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References
1. Heart Disease.
A Textbook of Cardiovascular Medicine
6th Ed Braunwald
2. Batess .Guide to physical examination
and history taking 8th Ed
HOW to START?
Greet client respectfully and with kindness
Introduce yourself
Explain about history taking
and the goal of history taking
Identify the patients data ( described elsewhere)
CHIEF COMPLAINT(S)
The one or more symptoms or concerns
causing the patient to seek care
Give the opportunity to relate their
experiences and complaints in their own
way
DYSPNEA
Dyspnea = abnormally uncomfortable
awareness of breathing
One of the principal symptom of cardiac and
pulmonary disorders
It occurs at rest or at a low level activity
DYSPNEA
Associated with problem in:
Heart and lung
Chest wall
Respiratory muscle
Anxiety
CHEST PAIN
Etiology of chest pain:
Cardiac origin
Noncardiac, intrathoracic structure
Tissues of neck, thoracic wall, joints, spine
Subdiaphragmatic organs
Angina pectoris =
discomfort in the chest/ adjacent area
associated with myocardial ischemia
it means tightening NOT PAIN
CHEST PAIN
Ask the patient to describe how the
chest pain developed
SYNCOPE
Most commonly caused by reduced
perfussion of the brain
Etiology:
Stoke Adam
Other cardiac arrhytmias
Seizure disorders
SYNCOPE
Cardiovascular syncope - quite promptly
Clues to differentiate the cause of syncope
Precedeing events
Type of onset
Position of onset
Postsyncopal clearing of sensorium
Associated events
PALPITATION
Palpitation = an unpleasant awareness of
the forceful or rapid beating of the heart
Changes in rhytm, rate
EDEMA
Cardiac edema is generally symetrical
It may involve thigh, genital, abdominal
wall
Causes of edema
Cardiac
Hepatic
Renal
Cardiac edema
- Dyspnea on exertion
- Often assc. with orthopnea or PND
Hepatic
- Dyspnea in frequent
Renal
- Usually chronic
CHIEF COMPLAINT(S)
Give the opportunity to relate their
experiences and complaints in their own
way
Q: How can I help you?
What can I do for you?
What concerns bring you here today
Which one you are most concerned about?
PRESENT ILLNESS
Describe how each symptom developed
1. Onset and chronology of chief complaint
2. Location
3. Quality and intensity
4. Factors that precipitate, aggravate or alleviate
5. Timing ( onset, duration, frequency)
6. Setting in which the symptoms occur
7. Any associated manifestation(s)
8. History of previous treatment and its responses
(name, dose, frequency of the drug(s)