what were you doing when it happened)
  • Triggers (stress, alcohol, caffeine, etc)
  • Duration and frequency
• History of Presenting Complaint - Previous similar episodes

  1. How did it progress?

  2. How it differs from this episode?

  3. Any intervention at the time?

  4. Any evolving pattern?