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Cardiovascular History Taking | Geeky Medics

3/4/15, 7:23 PM

CARDIOVASCULAR HISTORY TAKING


Cardiovascular history taking is an important skill that is often assessed in the
OSCE setting. Its important to have a systematic approach to ensure you dont miss
any key information. The guide below provides a framework to take a thorough
cardiovascular history.
Presenting Complaint
Its important to use open questioning to elicit the patients presenting
complaint
So whats brought you in today? or Tell me about your symptoms
Allow the patient time to answer, trying not to interrupt or direct the
conversation.
Facilitate the patient to expand on their presenting complaint if required
Ok, so tell me more about that Can you explain what that pain was like?
History of Presenting Complaint
Onset - When did the symptom start?
Acute or gradual Did it come on suddenly or has it gotten worse gradually?
Duration? minutes / hours / days / weeks / months / years
Progression of symptom - Has it gotten worse/better or stayed same over the
stated time frame?
Intermittent or continuous? Is the symptom always there or does it come and
go?
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Cardiovascular History Taking | Geeky Medics

3/4/15, 7:23 PM

Pain if pain is a symptom, clarify the details of the pain using SOCRATES
Site where exactly is the pain / where is the pain worst
Onset when did it start? / did it come on suddenly or gradually?
Character what does it feel like? (sharp stabbing / dull ache / burning?)
Radiation does the pain move anywhere else? (e.g. chest pain with left arm
radiation)
Associations any other symptoms associated with the pain (e.g. chest pain with
SOB)
Time course does the pain have a pattern (e.g. worse in the mornings)
Exacerbating / Relieving factors anything make it particularly worse or better?
Severity on a scale of 0-10, with 0 being no pain & 10 being the worst pain
youve ever felt
Associated symptoms dyspnoea, chest pain, orthopnea, PND, palpitations,
syncope, sweating, nausea, leg swelling, reduced exercise tolerance, fever, loss
of consciousness, cough
Cardiovascular 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 dont know ask if their on a statin or
check
Diabetes establish how long theyve had it & how good their glycaemic control
is (HBA1C useful)
Ideas, Concerns & Expectations
Ideas what are the patients thoughts regarding their symptoms?
Concerns explore any worries the patient may have regarding their symptoms

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Cardiovascular History Taking | Geeky Medics

3/4/15, 7:23 PM

Expectations gain an understanding of what the patient is hoping to achieve from the
consultation
Summarising
Summarise what the patient has told you about their presenting complaint.
This allows you to check your understanding regarding everything the patient has
told you.
It also allows the patient to correct any inaccurate information & expand further
on certain aspects.
Once you have summarised, ask the patient if theres anything else that youve
overlooked.
Continue to periodically summarise as you move through the rest of the history.
Signposting
Signposting involves explaining to the patient;
What you have covered Ok, so weve talked about your symptoms & your
concerns regarding them
What you plan to cover next - Now Id like to discuss your past medical history
and your medications
Past Medical History
Medical conditions - AF, hypertension, hypercholesterolaemia, ischaemic heart
disease, etc
Any operations? CABG, Stents, valve replacements, Fem-Pop bypass, Amputation,
etc

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Cardiovascular History Taking | Geeky Medics

3/4/15, 7:23 PM

Any acute hospital admissions? when and why?


Drug History
Regular medication? Beta blockers, Antihypertensives, Calcium channel blockers,
etc
Over the Counter drugs? NSAIDS etc
Herbal remedies? - St Johns Wart enzyme inducer can affect Warfarin etc
Contraceptive pill? increased risk of thromboembolic disease
Home oxygen? patient may have end stage COPD with Cor-pulmonale
ALLERGIES?
Family History
Any illnesses that seem to run in the family? MIs, Hypertension,
Thrombophilia, etc
Are parents still in good health? if deceased determine age & cause of death
Any unexplained deaths in young relatives? - Long QT syndrome /
Channelopathies
Social History
Smoking - How many cigarettes do they smoke a day? How many years have they
smoked for?
Alcohol How many units a week? Be specific about type / volume / strength of
alcohol.

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Cardiovascular History Taking | Geeky Medics

3/4/15, 7:23 PM

Drug use Cocaine causes coronary artery vasospasm can present as young
person with chest pain
Diet - Overweight? Fatty foods? Salt intake? significant cardiovascular risk factors
Exercise levels gives an idea regarding baseline level of patients activity
Living Situation:
House/bungalow? the presence of stairs is important will the patient manage?
Who lives with the patient? are they a source of support?
Any carer input? - what level of care do they receive?

Activities of Daily Living - Does illness impact patients ADLs? e.g. stairs, going to
shop, cooking
Occupation? those with sedentary jobs are at increased cardiac risk e.g. Lorry
Driver
Systemic Enquiry
Systemic enquiry involves performing a brief screen for symptoms in other body
systems.
This may pick up on symptoms the patient failed to mention in the presenting
complaint.
Some of these symptoms may be relevant to the diagnosis e.g. reduced urine output in
fluid overload
Choosing which symptoms to ask about depends on the presenting complaint & your
level of experience

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Cardiovascular History Taking | Geeky Medics

3/4/15, 7:23 PM

Cardiovascular Chest pain / Palpitations / Cyanosis / SOB / Syncope


/ Orthopnoea / Ankle swelling
Respiratory Cough / Sputum / Chest Pain / SOB / Wheezing / Stridor/
Haemoptysis
GI - Appetite / Nausea / Vomiting / Indigestion / Dysphagia / Weight loss
/Pain / Bowel habit
Urinary - Frequency / Dysuria / Polyurea / Urgency / Hesitancy / Nocturia
/ Incontinence
Nervous System Vision / Headache / Weakness / Sensory disturbance /
LOC / Seizures / Incontinence
Musculoskeletal Bone & Joint pain / Muscle pain / Joint swelling /
Difficulty mobilising
Dermatology Rashes / Skin breaks / Ulcers

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