Cardiovascular: History
  1. Chest pain, discomfort
  2. Dyspnoea
  3. Palpitations
  4. Fatigue
  5. Syncope, dizziness
  6. Intermittent claudication
  7. Ankle swelling
  8. Past medical, surgical history
  9. Family, social, drug history
  10. Systems
Chest pain, discomfort
  • SOCRATES.
  • Onset: recent pattern changes.
  • Character: dull discomfort (angina).
  • Timing: at rest vs. exertion, meals (GERD).
  • Exacerbating: inspiration, movement.
  • Alleviating: sublingual nitrates, leaning forward.
Dyspnoea
  • Exertional: how far can you walk?
  • Orthopnoea: sleep with pillows?
  • Paroxysmal nocturnal dyspnoea: gasp at night?
Palpitations
  • Ever unusually aware of heartbeat?
  • SOCRATES.
  • Onset: sudden vs. gradual.
  • Timing: slow vs. fast.
  • Timing: regular vs. irregular.
  • Missed beat sensations.
Fatigue
  • Change in fatigue levels.
Syncope, dizziness
  • SOCRATES.
  • Onset: saw blood (vasovagal).
  • Onset: stood up (HTN drugs, angina drugs).
  • Onset: felt it coming on.
  • Conscious vs. unconscious.
Intermittent claudication
  • Distance walked before leg pain.
Ankle swelling
  • Symmetrical vs. asymmetrical.
  • How far up leg.
Past medical, surgical history
  • MI, angina.
  • Rheumatic fever.
  • HTN, HTN of pregnancy.
  • Congenital heart problems.
  • STDs, infections.
  • Dental work (S. viridans).
  • Investigations: angiogram.
  • Surgery: CABG, (Coronary Artery Bypass Graft Surgery) transplant, valve replacement, angioplasty.
Family history
  • Condition in a relative, what age.
  • MI.
  • Angina.
  • Congenital heart dz.
  • Mitral valve prolapse.
  • Marfan's.
  • DM.
  • HTN.
Social history
  • Smoking: ever smoked, how many per day, for how long, type [cigarette, pipe, chew].
  • Alcohol (hypercholesteremia risk).
  • Occupation: stress, work interruption.
  • Activity levels.
  • High cholesterol diet.
  • See Atherosclerosis Risk Factors Reference.
  • Describe your home: stairs, etc.
  • Who is with you there at home [help if MI, help with tasks].
Drug history
  • HRT.
  • Thyroid drugs.
  • Diabetic drugs.
  • Prostate dz drugs.
  • Steroids.
  • Vasodilator (cause of ankle edema).
  • Allergies.
  • Allergies to drugs, dyes.
Systems
  • Pulmonary (dyspnea cause).
  • Alimentary GERD (chest pain cause).
  • Nervous (syncope cause).

Cardiovascular Exam