What Review of Systems (ROS) questions are pertinent to cardiac history in cardiology patients in an inpatient setting?

Pertinent Review of Systems Questions for Cardiac Patients in Inpatient Setting

The most critical ROS questions for cardiology inpatients should focus on symptoms of volume status, cardiac output, and specific cardiac conditions that impact morbidity and mortality.

Core Cardiac Symptoms to Assess

Dyspnea Assessment

• Dyspnea at rest: Ask if the patient experiences uncomfortable breathing while sitting still 1
• Dyspnea on exertion: Document specific activities that trigger breathlessness:
  • Walking distance before dyspnea occurs
  • Ability to climb stairs
  • Need to stop while dressing
  • Duration standing before dyspnea occurs 1
• Orthopnea: Ask about:
  • Discomfort breathing when lying flat
  • Number of pillows needed for comfortable sleep (≥3 pillows is significant)
  • Recurrent cough when supine 1
• Paroxysmal nocturnal dyspnea: Ask if patient awakens suddenly with breathing difficulty relieved by sitting upright 1

Chest Pain Characterization

• Chest pain at rest: Frequency, duration, and intensity
• Chest pain with exertion: Specific activities that trigger pain
• Radiation pattern: Particularly note radiation to both arms (high specificity for ACS) 2
• Quality of pain: Pressure, squeezing, burning, stabbing
• Relieving/aggravating factors: Response to rest, nitroglycerin, position changes

Other Critical Cardiac Symptoms

• Palpitations: Ask about fluttering sensations or rapid heartbeats 1, 3
• Syncope/presyncope: Episodes of dizziness, light-headedness, or loss of consciousness 1
• Fatigue: Unusual tiredness affecting daily activities 1
• Edema: Swelling in extremities or abdomen 1
• Weight changes: Recent gain or loss and timeframe 1

Condition-Specific Questions

Heart Failure Assessment

• NYHA functional classification: Determine class based on activity limitations:
  • Class I: No limitation of physical activity
  • Class II: Slight limitation (ordinary activity causes symptoms)
  • Class III: Marked limitation (less than ordinary activity causes symptoms)
  • Class IV: Symptoms at rest or minimal exertion 1
• Weight changes: Recent gain indicating fluid retention
• Nocturnal symptoms: Cough, need to urinate, awakening due to breathlessness

Angina Assessment

• Canadian Cardiovascular Society Angina Classification:
  • Class 0: Asymptomatic
  • Class 1: Angina with strenuous activity only
  • Class 2: Slight limitation of ordinary activity
  • Class 3: Marked limitation of ordinary activity
  • Class 4: Inability to perform any activity without discomfort 1

Arrhythmia Assessment

• Palpitation characteristics: Duration, frequency, triggers, associated symptoms
• Syncope/presyncope: Circumstances, prodromal symptoms, recovery time
• Symptoms suggesting bradycardia: Fatigue, exercise intolerance, dizziness 1

Rationale for These Questions

1. Early detection of life-threatening conditions: These questions help identify patients at risk for acute coronary syndrome, heart failure decompensation, and malignant arrhythmias 2

2. Volume status assessment: Questions about orthopnea, PND, and edema help evaluate fluid overload, which is critical for heart failure management 1

3. Cardiac output evaluation: Symptoms like fatigue, exercise intolerance, and syncope help assess cardiac output adequacy 1

4. Risk stratification: Symptom severity helps determine urgency of interventions and level of monitoring needed 1

5. Treatment response monitoring: Tracking symptom changes helps evaluate effectiveness of current therapies 1

6. Functional status determination: Activity limitations guide treatment goals and discharge planning 1

Common Pitfalls to Avoid

• Overlooking atypical presentations: Elderly, diabetic, and female patients may present with atypical symptoms like fatigue or dyspnea rather than chest pain 2

• Focusing only on chief complaint: A comprehensive cardiac ROS may reveal additional significant findings beyond the presenting symptom 4

• Neglecting non-cardiac causes: Remember that chest pain may have non-cardiac origins but still require attention 5

• Incomplete dyspnea assessment: Always quantify dyspnea by specific activities rather than vague descriptions 1

• Missing temporal patterns: Recent changes in symptom frequency or severity are often more important than long-standing symptoms 1

By systematically assessing these key areas, you'll gather the most clinically relevant information to guide diagnosis, risk stratification, and treatment decisions for cardiology inpatients.