History taking in Cardiac cases
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This document provides guidance on how to conduct a thorough history taking for cardiac cases. It outlines the key areas of inquiry including: presenting complaints, history of present illness, risk factors, past medical history, family history, medications, lifestyle habits, functional status and expected diagnosis. For each complaint such as chest pain, breathlessness or palpitations, it lists the important questions to ask to fully characterize the symptom. The goal is to obtain a comprehensive history to inform the diagnosis and appropriate treatment plan.
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History taking in Cardiac cases
- 1. History Taking in Cardiac Cases Shahid Abbas Interventional cardiologist and Physician
- 4. Presenting Complaints 1 or 2 How to ask ?
- 5. H/o present Illness • How to start ? • Detail of PC and all the pertaining Issues Missed D/D
- 6. Chest Pain ?
- 7. Chest Pain • • • • • • • • • Intensity Associations Pattern • Sweating Location • ACS Duration • Palpitations • Pneumonia Radiation • Fever • PE Aggravating/ relieving F • Breathlessness • Dissection of Aorta Frequency • vomiting • APD GERD Progression • Costochondritis D/D
- 9. 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
- 10. Palpitation ?
- 12. MI ?
- 13. H/o MI • • • • • • • • • DDT SK Door to Needle/ balloon time DC Shock LV dysfunction Shock Rehabilitation TLC Education
- 15. Risk Factors • • • • • • DM HTN Smoking Dyslipedemia Family History Menopause CAD equivalents • DM • Abd Aortic aneurysm • PVD • Symptomatic Carotid Artery disease
- 16. Cardinal points • • • • • • • • • Dizziness Syncope CVA Carotid Artery Disease Chest Pain Breathlessness Palpitations MI Intermittent Claudication Oedema Feet
- 19. Treatment Compliance Response to medications Side effects Admissions Drug Allergies
- 20. Personal / family History Exercise Smoking Alcohol Marital Status Kids Socioeconomic Bracket
- 21. 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)
- 22. Pace Maker (Cont) • • • • Hysteresis Bipolar pacing Magnet VOO Over sensing/ under sensing
- 23. VHD Presenting Symptoms • decompensation First symptom Breathlessness • • • • • Orthopnia Life style modification Otners synd Wheeze Palpitation
- 24. VHD (cont ) Chest Pain • Angina • IHD risk Factor Hemoptysis • Fever • Pulm oedema • Chest Pain (infarction/ Embolism)
- 25. VHD (cont ) IE • Fever duration response to Medications • Admission Thrombo-Embolism • • • • • Palpitations KID CVA Gut Limbs
- 26. 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
- 27. VHD (cont ) Treatment • Compliance • Response • Side effects
- 28. Diagnosis Expected Patient is a case of Coronary Artery Disease having RATAFICATION Angina CCS II and breathlessness NYHA Class II SIR With no clinical evidence of LV de-compensation IHD ka Case ha And has Functional disability Class II/IV Meriting Coronary evaluation and possible Intervention
- 29. Diagnosis Expected Patient is a case RATAFICATION of Post Rehumatic Mitral Valve Disease with predominant Mitral Stenosis SIR complicated by severe Pulmonary hypertension; RHD ha sath MS aur AR ha In Sinus rhythm With compensated heart with no clinical stigmata of Infective endocarditis And has Functional disability Class II/IV
- 30. 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 endocarditis And has Functional disability Class III/IV Meriting intervention
- 31. Functional Disabilty Class 0 Class I ClassII Class III Class IV • • • • • Transfer Dressing Wash room utility Ablation Eating
- 32. Thank You