History Taking of

CVS

Anatomy department
Faculty of Medicine & Dentistry
October 2014
 For me, the only things of
interest are those linked to the
heart (Audrey Hepburn)
 Presenting Complaint

Chest pain
Shortness of breath
Ankle swelling
Palpitations
Syncope
Intermittent claudication
 QUESTIONS OF THE
CARDIOVASCULAR SYSTEM
Cardiac symptoms
Breathlessness
Cardiac pain
Palpitations
Cough and sputum
Dizziness and headaches
Peripheral vascular symptoms
 BREATHLESSNESS

Orthopnea- breathlessness when lying

down

Paroxysmal nocturnal dyspnea-

sudden attack in the middle of the
night that awakes the pt.
 CARDIAC PAIN

Usually retrosternal

Its nature- constricting, band-like or

squeezing

Usually related to exercise or

excitement
 Chest Pain

Character of pain Relieving factors

Severity Worse on taking a deep
Duration breath (pleuritic)
Radiation Worse on movement
At rest or on exertion Autonomic symptoms
Previous episodes Sweating
Nausea
 QUESTIONS

Does the pain radiate to the neck or to

the left arm?

Is it relieved by taking rest?

Acute Anteroseptal MI
 PALPITATIONS

Episodes of tachycardia

Sudden fluttering or thumping of the

heart in the chest
 Palpitations

Unexpected Sinus tachycardia

awareness of Ventricular
heartbeat extrasystoles
Ask patient to tap Atrial fibrillation
palpitations on chest Atrial flutter
Slow or fast Supraventricular
Regular or irregular tachycardia
Duration Ventricular tachycardia
Speed of onset or
offset
Relieving manoeuvres
 Dyspnoea
Unexpected awareness of breathing
At rest or on exertion
Quantify exercise tolerance (yards walked, stairs
climbed)
Orthopnoea = shortness of breath on lying supine
Number of pillows
Paroxysmal nocturnal dyspnoea
 Causes of Dyspnoea
Airways disease Chest wall
COPD Pleural effusion
Chronic bronchitis Rib fracture
Emphysema Kyphoscoliosis
Asthma Neuromuscular
Bronchiectasis Cardiac
Cystic fibrosis Left ventricular failure
Parenchymal disease Mitral valve disease
Pneumonia Cardiomyopathy
Pulmonary fibrosis Pericardial effusion
Tumour Other
Pneumothorax Anaemia
Pulmonary vasculature Acidosis
Pulmonary embolism Psychogenic
Pulmonary hypertension
DIZZINESS AND HEADACHES

Dizziness- hypotension

Headache- hypertension
PERIPHERAL VASCULAR
SYMPTOMS
Do you get pain in the leg muscles on
exercise? - intermittent claudication
How far can you walk?
How long does the pain take to
disappear ?
Is there any pain in the limb at rest ?
PERIPHERAL VASCULAR
SYMPTOMS
Does the pain interfere with sleep ?

What positions relieve the pain ?

Are the extremities of the limbs cold ?

Are there colour changes in the skin ?

 Intermittent Claudication

Pain in one or both calves, thighs or buttocks

Brought on by walking a certain distance
(claudication distance)
Worse on walking uphill
Relieved by rest
Suggests peripheral vascular disease
 Ankle Swelling

Unilateral or bilateral Drugs

Proximal extent of oedema Calcium channel
blockers
Pitting/non-pitting
Other
Cardiac
Cirrhosis
Congestive cardiac failure Nephrotic syndrome
Right ventricular failure Protein-losing
Cor pulmonale enteropathy
Constrictive pericarditis Deep vein thrombosis
Hypothyroidism
Lymphoedema
 Pulmonary Oedema

Normal Chest Radiograph Pulmonary Oedema

 Syncope

Transient loss of consciousness due to cerebral

hypo-perfusion
What was the patient doing at the time?
Standing for prolonged period
Standing up suddenly (postural hypotension)
Coughing
Prodromal symptoms
Abnormal movements (epilepsy)
Sensation of room spinning (vertigo)
Risk factors for Ischaemic Heart Disease

1. Hyperlipidaemia
2. Diabetes mellitus
3. Smoking
4. Hypertension
5. Obesity
6. Family history
 Past Medical History

Rheumatic fever
Previous cardiac investigations
Previous myocardial infarction
Coronary angioplasty + stent insertion
Coronary artery bypass grafting
Pacemaker insertion
 Medications

Anti-anginal agents
Use of sublingual nitrate spray
Antihypertensive agents
Anti-arrhythmics
Statins
Platelet inhibitors, e.g., Aspirin
Anticoagulants, e.g., Warfarin

Allergies
NB Document in front of chart and inform nurses
 Social History

Occupation
e.g., train driver, long distance truck driver
Smoking
Number of pack years
Alcohol intake
Stairs at home
 Family History

Ischaemic heart disease (IHD)

Angina
MI
CABG
Hypertrophic obstructive cardio-myopathy
Dilated cardio-myopathy
 Systemic Review
Look for other causes of chest pain.

Start . To RULE OUT!

Cut down the differential diagnosis by excluding other

systems one by one.
 Causes of Chest Pain
Cardiovascular
Chest wall
Angina
Stable Coughing
Unstable Intercostal muscle
Myocardial infarction strain/myositis
Aortic dissection Herpes zoster
Myocarditis Viral pleurodynia
Pleuropericardial Thoracic radiculopathy
Pericarditis Rib fracture
Pleurisy Rib tumour
Pneumothorax Costochondritis
Gastrointestinal
Gastro-oesophageal
reflux
Oesophageal spasm