1.

Chest pain or discomfort:

Duration
Onset - sudden, insidious
Site
Radiation
Character - dull, stabbing, pricking, etc
Aggravating factors - cough, sneeze, movements, exertion
Relieving factors - posture, rest

2. Breathlessness:
Duration
Onset - sudden, sub-acute, insidious
Progression
Persistent, paroxysmal?
Associated symptoms - cough, pain, palpitation, sweating
Aggravating factors - exertion
Relieving factors - rest, posture
Severity – NYHA class
PND, orthopnea, platypnea, trepopnea?

3. Palpitation:
Duration
Onset
Persistent, paroxysmal?
- mode of termination (if paroxysmal)
Precipitating factors:
- exertion, stress, anxiety (relieved by rest)
- [OR] present even at rest
Postural variation

4. Giddiness (Pre-syncope)
5. Syncope:
Duration
Precipitating factors:
- prolonged standing
- getting up from supine or sitting posture
- emotional stress
- exertion
- cough
- micturition

6. Fatigue

1. Swelling of legs:
Duration
Onset
Progression
Side:
- bilateral:
- symmetrical?
- simultaneous?
- unilateral
Diurnal variation
Associated with weight gain?

[Abdominal symptoms]
2. Oliguria
3. Abdominal distension
4. Right hypochondrial pain
5. Loss of appetite
6. Vomiting

[Respiratory symptoms]
7. Cough
8. Hemoptysis

[Pressure symptoms]
9. Difficulty in swallowing
10. Hoarseness of voice
[Neurological complications]
11. Weakness of limbs
12. Seizures

[Symptoms of acute rheumatic fever]

13. Fever
14. Sore throat
15. Involuntary movements
16. Joint pain or swelling:
Duration
Onset
Joints involved
Migratory, additive?
Functional disability - bedridden
Prompt response to drugs?
Residual deformity?

[Cyanotic heart diseases]

17. Squatting episodes

1. Similar episodes in the past?

2. Diabetes, Hypertension, Dyslipidemia, CAD, CKD
3. Hypothyroidism, Hyperthyroidism
4. Rheumatic fever
5. Tuberculosis

1. Recent hospitalization
2. Drugs (present as well as significant past medications)
3. Dental procedures
4. Valve replacement, Cardiac surgeries, PCI, Pacemakers
5. Radiotherapy, Chemotherapy (Doxorubicin)
6. Known allergies

1. Diet
2. Smoking (calculate pack-years)
3. Alcohol
4. Drugs of abuse - cocaine; intravenous?
5. Sexual promiscuity
1. Nature of job to know about limitation of activities
2. Medico-legal consequences - pilots, drivers of heavy vehicles

1. DM, HT, Dyslipidemia, CAD, Sudden cardiac death

2. Rheumatic heart disease
3. Infections like tuberculosis
4. Consanguinity
5. Age of mother at delivery (in relevant cases)

1. Antenatal history of mother - exanthematous fevers, drugs, SLE

2. Intranatal history - mode of delivery, child crying at birth, cyanosis
3. Developmental history
- delayed milestones, retarded growth
- recurrent respiratory tract infections
- cyanotic spells, squatting episodes

Conscious level
Stature, Built and Nourishment
Comfortable at rest or Dyspneic
Febrile?
Pallor or Polycythemia
Icterus
Cyanosis - Peripheral, Central or Differential
Clubbing
Nail changes - Koilonychia, Leukonychia (if present)
Pedal edema
Lymphadenopathy
Thyroid - Goitre

Anthropometry: Height, Arm-span and Upper segment : Lower Segment Ratio

* Markers of congenital heart diseases

* Markers of atherosclerosis
* Signs of rheumatic fever
* Signs of infective endocarditis
* Peripheral signs of wide pulse pressure
Pulse:
- rate
- rhythm
- volume
- character
- condition of vessel wall
- radio-femoral delay and radio-radial delay
- whether felt in all palpable peripheral vessels
- (pulse deficit in case of AF)

Blood Pressure:
- measure in all four limbs
- record upper limb BP in supine and standing postures also

Respiration:
- rate
- regularity
- type

Temperature: (Measured)

JVP:
- pressure
- wave-forms (if JVP is elevated)

1. Shape and type of chest

2. Precordial bulge or flattening?
3. Tracheal position
4. Apical impulse - position (if visible)
5. Parasternal impulse
6. Any other pulsations?
- suprasternal
- supraclavicular
- aortic and pulmonary
- epigastric
- back
7. Scars
1. Tracheal position
2. Apical impulse - position, character
3. Parasternal impulse or heave - grade (if present)
4. Other pulsations
5. Palpable heart sounds, (Palpable rub - if present)
6. Thrills - precordial, carotid
7. Tracheal tug

1. Right cardiac border

2. Left cardiac border

1. Heart sounds - S1 and S2

Intensity - muffled, normal, accentuated
Splitting - narrow, normal, wide, fixed, paradoxical
2. Added sounds:
S3, S4
Opening snap
Ejection sound
Non-ejection click
Pericardial rub
Pericardial knock
Ventricular knock
Prosthetic valve sounds
3. Murmurs:
Site
Pitch
Quality
Timing
Intensity
Posture, Respiration
Conduction or Transmission
Dynamic auscultation