CARDIOVASCULAR PROFORMA- DR S V PRASHANTHI RAJU
MD ASST PROF MEDICINE AIMSR
Demographic data:
Name
Age
Sex
Address
Occupation
Chief complaint: It’s important to use open questioning to elicit the patient’s
presenting complaint “So what’s brought you in today?” or ”Tell me about your symptoms”
Allow the patient time to answer, trying not to interrupt or direct the conversation.
Facilitate the patient to expand on their presenting complaint if required
“Ok, so tell me more about that” ”Can you explain what that pain was like?”
Presenting complaint: The following questions should be asked for each symptom the
patient is experiencing.
Onset – When did the symptom start? / Was the onset acute or gradual?
Duration – minutes / hours / days / weeks / months / years
Severity – e.g. if symptom is shortness of breath – are they able to talk in full sentences?
Course – is the symptom worsening, improving, or continuing to fluctuate?
Intermittent or continuous? – Is the symptom always present or does it come and go?
Precipitating factors – are there any obvious triggers for the symptom?
Relieving factors – does anything appear to improve the symptoms e.g. an inhaler
Associated features – are there other symptoms that appear associated e.g. fever /
malaise
Previous episodes – has the patient experienced this symptoms previously?
Cardinal sypmptoms of cardiovascular system:
o Chest pain – SOCRATES
Pain – if pain is a symptom, clarify the details of the pain using SOCRATES
o Site – where is the pain
o Onset – when did it start? / sudden vs gradual?
o Character – sharp / dull ache / burning
o Radiation – does the pain move anywhere else?
o Associations – other symptoms associated with the pain
o Time course – worsening / improving / fluctuating / time of day dependent
o Exacerbating / Relieving factors – anything make the pain worse or better?
, o Causes of chest pain :
o
- -
-
~
~
-
Angina: It is a symptom not a diagnosis. Typical patient is a middle-aged or elderly man
or woman often with a family history of coronary heart disease and one or more of the major
reversible risk factors (smoking, hypertension, hypercholesterolaemia)
Major symptoms
Exertional chest pain and shortness of breath. Pain often described as 'heaviness' or
'tightness', and may radiate into arms, neck or jaw
MYOCARDIAL INFARCTION, UNSTABLE ANGINA
In these life-threatening cardiac emergencies the pain is similar in location and character to
angina but is usually more severe, more prolonged, and unrelieved by rest.
PERICARDITIS:This also causes central chest pain, which is sharp in character and
aggravated by deep inspiration,cough or postural changes. It is usually idiopathic or caused
by Coxsackie B infection. It may also occur as a complication of myocardial infarction, but
other causes are seen less commonly.
AORTIC DISSECTION: This produces severe tearing pain in either the front or the back of
the chest. The onset is abrupt, unlike the crescendo quality of ischaemic cardiac pain.
Rare cardiovascular causes of chest pain include mitral valve disease associated with
massive left atrial dilatation. This causes discomfort in the back, sometimes associated with
, dysphagia due to oesophageal compression. Aortic aneurysms can also cause pain in the
chest owing to local compression.
Dyspnoea – exertional / orthopnea / paroxysmal nocturnal dyspnoea
Dyspnoea is an abnormal awareness of breathing occurring either at rest or at an
unexpectedly low level of exertion. It is a major symptom of many cardiac disorders,
particularly left heart failure.
In acute pulmonary oedema and orthopnoea, dyspnoea is due mainly to the elevated left
atrial pressure that characterizes left heart failure. This produces a corresponding elevation
of the pulmonary capillary pressure and increases transudation into the lungs, which become
oedematous and stiff. The extra effort required to ventilate the stiff lungs causes dyspnoea.
In exertional dyspnoea, however, other mechanisms apart from changes in left atrial
pressure are also important.
EXERTIONAL DYSPNOEA: Exercise causes a sharp increase in left atrial pressure and this
contributes to the pathogenesis of dyspnoea by causing pulmonary congestion.
ORTHOPNOEA: In patients with heart failure lying flat causes a steep rise in left atrial
pressure, resulting in pulmonary congestion and severe dyspnoea. To obtain uninterrupted
sleep extra pillows are required, and in advanced disease the patient may choose to sleep
sitting in a chair.
PAROXYSMAL NOCTURNAL DYSPNOEA:Frank pulmonary oedema on lying flat wakes
the patient from sleep with distressing dyspnoea and fear of imminent death. The symptoms
are corrected by standing upright, which allows gravitational pooling of blood to lower the left
atrial pressure, the patient often feeling the need to obtain air at an open window.
FATIGUE:Exertional fatigue is an important symptom of heart failure and is particularly
troublesome towards the end of the day. It is caused partly by deconditioning and muscular
atrophy but also by inadequate oxygen delivery to exercising muscle, reflecting impaired
cardiac output.
PALPITATIONS – ASK PATIENT TO TAP OUT THE RHYTHM
Awareness of the heartbeat is common during exertion or heightened emotion. Under other
circumstances it may be indicative of an abnormal cardiac rhythm. A description of the rate
and rhythm of the palpitation is essential.
It is particularly important to determine whether the palpitations are: ! fast or slow, ! regular
or irregular.
Ask the patient to ‘tap out’ the rhythm by clapping their hands – this will usually make it
clearer whether the rhythm is regular or irregular. If it is irregular, determine whether it is
‘regularly irregular’ (e.g. bigeminy) or ‘irregularly irregular’ (e.g. atrial fibrillation).
