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History Taking
in
Cardiac Cases
Shahid Abbas
Interventional cardiologist and Physician
Introduction ?
Introduction
Name
Age
Occupation
Residence
Presenting Complaints
1 or 2

How to ask ?
H/o present Illness
• How to start ?
• Detail of PC and all the pertaining Issues

Missed D/D
Chest Pain ?
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
Breathlessness ?
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
Palpitation ?
Palpitation
•
•
•
•
•
•

Frequency
Rhythem
Micturtion reflex
DC cardioversion
Embolic
Drugs

•
•
•
•

CVA
Kid
Gut
Limb
MI ?
H/o MI
•
•
•
•
•
•
•
•
•

DDT
SK
Door to Needle/ balloon time
DC Shock
LV dysfunction
Shock
Rehabilitation
TLC
Education
Risk Factors
•
•
•
•
•
•

DM
HTN
Smoking
Dyslipedemia
Family History
Menopause

CAD
equivalents
• DM
• Abd Aortic
aneurysm
• PVD
• Symptomatic
Carotid Artery
disease
Cardinal points
•
•
•
•
•
•
•
•
•

Dizziness Syncope
CVA
Carotid Artery Disease
Chest Pain
Breathlessness
Palpitations
MI
Intermittent Claudication
Oedema Feet
Systemic review
Co-Morbidity

COAD
Br Astma
CLD
CKD
Contraindications to stenting
Investigations
Results
Treatment
Compliance
Response to medications
Side effects
Admissions
Drug Allergies
Personal / family History
Exercise
Smoking
Alcohol
Marital Status
Kids
Socioeconomic Bracket
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)
Pace Maker (Cont)
•
•
•
•

Hysteresis
Bipolar pacing
Magnet VOO
Over sensing/ under sensing
VHD
Presenting Symptoms
• decompensation

First symptom
Breathlessness
•
•
•
•
•

Orthopnia
Life style modification
Otners synd
Wheeze
Palpitation
VHD (cont )
Chest Pain
• Angina
• IHD risk Factor

Hemoptysis
• Fever
• Pulm oedema
• Chest Pain (infarction/ Embolism)
VHD (cont )
IE
• Fever duration response to Medications
• Admission

Thrombo-Embolism
•
•
•
•
•

Palpitations
KID
CVA
Gut
Limbs
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
VHD (cont )
Treatment
• Compliance
• Response
• Side effects
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
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
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
Functional Disabilty
Class 0
Class I
ClassII
Class III
Class IV

•
•
•
•
•

Transfer
Dressing
Wash room utility
Ablation
Eating
Thank You

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History taking in Cardiac cases