Cardiovascular History&OSCE

8/17/2019 Cardiovascular History&OSCE

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Cardiovascular History

Presenting Complaint

Concise description of symptoms the patient feels - (e.g. I’m short of breath)

History of Presenting Complaint

Onset - When did it all start?

Acute or gradual – Did it come on suddenly?

Duration? - is this an acute or chronic health problem?

Progression of symptoms - has it gotten worse/better or stayed same over that time frame?

Intermittent or continuous?

Pain – SOCRATES

Associated symptoms – Dyspnoea, chest pain, orthopnea, palpitations, syncope, sweating, nausea, leg

swelling, reduced exercise tolerance, fever, loss of conciousness

Risk Factors:

- Hypertension - if patient unsure, check their medications

- Smoking - very important risk factor, establish how many a day for how long

- Hypercholesterolaemia - patients often don’t know – ask if their on a statin or check - Diabetes - establish how long they’ve had it & how good their glycaemic control is (HBA1C useful)

Ideas, Concerns & Expectations…

Past Medical History

Any hospital admissions? – when, where & why?


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Any operations? – CABG, Stents, Carotid Endarterectomy, Fem-Pop bypass, Amputation

Dental work - if suspicious of infective endocarditis

Other medical diagnoses- atrial fibrillation, hypertension, hypercholesterolaemia, diabetes,

thyrotoxicosis, angina, previous MI, heart failure, cardiomyopathy?

Drug History

Do you take any regular medication? – Beta blockers, Ca+ channel blockers, Anti-hypertensives

OTC drugs?

Herbal remedies?

Contraceptive pill? - increased risk of thromboembolic disease – DVT/PE

Oxygen? - patient may have end stage COPD with Cor-pulmonale

ALLERGIES? - some patients are sensitive to beta blockers & develop bronchoconstriction / wheeze

Family History

Any illnesses that seem to run in your family? - MI’s, Clotting disorders, Haemophilia

Are your parents still in good health? – if deceased determine age & cause of death

Any unexplained deaths in young relatives? - Long QT syndrome / Channelopathies

Has anyone ever had any problems similar to what you are experiencing?

Social History

Smoking - How many smoked and for how long?

Alcohol - How much each week (convert to units)

Drug use - Cocaine causes coronary artery vasospasm – present as young people with chest pain

Diet - Fatty foods? Salt intake? – significant cardiovascular risk factor

Exercise levels - gives you an idea of this persons baseline & risk of cardiovascular disease

Living Situation:


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- House/bungalow? – the presence of stairs is important – will the patient manage?

- Who lives with you? – do they provide support?

- Any carers? - important factor when discharging a patient

Activities of Daily Living - Does illness impact patients ADL’s? e.g. stairs, going to shop, cooking

Occupation? - those with sedentary jobs are at increased cardiac risk – i.e. Lorry Driver

Systemic Enquiry

Cardiovascular – Chest pain, PND, Orthopnoea, SOB, Cough, Ankle swelling, Palpitations, Cyanosis

Respiratory – Cough, Sputum, Haemoptysis, Chest Pain, SOB, Tachypnoea, Hoarseness, Wheezing

GI - Appetite, Diet, Nausea, Indigestion, Dysphagia, Pain, Bowel habit, Haematemesis, Jaundice

Urinary - Frequency, Dysuria, Polyurea, Urgency, Hesitancy, Nocturia, Back pain, Incontinence

Nervous System – Visual/other senses, Headache, Fits/Faints, LOC, Weakness, Numbness

Musculoskeletal – Pain in muscles, bones & joints, swelling, gait

Dermatology – Skin changes, dryness, ulcers, rashes

IntroductionIntroduce yourself Explain what you would like to examine

Gain consent

Place patient at 45° with chest exposed

Ask if patient has any pain anywhere before you begin!

General InspectionBedside for treatments or adjuncts – GTN spray, O2, Tablets, Wheelchair, Warfarin

Comfortable at rest?

SOB

Malar Flush

Chest for scars & visible pulsationsLegs for harvest site scars and peripheral oedema

..

Hands

Temperature - poor peripheral vasculature


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Capillary refill – should be


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Bedside Blood Glucose

Fundoscopy

Documents

Cardiovascular History&OSCE