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CARDIAC HISTORY

Sara EL Sharkawy

Lect.of cardiology

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Personal history

Name ,Age ,Sex .

Residence ,Address ,occupation .

Marital status ,menstrual and obstetric history .

Special habits

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Special habits

Smoking

Alcohol

Drug abuse

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Complaint

Chest pain.
Shortness of breath.
Lower limb swelling .
Awerness of heart beat .
Transient loss of consiuosness
Bluish discoloration of skin and mucous membrane .

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Chest pain

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Cardiac causes of chest pain

Ischaemic
Angina pectoris .
myocardial infarction .
Non ischaemic
Pericarditis .
Aortic dissection .
Pulmonary embolism

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Non cardiac causes

Chest wall e.g herpes zoster .
Pleurisy .
Mediastinal.
Abdominal .(Gastric reflux)

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Dyspnea

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Causes of dyspnea

Cardiac
Valvular diseases
Pericardial diseases .
IHD
Heart failure .
Pulmonary embolism .
Non cardiac .
Obesity
Pregnancy
Pulmonary causes and metabolic causes (renal failure or DKA)

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According to New York Association functional classification based on symptoms and physical activity :-

Class I :- No limitation of physical activity .

Class II :- Slight limitation of physical activity .

Class III:-Marked limitation of physical activity .

Class IV :- unable to carry on any physical activity without discomfort symptoms .

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Associated symptoms

Orthopnea
PND
Cough
Wheeze
Haemptysis

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Lower limb swelling (oedema_

Bilateral
Cardiac
Nephrotic
Liver cell failure
Hypoalbuminemia.

Unilateral

DVT

Cellulitis

Varicose veins

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Syncope

Tranisent complete loss of consciousness due to reduced cerebral blood flow with loss of postural tone

Cardiac causes :-

Arryhthmia .

Obstructive valvular lesions (Aortic stenosis ,Hypertrophic cardiomyopathy ).

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Causes of syncope

Vasovagal

Orthostatic

Carotid sinus hypersensitivity .

Situational

Arrythmia

Mechanical (HOCM,Tight MS ,Tight As )

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Palpitation

Onset ,offset ,duration ,frequency
Exertional or at rest
Regular or iiregular
Associated symptoms (chest pain and syncope)

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Past history

Medical (HTN ,DM,RF and others )
Surgical
Drug history
Hospital admission
Trauma
Irradiation

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Family history

Genetic

Cardiomyopathies and channelopathies

Premature atherosclerosis

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General examination

General appearance
Mental state
Body built
Decubitus
Complexion
Vital data
Upper and lower limbs
Head and neck
Other systems

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Head and neck

.

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Neck examination

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Skin and extremities

skin
thin ,thick or dry
Cold or warm

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Hand examination

Pallor
Cyanosis
Clubbing
Infective endocarditis signs (splinter haemorrahge ,osler nodules ,janway lesion ).

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Pulse

Propagation of waves of ventricular contraction along blood vessel .
Carotid
Radial
Brachial
Femoral
Posterior tibial
Dorsalis pedis

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Comment

Rate
Rhythm
Force
Volume
Character
Arterial wall
Equality on both sides
Pulse on LL