CArdiac HC

Cardiovascular System Assessment
(10 Marks)
HISTORY TAKING
Patient Information
• Name: Full name to avoid confusion.

• Age: Helps identify disease prevalence (e.g., congenital heart disease in
children, coronary artery disease in older adults).
• Sex: Gender-specific risks (e.g., CAD is more common in males;
postmenopausal women at increased risk).
• Residence: Environmental and regional factors (e.g., rheumatic fever in
endemic areas).
• Occupation: Sedentary lifestyle (risk for CAD) or exposure to stress
(hypertension risk).
Chief Complaints
(Describe in chronological order)
Chest Pain
• Duration: Acute (<30 minutes, e.g., myocardial infarction) or chronic

(>weeks, e.g., stable angina).
• Onset: Sudden (e.g., aortic dissection) or gradual (e.g., pericarditis).
• Site: Retrosternal (e.g., ischemic heart disease) or localized (e.g.,
costochondritis).
• Type of Pain:
• Crushing or squeezing: Myocardial infarction.
• Tearing: Aortic dissection.
• Sharp or stabbing: Pericarditis.
• Radiation: Left arm or jaw (ischemic pain); back or abdomen (aortic
dissection).
• Aggravating Factors: Physical exertion (stable angina), lying down
(pericarditis), or stress.
• Relieving Factors: Rest or sublingual nitrates (stable angina); none
(unstable angina).
• Associated Symptoms:
• Nausea and vomiting: Often seen in myocardial infarction.
• Sweating: Sympathetic overdrive in acute coronary syndromes.
Dyspnea (Shortness of Breath)
• Duration: Acute (e.g., pulmonary edema) or chronic (e.g., heart failure).

• Onset:
• Sudden (e.g., pulmonary embolism).
• Gradual (e.g., left ventricular failure).
• Grade (NYHA Classification):
• Class I: No limitation of activity (early disease).
• Class II: Dyspnea on exertion (e.g., mild left heart failure).
• Class III: Dyspnea with minimal activity (e.g., advanced heart failure).
• Class IV: Dyspnea at rest (e.g., decompensated heart failure).
• Progression: Worsening suggests disease progression (e.g., worsening
mitral regurgitation).
• Aggravating Factors: Physical exertion, lying flat (orthopnea), bending
forward (bendopnea).
• Relieving Factors: Sitting upright (heart failure), diuretics.
Special Types of Dyspnea:

• Orthopnea: Seen in left-sided heart failure.
• Paroxysmal Nocturnal Dyspnea (PND): Waking up gasping for air (heart
failure).
• Trepopnea: Positional dyspnea relieved by lying on one side (e.g.,
unilateral pleural effusion).
• Platypnea: Dyspnea worse in an upright position (e.g., hepatopulmonary
syndrome).
• Bendopnea: Dyspnea triggered by bending forward (e.g., advanced heart
failure).
• Associated Symptoms: Cough, frothy sputum (pulmonary edema), or
wheeze (cardiac asthma).
Palpitations
• Duration: Short-lived (e.g., extrasystoles) or prolonged (e.g., atrial

fibrillation).
• Onset: Sudden (paroxysmal supraventricular tachycardia) or gradual
(anemia-induced tachycardia).
• Fast or Slow:
• Tachycardia: Atrial fibrillation, thyrotoxicosis.
• Bradycardia: Sinus node dysfunction.
• Regular or Irregular:
• Irregularly irregular: Atrial fibrillation.
• Regular: Sinus tachycardia.
• Precipitating Factors: Stress, exercise, caffeine, or medications.
• Dizziness or syncope: Suggests arrhythmia.
• Post-palpitation diuresis: Atrial fibrillation.
• Chest pain: Seen in tachyarrhythmias due to myocardial ischemia.
Syncope (Fainting)
• Duration: Seconds (vasovagal) or minutes (seizures, arrhythmias).

• Onset: Sudden (e.g., arrhythmias) or associated with warning signs (e.g.,
vasovagal).
• No. of Attacks: Frequent episodes may indicate recurrent arrhythmias or
neurocardiogenic syncope.
• Precipitating Factors: Emotional stress, prolonged standing (vasovagal),
or exertion (aortic stenosis).
• Palpitations: Suggestive of arrhythmias.
• Chest pain: Indicates ischemia.
• Postural symptoms: Orthostatic hypotension.
Pedal Edema
• Duration: Chronic (heart failure, venous insufficiency) or acute (deep vein

thrombosis).
• Onset: Gradual (heart failure) or sudden (thrombophlebitis).
• Progression: Bilateral (heart failure) vs unilateral (DVT).
• Aggravating Factors: Prolonged standing or sitting (dependent edema).
• Relieving Factors: Elevation of legs, diuretics.
• Facial puffiness: Renal involvement (e.g., nephrotic syndrome).
• Ascites: Right heart failure.
Other Symptoms
• Fatigability: Common in chronic heart failure due to low cardiac output.

• Hemoptysis: Frothy sputum in pulmonary edema; frank blood in
pulmonary embolism.
• Cyanosis:
• Central: Congenital cyanotic heart diseases.
• Peripheral: Seen in low cardiac output states.
• Gastrointestinal Symptoms:
• Right hypochondrial pain: Congestive hepatomegaly in heart failure.
• Anorexia and nausea: Seen in severe heart failure.
• Decreased Urine Output: Suggests reduced renal perfusion due to low
cardiac output.
• Fever: Seen in infective endocarditis.
Past History
• Hypertension: Common risk factor for CAD and heart failure.

• Diabetes Mellitus: Accelerates atherosclerosis and coronary artery
disease.
• Rheumatic Fever: Predisposes to valvular heart disease.
• Infective Endocarditis: History of valve replacement or cardiac defects.
Family History
• Include a three-generation pedigree.

• Look for familial hypercholesterolemia, early-onset CAD, or sudden
cardiac deaths.
Personal History
• Smoking History: Quantify pack-years to assess CAD risk.

• Alcohol Use: Chronic consumption can lead to alcoholic cardiomyopathy.
• Dietary Habits: High sodium intake (hypertension), fatty food
(atherosclerosis).
Treatment History
• Current Medications: Diuretics, ACE inhibitors, antiplatelets, or

anticoagulants.
• Monitoring: INR for warfarin, creatinine for ACE inhibitors.
Differential Diagnosis
1. Coronary Artery Disease (e.g., stable angina, myocardial infarction).

2. Heart Failure (left-sided or right-sided).
3. Valvular Heart Disease (e.g., mitral stenosis, aortic stenosis).
4. Pericarditis or Pericardial Effusion.

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Cardiovascular System Assessment

• Name: Full name to avoid confusion.

(Describe in chronological order)

• Duration: Acute (<30 minutes, e.g., myocardial infarction) or chronic

Dyspnea (Shortness of Breath)

• Duration: Acute (e.g., pulmonary edema) or chronic (e.g., heart failure).

Special Types of Dyspnea:

• Duration: Short-lived (e.g., extrasystoles) or prolonged (e.g., atrial

• Duration: Seconds (vasovagal) or minutes (seizures, arrhythmias).

• Duration: Chronic (heart failure, venous insufficiency) or acute (deep vein

• Fatigability: Common in chronic heart failure due to low cardiac output.

• Hypertension: Common risk factor for CAD and heart failure.

• Include a three-generation pedigree.

• Smoking History: Quantify pack-years to assess CAD risk.

• Current Medications: Diuretics, ACE inhibitors, antiplatelets, or

1. Coronary Artery Disease (e.g., stable angina, myocardial infarction).

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