Cardiovascular history taking is an important skill that is often assessed in bedside teaching . It’s important to have a systematic approach to ensure you don’t miss any key information. The guide below provides a framework to take a thorough cardiovascular history.

1. CARDIOVASCULAR
HISTORY TAKING
WITHOUT STETHOSCPRE

2. A good history supports the criteria

3. Warm up
• Introduce yourself – name / purpose
• Confirm patient details – name / DOB
• Explain the need to take a history
• Gain consent
• Ensure the patient is comfortable

4. Contents
• Presenting complaint in patient’s own verbatism
• History of presenting complaint
• Past medical history
• Drug history
• Family history
• Social history
• Systemic enquiry
• Summarizing
• Provisional Diagnosis based on history

5. Each one
counts many
Dyspnoea
Fatigue
Head reeling
Palpitation
Oedema
Chest pain

6. History of presenting complaint
1. Onset – When did the symptom start? / Was the onset acute or gradual?
2. Duration – minutes / hours / days / weeks / months / years
3. Severity – e.g. if symptom is chest pain, how bad is it on a scale of 1 to 10?
4. Course – is the symptom worsening, improving, or continuing to fluctuate?
5. Intermittent or continuous? – is the symptom always present or does it come
and go?
6. Precipitating factors – are there any obvious triggers for the symptom?
7. Relieving factors – does anything appear to improve the symptoms e.g. GTN
spray
8. Associated features –are there other symptoms that appear associated e.g.
fever / malaise
9. Previous episodes – has the patient experienced this symptom previously?

7. Pain – if pain is a symptom
• Site – where is the pain
• Onset – when did it start? / sudden vs gradual?
• Character – sharp / dull ache / burning
• Radiation – does the pain move anywhere else?
• Associations – other symptoms associated with the pain
• Time course – worsening / improving / fluctuating / time of day dependent
• Exacerbating / Relieving factors – anything make the pain worse or better?
• Severity – on a scale of 0-10, how severe is the pain?

8. Past medical history: Disease or risk factor
• Angina
• Myocardial infarction – bypass grafts / stents
• Atrial fibrillation
• Stroke
• Peripheral vascular disease
• Hypertension
• Hyperlipidaemia
• Rheumatic fever
• Other medical conditions – e.g. hyperthyroidism
• Surgical history – bypass graft / stents / valve replacements
• Acute hospital admissions? – when and why?

9. Cardiovascular medications history
• Beta blockers
• Calcium channel blockers
• ACE inhibitors
• Diuretics
• Statins
• Antiplatelets
• Anticoagulants
• Glyceryl trinitrate spray (GTN spray)
• Other regular medications
• Contraceptive pill – increased risk of thromboembolic disease
• Over the counter drugs – NSAIDS / Aspirin
• Herbal remedies – e.g. St John’s Wort – enzyme inducer (can affect Warfarin levels)

10. ALLERGIES
• FOOD
• COSMETICS
• Medication
• Climate change
• Toxins

11. Family history
• Cardiovascular disease at a young age – myocardial infarction /
hypertension / thrombophilia
• Are parents still in good health? – if deceased sensitively determine
age and cause of death
• Any unexplained deaths in young relatives? – long QT syndrome /
channelopathies

12. Social and personal history
• Smoking – How many cigarettes a day? How many years have they smoked
for?
• Alcohol – How many units a week? – type / volume / strength of alcohol
• Recreational drug use – e.g. Cocaine – coronary artery vasospasm
• Diet – Overweight? Fatty foods? Salt intake? – cardiovascular risk factors
• Exercise – baseline level of patient’s day to day activity
• Living situation:
• House/bungalow? – adaptations / stairs
• Who lives with the patient? – is the patient supported at home?
• Any carer input? – what level of care do they receive?

13. Activities of daily living and occupation
• Is the patient independent and able to fully care for themselves?
• Can they manage self hygiene / housework / food shopping?
• Occupation – sedentary jobs – ↑ cardiovascular risk – e.g. lorry
driver

14. Pin pointing a system
• Systemic enquiry involves performing a brief screen for symptoms in other body systems.
• This may pick up on symptoms the patient failed to mention in the presenting complaint.
• Some of these symptoms may be relevant to the diagnosis (e.g. reduced urine output in dehydration).
• Choosing which symptoms to ask about depends on the presenting complaint and your level of experience.
• Cardiovascular – Chest pain / Palpitations / Dyspnoea / Syncope / Orthopnoea / Peripheral oedema
• Respiratory – Dyspnoea / Cough / Sputum / Wheeze / Haemoptysis / Chest pain
• GI – Appetite / Nausea / Vomiting / Indigestion / Dysphagia / Weight loss / Abdominal pain / Bowel habit
• Urinary – Volume of urine passed / Frequency / Dysuria / Urgency / Incontinence
• CNS – Vision / Headache / Motor or sensory disturbance/ Loss of consciousness / Confusion
• Musculoskeletal – Bone and joint pain / Muscular pain
• Dermatology – Rashes / Skin breaks / Ulcers / Lesions

15. CARDIAC VS NON CARDIAC

16. A GOOD HISTORY CAN LOACTE THE DISEASE

17. Summarizing
• Summarise what the patient has told you about their presenting
complaint.
• This allows you to check your understanding regarding everything the
patient has told you.
• It also allows the patient to correct any inaccurate information and
expand further on certain aspects.
• Once you have summarised, ask the patient if there’s anything else
that you’ve overlooked.
• Continue to periodically summarise as you move through the rest of
the history.

18. Some examples

19. MITRAL STENSOSIS
PARTICULARS INFORMATION
Presenting complaint SOB/PALPITATION
History of presenting complaint Worsening SOB/PALPITATION for 5yrs
Past medical history BMV
Drug history PENCILLIN PROPHYLAXIS
Family history MATERNAL NICE
Social history PROVERTY AND 5 SIBLINGS
Systemic enquiry PND --------MITRAL STENOSIS
Summarizing Worsening SOB/PALPITATION for 5yrs WITH
PND and PENCILLIN PROPHYLAXIS
Provisional Diagnosis LEFT HEART FAILURE

20. Go ahead for physical examination