Cardiovascular History Taking | Key Symptoms | OSCE Guide | SCA | UKMLA | CPSA | PLAB 2

[0:07]Hey everyone, I'm Lewis and I'm the founder of Geeky Medics. Today I'm going to discuss the key cardiovascular symptoms you'd be expected to cover in the context of taking a cardiovascular history. This is a new format that I've been wanting to try out for some time, so I'd really love to hear your feedback on whether you found this helpful and how I might go about improving this moving forwards. Okay, let's get started. The key cardiovascular symptoms which you should try and cover in any cardiovascular history include chest pain, shortness of breath, palpitations and syncope, edema, intermittent claudication, and systemic symptoms, such as fever, weight loss, and weight gain. Let's start by discussing chest pain, because it is probably one of the most common symptoms in the context of a cardiovascular Osaki scenario. You can gather more details about chest pain using the acronym Socrates. Now this acronym can actually be applied to any type of pain, so it's a really useful tool to have in your metaphorical Osaki belt. To begin with, we need to clarify the site of the pain. We can do this by asking the patient questions such as, can you tell me where the pain is? If the patient seems to be struggling to describe the location of the pain, it can sometimes be helpful to ask them to point to where it hurts. Cardiac chest pain is typically left-sided or central in location. Next we need to clarify the onset of the pain, and by that I mean how and when did the pain start? Some useful questions to elicit this information might include, did the pain come on suddenly or gradually? When did the pain first start? What were you doing when the pain started? The pain of a myocardial infarction will typically develop suddenly over the course of seconds to minutes, whereas the pain associated with pericarditis for instance, might evolve over several days. Next up, we need to explore the character of the pain. So some useful questions to figure this out might include, how would you describe the pain? Is the pain sharp or more of a dull ache? Chest pain associated with myocardial infarction is typically sharp in nature and is often associated with a sense of pressure on the chest. Next we need to ask about radiation of the pain, and by that I mean, does the pain move anywhere else? Chest pain associated with myocardial infarction typically radiates to the left arm, neck, and jaw. Next we need to ask if the patient is experiencing any symptoms that seem associated with the pain. Some examples might include nausea and vomiting in the context of MI, or fever and malaise in the context of pericarditis. Next up, we need to clarify the time course, including how long the symptom has been going on, and whether it has changed over that time period. This is really important in the context of chest pain, as it can help differentiate between key conditions such as stable angina and MI with the chest pain from angina, typically lasting less than 20 minutes. Next up, we need to ask about exacerbating and relieving factors with questions such as, Have you noticed anything that seems to make the pain worse, or, does anything seem to improve the pain? In the context of angina, chest pain is typically exacerbated by exertion and relieved by rest or the use of GTN spray. In the context of pericarditis, chest pain is typically exacerbated by lying flat and relieved by leaning forwards. Finally, we need to determine the severity of the pain. And to do this, we need to ask patients to grade their pain on a scale of 0 to 10, with 0 being no pain and 10 being the worst pain they've ever experienced. Clearly, this is quite a subjective way of measuring pain, but it can be really helpful to gauge the initial pain severity and also a patient's response to treatment. So if a patient presents with acute coronary syndrome and they report their chest pain as eight out of 10, and then you administer some morphine and GTN, and they then report their pain as two out of 10, that's helpful information. The next symptom we're going to cover is dyspnea, which is also known as shortness of breath. Shortness of breath is associated with a wide range of cardiovascular pathology, including myocardial infarction and congestive heart failure. Some questions that might be useful to further explore dyspnea include, have you felt more short of breath recently? How far are you able to walk before you feel short of breath? Is there anything you're unable to do because of the shortness of breath? Shortness of breath when lying flat is known as orthopnea. Now this is a common symptom of heart failure, and patients often use multiple pillows to prop themselves up to reduce this symptom. As a result, it can often be worth asking patients how many pillows they use to get an idea of the severity. Some patients may describe waking in the night gasping for air, needing to get out of bed and to a nearby window to catch their breath. This is known as paroxysmal nocturnal dyspnea, or PND, and it is strongly associated with heart failure. Okay, now let's talk about palpitations, another key cardiovascular symptom. Palpitations are a sense of a fast-beating, fluttering or pounding heart. Patients might describe palpitations as feeling regular or irregular in their rhythm. If patients aren't quite sure if their palpitations are regular or not, it could be useful to ask them to tap out the rhythm on their hand. Palpitations have a wide range of causes, including anxiety, atrial fibrillation, and a range of other arrhythmias. The next key symptom we're going to discuss is syncope. Syncope involves rapid loss of consciousness secondary to reduced cerebral perfusion. The loss of consciousness is typically short in duration with the patient recovering quite quickly. This is quite different to the loss of consciousness associated with seizures, which is typically longer in duration and followed by a period of drowsiness, confusion and memory loss, often referred to as a post-ictal phase. Patients often refer to syncopal episodes using a wide range of terminology such as dizzy spells, funny turn, faints or blackouts. So it's really important that you clarify exactly what they mean by those terms. It's particularly important to ask about triggers for the patient's syncopal episode with questions such as, Did anything seem to cause the blackout? What were you doing immediately before the faint? Syncope associated with a sudden change in posture, such as moving from a lying to a standing position, is suggestive of postural hypertension. Whereas syncope associated with exertion may indicate an underlying diagnosis of aortic stenosis or an arrhythmia. Now let's discuss edema. So this refers to fluid retention in various body tissues and depending on the location of the edema, it has a different name. So if there is edema affecting the lower limbs, we call this pedema. If there's edema within the abdomen, we often refer to this as ascites, and if there is edema within the lungs themselves, we call this pulmonary edema. Patients with pedema typically complain of ankle swelling that worsens as the day goes on as a result of gravity drawing fluid into the legs. Patients may also report that their legs feel heavier than usual or that their skin feels tight and uncomfortable. Questions that might be useful to identify and explore pedema include, have you noticed that your ankles seem more swollen than usual? Does the swelling in your ankles get worse as the day goes on? Medications such as amlodipine can also worsen peripheral edema. Patients with pulmonary edema often present with shortness of breath, a rattly chest, and reduced exercise tolerance. Pulmonary edema is typically caused by left ventricular failure, whereas right ventricular failure typically causes peripheral edema. Intermittent claudication refers to muscle pain that develops during mild exertion and resolves with rest. And this occurs because of inadequate perfusion to the affected muscle groups as a result of peripheral vascular disease. Patients often complain of pain in a specific leg that develops during exertion and then settles with rest. Some useful questions to further explore intermittent claudication include, how far are you able to walk before the pain develops? Does the pain go away when you rest? Have you ever developed this pain whilst at rest? Have you ever experienced any change in sensation or weakness of the leg? The presence of intermittent claudication suggests underlying peripheral vascular disease or PVD. This is important to know as the presence of PVD is a significant risk factor for other cardiovascular pathology such as angina and myocardial infarction. Finally, let's discuss systemic symptoms. So some examples of systemic symptoms include fatigue, fever, weight loss, and weight gain. Although these symptoms might not seem obviously connected to the cardiovascular system, they may still be relevant. Some examples include fatigue and weight gain in the context of heart failure, fever in the context of infective endocarditis or pericarditis, and weight loss and fatigue in the context of atrial mixoma. And that's a wrap. So we've now discussed the key cardiovascular symptoms you'd be expected to cover when taking a cardiovascular history. To learn more about cardiovascular history taking, make sure to check out the guide on the Geeky Medics website. I'd really appreciate it if you could let me know if this was helpful, and also how I might go about improving future videos. And finally, thanks for tuning in.