Lesson Objectives:

• Master key history-taking techniques for cardiovascular patients.

• Recognize critical symptoms such as chest pain, dyspnea, and syncope.

• Perform a thorough cardiac physical exam, including murmurs and vascular signs.

History-Taking in Cardiology

A detailed history is essential in diagnosing cardiovascular conditions. The mnemonic OPQRST helps assess chest pain:

O – Onset (Sudden vs. gradual)
P – Provocation/Palliation (Worse with exertion? Better with rest?)
Q – Quality (Sharp, dull, pressure, squeezing?)
R – Radiation (Neck, jaw, left arm, back?)
S – Severity (Scale 1-10)
T – Timing (Constant or intermittent?)

🔹 Key Symptoms & Their Implications:

• Chest pain: Can be ischemic (e.g., MI, angina) or non-ischemic (e.g., pericarditis, costochondritis).

• Dyspnea (Shortness of breath): Common in heart failure, pulmonary embolism, or valvular disease.

• Syncope: Suggests arrhythmias, aortic stenosis, or neurocardiogenic syncope.

• Palpitations: Consider AFib, PVCs, hyperthyroidism.

Cardiac Physical Exam

1️⃣ Inspection

• Look for cyanosis (hypoxia), jugular venous distension (JVD), edema (CHF).

2️⃣ Palpation

• Apical impulse: Displaced laterally in LVH or cardiomyopathy.

• Pulses: Weak pulses in cardiogenic shock, bounding pulses in aortic regurgitation.

3️⃣ Auscultation (Heart Sounds & Murmurs)

• S1 & S2: Normal heart sounds.

• S3 (ventricular gallop): Suggests heart failure.

• S4 (atrial gallop): Seen in hypertension, LVH, aortic stenosis.

• Murmurs:

  • Systolic Murmurs: Aortic stenosis (crescendo-decrescendo), mitral regurgitation (holosystolic).

  • Diastolic Murmurs: Aortic regurgitation (decrescendo), mitral stenosis (rumbling).