Cardiovascular History Taking
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A good and thorough cardiovascular medical history is crucial for the diagnosis of patients presenting with issues of the cardiovascular system like chest pain, or palpitations. It is also helpful in determining the cardiac status of the patient, and their future risk of cardiovascular disease.
Chief Complaint[edit]
Common chief complaints involving the cardiovascular system include:[1]
- Chest pain – a very common presenting complaint and has multiple cardiac and non-cardiac causes.
- Dyspnea (shortness of breath) – a common symptom of heart failure.
- Palpitations – abnormal sensation of one's heartbeat.
- Peripheral edema.
- Presyncope and syncope.
History of Presenting Complaint[edit]
The history of the presenting complaint can be determined by analyzing the chief complaint. Different mnemonics exist for remembering the components of the history of presenting complaint, including the SOCRATES mnemonic,[1][2] applied below to an example of chest pain:
- Site – the location of the pain in the chest, whether it is central, in the left, or in the right. The pain could also be generalized.
- Onset – did the pain start suddenly or gradually, and what was the patient doing when it started.
- Character – description of the pain, whether it is tight, crushing, or stabbing, for example.
- Radiation – whether the pain radiates to anywhere else, like the arm, shoulder, jaw, or back.
- Associated Symptoms – any associated symptoms with the pain, like nausea, vomiting, fever, diaphoresis, dyspnea or coughing.
- Timing – for how long has the pain going on for.
- Exacerbating and Alleviating Factors – if anything makes the pain better or worse, like if eating food exacerbates the pain, or if leaning forward alleviates the pain.
- Severity – the rating of the severity of the pain from 1 to 10, with 10 being the worst possible pain.
Past Medical History[edit]
When asking about the past medical history, it is important to ascertain any previous history of cardiovascular disease, including previous episodes of myocardial infarction, or arrhythmias. If present, the time of diagnosis of the condition, received treatment, and any complications, should be inquired about.[1][2] Any chronic medical conditions that the patient might have, including conditions that increase the risk of cardiovascular disease like hypertension, diabetes mellitus, hyperlipidemia, and obesity, should also be identified. The treatment that the patient takes for any medical conditions that they have should be notes.[1] Finally, the presence of any cardiac devices like pacemakers should also be determined.[1]
Drug History[edit]
In the drug history, any drugs that the patient takes should be identified, recording what do they take them for, and what side effects they have had because of them.[1][2]
Family History[edit]
The family history should include any conditions that are present in the patient's family, especially noting any history of cardiovascular disease such as ischemic heart disease, cardiomyopathies, and arrhythmias.[1] It is also important to ask about any sudden cardiac death that may have occurred in the family.[1][2]
Social History[edit]
Key components of the social history include:
- Smoking – for how long has the patient been smoking, how many cigarettes they smoke per day, and how long since they quit, if appropriate.[1]
- Alcohol - alcohol is a risk factor for some cardiovascular diseases.[1]
- Recreational Drug Use[2][1] - including IV drug use, as it might be a risk factor for infective endocarditis.[1]
- Occupation – some cardiovascular diseases might interfere with the patient's occupation.[2]
- Nutritional History - how many meals the patient eats, and what does he eat in a typical day.[1]
- Exercise History – the type of exercise the patient performs, and the duration. A sedentary lifestyle is a strong risk factor for cardiovascular disease.[1]
References[edit]
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