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Cardiovascular History

1)Chest Pain
1) SOCRATES
1)
2)
3)
4)

Site
Onset
Character
Radiation
Under arm, stomach

5) Associated symptoms
Nausea, Vomiting, Dizziness, Anxiety, Doom
Breathlessness - angina
Heartburn/acid reflux

6) Timing
Has it happened before

7) Exacerbating/Alleviating factors
Breathing in/out
Posture eg. leaning forward

8) Severity

2) Red Flags
1)
2)
3)
4)
5)
6)
7)
8)
9)

Orthopnoea - pillows
SOB - exertion
Sudden SOB at night - PND
Palpitations
Swelling
Chest Pain
Dizziness/Syncope
Ankle Swelling
Claudication - pain when walking

3) Past Medical History


1)
2)
3)
4)
5)
6)
7)
8)
9)

Ischaemic Heart DIsease


Hypercholesterolaemia
Diabetes
High Blood Pressure
Rheumatoid Fever
MI
Reflux or indigestion
Pulmonary Disease
Cardiac Operations

4) Drugs that affect the heart


1) Aspirin

2)
3)
4)
5)

GTN
Statins
Diuretics
Beta-blockers or Beta-Agonists for asthma

5) Family History
1)
2)
3)
4)

Stroke
MI
Angina
Hypercholesterolaemia

6) Social History
1) Smoking
2) Alcohol
3) Recreational Drugs
Cocaine
Amphetamines

7) Main DIfferentials
1)
2)
3)
4)
5)

MI
Angina
Pericarditis
Aortic Dissection
GORD

6) Musculoscheletal pain
7) Pneumothorax

2)Breathlessness
1) History
1) Onset
Gradual or sudden
What activity were they doing

2)
3)
4)
5)
6)
7)

Duration
Progression (getting worse?)
What brings it on?
PND - pillows
Exercise tollerance
Any accompanying symptom
Chest pain
Haemoptysis
Cough
Palpitations
Wheeze

2) Red Flags
1) Chest Pain
2) Swelling

3) Haemoptysis
4) Persistent Cough
5) Wheeze

3) Past medical History


1)
2)
3)
4)
5)
6)
7)

Has it happened before?


COPD
Asthma
Heart Failure
Diabetes - diabetic ketoacidosis
Renal Failure
Allergies

4) Drugs
1) Nebulisers
2) Amiodarone - pulmonary fibrosis
3) Inhalers/Home O2

5) Family History
1) Heart Failure
2) Heart conditions
3) Asthma/Allergy

6) Social History
1) Smoking

2)
3)
4)
5)

Exposure to Asbestos
Exposure to TB
Recent travel
Does breathlessness interfere with activities?

7) Main Differentials
1)
2)
3)
4)
5)
6)
7)
8)
9)

Angina
MI
Pneumothorax
Pulmonary Oedema - Heart Failure
Fibrosis
Infection
COPD
Asthma
Metabolic Acidosis

3)Palpitations
1) History
1)
2)
3)
4)

What do you mean by palpitations?


How did it start?
How long did it last for? What terminated it?
Accompanying symptoms
Faintness

Sweat
Breathlessness
Chest Pain
Loss of consciousness

5) Rate (fast/slow)
6) Regular or irregular
7) Signs of Thyrotoxicosis
tremor
sweaty
goitre
eye signs
Hot/cold tolerance

2) Red Flags
1)
2)
3)
4)

Chest Pain
Orthopnea
Breathlessness
Swelling

3) Past medical History


1) Has it happened before
2) Every diagnosed with any heart condition
3) Ever had problems with thyroid

4) Asthma corrected with inhalers


5) History of collapse

4) Drugs
1) Any drugs that could cause electrolyte imbalances? (loop
diuretics)
2) Anticoagulants
3) Beta agonist inhalers

5) Family History
1) Family history of syncope or sudden death
2) Family history of heart disease

6) Social History
1) Smoking
Including e-cigarettes or nicotine patches

2)
3)
4)
5)

Alcohol
Caffeine
Job and stress
Recreational drugs
cocaine and amphetamine

7) Main Differentials
1) Cardiac Diseases
IHD
Hypertension
Atrial fibrillation

2) Thyrotoxicosis
3) Anxiety

Systems Review

GI

Change in bowel habit

Difficulty Swallowing

Nausea and Vomiting

Abdominal Pain

Change in colour of stools

Respiratory

SOB

Cough

Chest Pain

Wheeze

Genitourinary

Difficulty passing urine

Change in urine volume

Change in frequency

Blood in urine

Musculoskeletal

Joint pain

Muscle pain

CNS

Headaches

Dizziness

Faints

Fits

Weakness

Visual Disturbances

General Red Flags


Loss of Weight
Fatigue
Change in appetite
Any blood anywhere
Lumps or Bumps