History
·
Major symptoms:
o Chest pain/heaviness/discomfort
o SOB (exertional, orthopnoea, PND)
o Ankle swelling
o Palpitations (due to EDV, or do they mean arrhythmia – usually sudden onset – or tachycardia
– usually gradual onset)
o Syncope
o Intermittent claudication (pain in legs on exertion due to ischaemia)
o Fatigue
·
Key differentials:
o Does it change with breathing? (Þ ?respiratory cause)
o Does it change with movement or localised pressure (Þ
?musculoskeletal cause)
·
Past history screen: Rheumatic
fever, STDs, recent dental work, thyroid disease, history of heart disease,
drugs
·
Social history: tobacco (ask
„have you ever smoked‟ not „do you smoke‟ just in case they „gave up this
morning‟), alcohol, occupation
·
Family history: Ischaemic heart
disease, valve disease, congenital disease, Marfan‟s
·
Risk factors of Coronary Artery
disease: hyperlipidaemia, smoking, hypertension, family history, diabetes
mellitus, obesity, ¯exercise, male, advanced age
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