History taking in Cardiac cases

History Takingin

Cardiac CasesShahid Abbas

Interventional cardiologist and Physician

Introduction ?

Introduction

NameAgeOccupationResidence

Presenting Complaints

1 or 2How to ask ?

H/o present Illness

• How to start ?• Detail of PC and all the pertaining IssuesMissed D/D

Chest Pain ?

Chest Pain• Intensity• Pattern• Location• Duration• Radiation• Aggravating/ relieving F• Frequency• Progression• D/D

• ACS• Pneumonia• PE• Dissection of Aorta• APD GERD• Costochondritis

Associations• Sweating• Palpitations• Fever• Breathlessness• vomiting

Breathlessness ?

Breathlessness• NYHA• Orthopnia /PND (No of Pillows)• Palpitations• Oedema feet• Abd Distension• Otners• Life style modification• Fever • Hemoptysis• D/D

• LVF• COAD/ Br

Asthma• Infections/TB• PEmbolism

Palpitation ?

Palpitation• Frequency• Rhythem• Micturtion reflex• DC cardioversion• Embolic• Drugs

• CVA• Kid• Gut• Limb

MI ?

H/o MI • DDT• SK• Door to Needle/ balloon time• DC Shock• LV dysfunction• Shock• Rehabilitation• TLC• Education

Risk Factors

• DM• HTN• Smoking• Dyslipedemia• Family History• Menopause

CAD equivalents

• DM• Abd Aortic

aneurysm• PVD• Symptomatic

Carotid Artery disease

Cardinal points

• Dizziness Syncope• CVA• Carotid Artery Disease• Chest Pain• Breathlessness• Palpitations• MI• Intermittent Claudication• Oedema Feet

Systemic review

Co-MorbidityCOADBr AstmaCLDCKDContraindications to stenting

Investigations

Results

Treatment

ComplianceResponse to medicationsSide effectsAdmissionsDrug Allergies

Personal / family History

ExerciseSmokingAlcohol

Marital StatusKidsSocioeconomic Bracket

Pace Makers

• Old Documents• 1 Lead or 2 Leads• Syncope• Pus discharge from pocket - I/v Drugs Antibiotics• Pace Maker follow up trouble shooting• Threshold • Sensing not possible in demand mode• Anticoagulation (AF + Pacing)

Pace Maker (Cont)

• Hysteresis• Bipolar pacing• Magnet VOO• Over sensing/ under sensing

VHD

Presenting Symptoms• decompensation

First symptom

Breathlessness• Orthopnia• Life style modification• Otners synd• Wheeze• Palpitation

VHD (cont )

Chest Pain• Angina• IHD risk Factor

Hemoptysis • Fever • Pulm oedema• Chest Pain (infarction/ Embolism)

VHD (cont )

IE• Fever duration response to Medications• Admission

Thrombo-Embolism• Palpitations• KID• CVA• Gut• Limbs

VHD (cont )Progression of Disease

Rehumatic Fever Child hood• Sore throat• Joint pains• Monthly painful Inj

Admissions in the Past

Investigations• Xray Chest• ECG, ECHO

VHD (cont )Treatment• Compliance • Response• Side effects

Diagnosis Expected

RATAFICATIONSIR

IHD ka Case ha

Patient is a case of Coronary Artery Disease having Angina CCS II and breathlessness NYHA Class II

With no clinical evidence of LV de-compensationAnd has Functional disability Class II/IV

Meriting Coronary evaluation and possible Intervention

Diagnosis Expected

RATAFICATIONSIR

RHD ha sath MS aur AR ha

Patient is a case of Post Rehumatic Mitral Valve Disease with predominant Mitral Stenosis

complicated by severe Pulmonary hypertension;In Sinus rhythm With compensated heart with no

clinical stigmata of Infective endocarditisAnd has Functional disability Class II/IV

Diagnosis Expected

Patient is a case of Post Rehumatic Mitral Valve Disease with predominant Mitral Stenosis

complicated by severe Pulmonary hypertension;Decompensated by Atrial Fibrillation but there are no

clinical stigmata of Infective endocarditisAnd has Functional disability Class III/IV

Meriting intervention

Functional Disabilty

Class 0Class IClassIIClass IIIClass IV

• Transfer• Dressing• Wash room utility• Ablation• Eating

Thank You