From the Guidelines
When rotating in cardiology, residents should ask patients about their chief cardiac complaint, including onset, duration, and severity of symptoms like chest pain, shortness of breath, palpitations, syncope, or edema, as well as inquire about cardiovascular risk factors and previous cardiac events, procedures, or surgeries, to establish a comprehensive cardiac history and guide management plans 1.
Key Components of Cardiac History
- Inquire about cardiovascular risk factors such as hypertension, diabetes, hyperlipidemia, smoking history, and family history of heart disease
- Ask about previous cardiac events, procedures, or surgeries
- Medication history should include current cardiac medications, dosages, adherence, and any side effects
- Use the OPQRST framework (Onset, Provocation/Palliation, Quality, Region/Radiation, Severity, Time) to characterize chest pain
- Ask about exercise tolerance, orthopnea, paroxysmal nocturnal dyspnea, and peripheral edema to assess heart failure symptoms
- Review systems should include questions about syncope, dizziness, palpitations, claudication, and cyanosis
Importance of Comprehensive Cardiac History
A thorough history is essential for accurate diagnosis, especially in elderly patients, women, and those with diabetes, who may present with atypical cardiac symptoms 1.
Additional Considerations
- Assess patient’s functional capacity and determine whether they have a prior history of a pacemaker or implantable cardioverter defibrillator (ICD) or a history of orthostatic intolerance 1
- Evaluate patient’s perceived health-related quality of life or health status 1
- Document patient assessment information to guide development and implementation of a patient treatment plan and discharge/follow-up plan 1
From the FDA Drug Label
Ask a doctor or pharmacist before use if you are taking a prescription drug for: Gout, Diabetes, Arthritis When asking questions to a patient from a resident rotating in cardiology, key points to consider include:
- Medication interactions: Ask about prescription drugs for Gout, Diabetes, and Arthritis as they may interact with aspirin 2.
- Current medications: Inquire about the patient's current medication regimen to identify potential interactions.
From the Research
Patient Assessment
When assessing a patient with potential acute coronary syndrome (ACS), the following questions can be asked:
- Can you describe your chest discomfort? Is it substernal or spreading to the arms or jaw? 3
- How long have you been experiencing these symptoms? 3
- Are you experiencing any other symptoms such as shortness of breath or dizziness?
- Do you have a history of hypertension, diabetes mellitus, hyperlipidemia, or a family history of premature coronary artery disease? 3
- Are you a current smoker or have you smoked in the past? 3
- Have you had any prior abnormal cardiac stress test results? 3
- Can you describe any factors that trigger or relieve your symptoms?
Medical History
It is also important to ask about the patient's medical history, including:
- Previous myocardial infarction or coronary artery disease
- History of cardiac procedures such as percutaneous coronary intervention or coronary artery bypass grafting
- Presence of comorbidities such as heart failure, atrial fibrillation, or chronic kidney disease
Risk Factors
Assessing the patient's risk factors for ACS is crucial, including:
- Age: are you at least 65 years old? 3
- Body mass index: is your BMI greater than 25 kg per m2? 3
- Family history: do you have a family history of premature coronary artery disease? 3
- Lifestyle factors: do you engage in regular physical activity, and do you have a healthy diet?
Physical Examination
A physical examination should also be performed, including: