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CARDIOVASCULARtaking the history : 

N671 Tammy Valenta RN, MSN, PHN Assistant Professor CARDIOVASCULARtaking the history PART 3

Cardiovascular Risk Factors : 

Cardiovascular Risk Factors Family History Sex Race Hypertension Smoking Excessive Weight Increased lipids Diabetes Mellitus Physical inactivity Stress

Subjective Data- Health History : 

Subjective Data- Health History Chest pain: angina Dyspnea Orthopnea Cough Fatigue Cyanosis or pallor Edema Nocturia Palpitations 3

PND : 

PND Paroxysmal nocturnal dyspnea occurs with heart failure. Lying down increases volume of intrathoracic blood, and the weakened heart cannot accommodate the increased load. Classically, the person awakens after 2 hours of sleep, arises, and flings open a window with the perception of needing fresh air. 4

Chest Pain : 

Chest Pain Myocardial Ischemic Pain: Angina Angina: “Choking of the heart” Viceral pain: rarely sharp or stabbing Pericardial Chest Pain Atypical Chest Pain


Chest pain: GENDERDIFFERENCES Men Experience onset of heart disease earlier than women Often less ill on presentation Have more typical angina sx- “acute chest pain” Pain is described as substernal, crushing pain Women Onset of heart disease approximately 10 yrs later than men Often more ill on presentation Often have angina sx that are not typical SOB, weakness, unusual fatigue, nausea, dizziness, lower chest discomfort (may feel like indigestion), back pain 6

Cardiac Dyspnea : 

Cardiac Dyspnea Cardiac Dyspnea The sensation of increased awareness of or increased difficulty with breathing Symptoms often experienced after exertion and when recumbent. Ask the patient: “do you feel as if you are smothering or suffocating?”

Paroxysmal Nocturnal Dyspnea : 

Paroxysmal Nocturnal Dyspnea Sudden awakening from sleep because of severe orthopnea. Patients often describe awakening from sleep with the need to sit up and breath Sign of CHF Patients with non-productive cough and orthopnea should be suspected of having PND/CHF.

Weakness/Fatigue : 

Weakness/Fatigue Results from insufficient cardiac output. First noticed with exertion but as disease progresses may be noticed throughout the day. Not relieved by rest or sleep. May experience “heaviness” in limbs.

Syncope : 

Syncope Lightheadedness (Pre-syncope), and Syncope occurs when blood supply to the reticular activating system in the brainstem is interrupted or reduced. Caused by insufficient CO from either an arrhythmia or organic heart disease. Aortic stenosis Hypertrophic cardiac myopathy Non-cardiac causes Postural hypotension Vasovagal syncope

History of Present Illness : 

History of Present Illness General Description Mode of Onset Location/Radiation Character/Quality Aggravating Factors Alleviating Factors Past Treatment Effect on Daily Life Associated Symptoms

History of Present Illness : 

History of Present Illness Assoc. Sx: Anxiety; SOB; sweating; dizziness; nausea/vomiting; faintness; cold, clammy skin; bluish lips; pallor; swelling or edema Treatments tried: Rest, position change, exercise, NTG, digoxin, diuretics, Beta Blockers, ACE inhibitors, NSAIDs, antihypertensives

Past Medical History : 

Past Medical History Cardiovascular dx/ Congenital heart dx MI/ Heart Murmur/Chest Injury HTN Angina Last lipid panel, EKG, Echo? Elevated lipids Lung disease/Asthma Diabetes Phlebitis Emotional problems/Anxiety/Depression

Medication : 

Medication Oral Contraceptives Diuretics Digitalis Bronchodilators Nitroglycerin Tranquilizers/sedatives Antacids/ H2 blockers/ PPIs


PERSONAL/SOCIAL HISTORY Personal/Social History Nutrition: diet, usual weight, weight change ETOH: what, how much, how often Smoking or other tobacco use Activity/Exercise pattern Stress levels and coping mechanisms

Family History : 

Family History Cardiovascular disease (especially 1rst degree relative with significant CAD before age 55 for men or age 60 for women) Premature death < age 50) Diabetes Hypertension Hyperlipidemia Congenital heart disease/defect

Review of Systems : 

Review of Systems ROS: “Have you ever been told you had a heart condition?” Chest pain – ask 8 descriptive questions May be cardiac, pulmonary, MS, GI Angina – indicates heart cannot supply enough O2 to muscle tissue. Levine’s sign: clenched fist on sternum Palpitations: skipped beats or rapid HR

Review of Systems : 

Review of Systems ROS (cont): Dyspnea: shortness of breath – with or without activity Orthopnea: difficulty breathing when supine Paraoxysmal nocturnal dyspnea (PND): awakened during sleep unable to catch breath Cough: may be cardiac or pulmonary – duration, frequency, mucous, associated with activity?

Review of Systems : 

Review of Systems ROS (cont): Fatigue: onset gradual vs. sudden, any recent change in activity level Results when cardiac output is decreased Generally worse in evening Note any progression of fatigue syndrome Syncope: lightheadedness/fainting Need to determine cause whether CV, neurological, metabolic, from bleeding Associated symptoms: dizziness, LOC, numbness, confusion, chest pain, diaphoresis, palpitations, hunger

Review of Systems : 

Review of Systems ROS (cont): Nocturia: can occur with heart failure; lying down at night promotes reabsorption of fluid and its excretion