Cardiovascular History-Taking

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Overview

A thorough history is vital for the diagnosis of patients with issues such as chest pain, heart failure symptoms, palpitations or syncope. The cardiovascular history may also provide important insight into patients' cardiac status, and their risk of future cardiovascular disease in the future.

The first step is to ask the patient why they presented with their current issue.
- Common cardiovascular symptoms include:
- Chest pain - concerning for coronary ischaemia infarction, though there are a wide variety of causes of chest pain
- Dyspnoea (shortness of breath) - a common symptom of heart failure
- Palpitations - the sensation of fast, slow or irregular beating of the heart
- Presyncope / syncope - the feeling of fainting, or being about to faint
- Peripheral oedema (swelling) - classically a symptom of heart failure
- Lower limb pain

When asking for more information about a patient’s symptoms, start by asking general questions such as “could you please tell me more about that”, and then narrow down the questions as more information is provided.
- Generally speaking, the following questions are a good starting point for any type of pain, and may be useful in gaining information about other symptoms:
- Site - localised or generalised; unilateral or bilateral
- Onset - sudden or gradual, and what the situation was (e.g. following trauma)
- Character - sharp, dull, burning or pressure-like
- Radiation - e.g. down the arm or across the back
- Associated symptoms - e.g. fevers, nausea / vomiting, bony pain
- Timing - duration of symptoms, frequency of episodes, changes through the day
- Exacerbating & alleviating factors - e.g. exacerbation with exertion and alleviation with rest
- Severity - on a scale of 1 to 10, with 10 being the worst

Ask about any medical conditions the patient has previous been diagnosed with, the management of these conditions, and any complications they may have.
- Common cardiovascular conditions include:
- Ischaemic heart disease
- Arrhythmia - e.g. atrial fibrillation, atrial flutter, Wolff-Parkinson-White syndrome
- Heart failure
- Pulmonary hypertension
- Cardiomyopathy
- Peripheral vascular disease
- Rheumatic heart disease
- Valvular disease - e.g. aortic stenosis, aortic regurgitation, mitral regurgitation
- Congenital heart disease
- Also ask about any cardiac risk factors that may be present, such as:
- Diabetes mellitus
- Hyperlipidaemia
- Hypertension
- Chronic kidney disease
- Obesity
Finally, ask about any cardiac devices that may be present, such as pacemakers or defibrillators.

Ask about family history of cardiac disease, such as ischaemic heart disease, cardiomyopathies or arrhythmias.
Also ask about any sudden cardiac death that may have occurred in the family.

It is important to understand any patient’s social situation when taking their history. This includes key aspects such as their occupation (or previous occupation, if retired), living situation, mobility and ability to perform activities of daily living.
Of particular importance in the cardiovascular history is a patient’s diet and exercise history.
When taking a nutritional history, ask about the number of meals the patient eats per day, any snacking in between, and what they would eat on a usual day. This can provide valuable information about a patient’s cardiovascular risk, particularly in an obese or diabetic patient.
In assessing a patient’s exercise history, ask about the amount of time they spend exercising as well as what type of exercise they perform. A sedentary lifestyle is a strong risk factor for cardiovascular disease.

Smoking is a major risk factor for atherosclerotic disease. Ask about how long a patient has smoked for, how many cigarrettes they smoke per day, and how long since they quit (if appropriate).
Ask about alcohol intake, as alcohol is an important risk factor for hypertenion, dilated cardiomyopathy and atrial fibrillation. Ask how many drinks the patient has per week, what type of drinks, and whether they have considered cutting down their intake if heavy.
Finally, ask about recreational drug use, and particularly intravenous drug use: this is an important risk factor for infective endocarditis