Palpitations are usually episodic, and so you should ask the following questions.
MD ASST PROF MEDICINE AIMSR
Demographic data:
Name
Age
Sex
Address
Occupation
Chief complaint: It’s important to use open questioning to elicit the patient’s
presenting complaint “So what’s brought you in today?” or ”Tell me about your symptoms”
Allow the patient time to answer, trying not to interrupt or direct the conversation.
Facilitate the patient to expand on their presenting complaint if required
“Ok, so tell me more about that” ”Can you explain what that pain was like?”
Presenting complaint: The following questions should be asked for each symptom the
patient is experiencing.
Onset – When did the symptom start? / Was the onset acute or gradual?
Duration – minutes / hours / days / weeks / months / years
Severity – e.g. if symptom is shortness of breath – are they able to talk in full sentences?
Course – is the symptom worsening, improving, or continuing to fluctuate?
Intermittent or continuous? – Is the symptom always present or does it come and go?
Precipitating factors – are there any obvious triggers for the symptom?
Relieving factors – does anything appear to improve the symptoms e.g. an inhaler
Associated features – are there other symptoms that appear associated e.g. fever /
malaise
Previous episodes – has the patient experienced this symptoms previously?
Cardinal sypmptoms of cardiovascular system:
o Chest pain – SOCRATES
Pain – if pain is a symptom, clarify the details of the pain using SOCRATES
o Site – where is the pain
o Onset – when did it start? / sudden vs gradual?
o Character – sharp / dull ache / burning
o Radiation – does the pain move anywhere else?
o Associations – other symptoms associated with the pain
o Time course – worsening / improving / fluctuating / time of day dependent
o Exacerbating / Relieving factors – anything make the pain worse or better?
, o Causes of chest pain :
o
- -
-
~
~
-
Angina: It is a symptom not a diagnosis. Typical patient is a middle-aged or elderly man
or woman often with a family history of coronary heart disease and one or more of the major
reversible risk factors (smoking, hypertension, hypercholesterolaemia)
Major symptoms
Exertional chest pain and shortness of breath. Pain often described as 'heaviness' or
'tightness', and may radiate into arms, neck or jaw
MYOCARDIAL INFARCTION, UNSTABLE ANGINA
In these life-threatening cardiac emergencies the pain is similar in location and character to
angina but is usually more severe, more prolonged, and unrelieved by rest.
PERICARDITIS:This also causes central chest pain, which is sharp in character and
aggravated by deep inspiration,cough or postural changes. It is usually idiopathic or caused
by Coxsackie B infection. It may also occur as a complication of myocardial infarction, but
other causes are seen less commonly.
AORTIC DISSECTION: This produces severe tearing pain in either the front or the back of
the chest. The onset is abrupt, unlike the crescendo quality of ischaemic cardiac pain.
Rare cardiovascular causes of chest pain include mitral valve disease associated with
massive left atrial dilatation. This causes discomfort in the back, sometimes associated with
, dysphagia due to oesophageal compression. Aortic aneurysms can also cause pain in the
chest owing to local compression.
Dyspnoea – exertional / orthopnea / paroxysmal nocturnal dyspnoea
Dyspnoea is an abnormal awareness of breathing occurring either at rest or at an
unexpectedly low level of exertion. It is a major symptom of many cardiac disorders,
particularly left heart failure.
In acute pulmonary oedema and orthopnoea, dyspnoea is due mainly to the elevated left
atrial pressure that characterizes left heart failure. This produces a corresponding elevation
of the pulmonary capillary pressure and increases transudation into the lungs, which become
oedematous and stiff. The extra effort required to ventilate the stiff lungs causes dyspnoea.
In exertional dyspnoea, however, other mechanisms apart from changes in left atrial
pressure are also important.
EXERTIONAL DYSPNOEA: Exercise causes a sharp increase in left atrial pressure and this
contributes to the pathogenesis of dyspnoea by causing pulmonary congestion.
ORTHOPNOEA: In patients with heart failure lying flat causes a steep rise in left atrial
pressure, resulting in pulmonary congestion and severe dyspnoea. To obtain uninterrupted
sleep extra pillows are required, and in advanced disease the patient may choose to sleep
sitting in a chair.
PAROXYSMAL NOCTURNAL DYSPNOEA:Frank pulmonary oedema on lying flat wakes
the patient from sleep with distressing dyspnoea and fear of imminent death. The symptoms
are corrected by standing upright, which allows gravitational pooling of blood to lower the left
atrial pressure, the patient often feeling the need to obtain air at an open window.
FATIGUE:Exertional fatigue is an important symptom of heart failure and is particularly
troublesome towards the end of the day. It is caused partly by deconditioning and muscular
atrophy but also by inadequate oxygen delivery to exercising muscle, reflecting impaired
cardiac output.
PALPITATIONS – ASK PATIENT TO TAP OUT THE RHYTHM
Awareness of the heartbeat is common during exertion or heightened emotion. Under other
circumstances it may be indicative of an abnormal cardiac rhythm. A description of the rate
and rhythm of the palpitation is essential.
It is particularly important to determine whether the palpitations are: ! fast or slow, ! regular
or irregular.
Ask the patient to ‘tap out’ the rhythm by clapping their hands – this will usually make it
clearer whether the rhythm is regular or irregular. If it is irregular, determine whether it is
‘regularly irregular’ (e.g. bigeminy) or ‘irregularly irregular’ (e.g. atrial fibrillation).
Palpitations are usually episodic, and so you should ask the following questions.
