CVS History and Key Cardiovascular Conditions Review
A comprehensive cardiovascular history requires assessing patient profile, chief complaint, and history of presenting illness. Key conditions manifest through five common complaints: chest pain (angina, MI, dissection), breathlessness (heart failure, PE), palpitations (arrhythmias), syncope, and edema. Differentiating these symptoms is crucial for accurate diagnosis and management of serious cardiac events.
Key Takeaways
Cardiovascular history includes CC, HPI, and comprehensive social/medical background.
Angina pain is intermittent, lasting under 10 minutes, and relieved by rest or nitroglycerine.
Acute chest pain requires immediate differentiation between MI, aortic dissection, and pericarditis.
Dyspnea features like orthopnea and PND strongly suggest underlying heart failure.
Palpitations must be analyzed by rhythm, timing, and associated symptoms to rule out serious arrhythmias.
What are the essential components of a cardiovascular patient history?
A thorough cardiovascular patient history is the foundation for accurate diagnosis, systematically gathering information to understand the patient's current state and risk factors. This process begins by establishing the patient's profile and identifying the Chief Complaint (CC), which guides the subsequent detailed investigation. The History of Presenting Illness (HPI) then explores the nature, onset, and progression of the symptoms. Finally, a comprehensive review of past medical, surgical, social history, and current medications provides necessary context for clinical decision-making, ensuring all potential contributing factors are considered early in the diagnostic process.
- Patient's profile: Basic demographic and identifying information.
- Chief Complaint (CC): The primary reason for the visit, stated in the patient's own words.
- History of Presenting Illness (HPI): Detailed exploration of the CC, including onset, duration, severity, and associated symptoms.
- Others: Comprehensive review covering social history, past medical history, surgical history, and current medication use.
How are the five most common cardiovascular chief complaints analyzed?
The five most common chief complaints—chest pain, dyspnea, palpitation, syncope, and edema—are analyzed by characterizing their onset, duration, severity, and relieving factors to distinguish between cardiac and non-cardiac causes. Chest pain, for instance, is classified as acute or intermittent, with intermittent pain often pointing toward angina. Dyspnea requires assessing its relationship to exertion and posture, while palpitations demand analysis of the heart rhythm. Syncope and edema are evaluated for underlying structural heart disease or heart failure, respectively, ensuring life-threatening conditions are identified quickly and appropriate diagnostic pathways are initiated based on symptom presentation.
- Chest Pain / Discomfort: Must be classified as acute (sudden attack) or intermittent (multiple attacks), with intermittent pain often being angina caused by myocardial ischemia. Acute causes include Myocardial Infarction, Aortic Dissection, and Pericarditis.
- Breathlessness / Dyspnea: Defined as the uncomfortable sensation of difficult breathing, requiring analysis of onset, duration, exercise tolerance, and associated symptoms like cough, sputum, or syncope, to differentiate cardiac causes like Heart Failure or PE from non-cardiac origins.
- Palpitation: The unpleasant awareness of the heart beating, analyzed by its nature (rapid, forceful, irregular), timing, frequency, and precipitants like stress or drug use, which is crucial for ruling out underlying arrhythmias.
- Syncope / Presyncope: Transient loss of consciousness, with cardiovascular causes including arrhythmias (VT/SVT), valvular disease (Aortic Stenosis), and Hypertrophic Cardiomyopathy (HCM), requiring careful history taking to distinguish from simple faints or epilepsy.
- Edema: Swelling, commonly caused by cardiovascular issues like Heart Failure (due to increased venous return), venous stasis, or constrictive pericarditis, but also non-cardiac conditions such as nephrotic syndrome or liver disease.
What are the key characteristics of Heart Failure (HF) and major Arrhythmias?
Heart Failure (HF) is defined by the impaired ability of the heart to pump sufficient blood, typically presenting with exertional dyspnea and pitting edema. HF severity is graded using the NYHA classification, ranging from Class I (no limitation) to Class IV (symptoms at rest). Arrhythmias, such as Supraventricular Tachycardia (SVT) and Ventricular Tachycardia (VT), manifest as palpitations or syncope. While SVT is often benign and terminated by vagal maneuvers, VT is high-risk, frequently associated with prior MI or cardiomyopathy, and often requires immediate DC shock if unstable, highlighting the need for rapid differentiation.
- Heart Failure (HF): Defined by impaired ability to pump blood, characterized by symptomatic hallmarks of exertional dyspnea and pitting edema. Severity is classified using the NYHA system, from Class I (asymptomatic) to Class IV (symptoms at rest).
- Special Features of Dyspnea in HF: Includes Orthopnea (worse lying flat, graded by pillows), Paroxysmal Nocturnal Dyspnea (PND, sudden nocturnal breathlessness often with frothy secretions), and Bendopnea (dyspnea when bending at the waist).
- Ectopic Beats (Extrasystoles): Described as 'missed beats' followed by a strong beat due to compensatory pause, originating from an extra impulse outside the SA node, and are generally benign and abolished by exercise.
- Supraventricular Tachycardia (SVT): A regular, fast rhythm (>160 BPM) starting above the ventricles, causing regular palpitations and lightheadedness, often terminated by vagal stimulation like the Valsalva maneuver.
- Ventricular Tachycardia (VT): A high-risk arrhythmia often associated with presyncope or syncope, typically occurring in patients with prior Myocardial Infarction or cardiomyopathy, requiring immediate DC shock for unstable cases.
- Atrial Fibrillation (AFib): Characterized by an irregular rhythm, which necessitates chronic management with anticoagulants to prevent thromboembolic events and clot formation.
- High-Risk Features for Life-Threatening Arrhythmias: Include previous MI or cardiac surgery, associated syncope or severe chest pain, a family history of sudden death, or significant structural heart disease such as Hypertrophic Cardiomyopathy.
Which conditions cause common cardiovascular symptoms like chest discomfort, breathlessness, and palpitations?
Common symptoms like chest discomfort, breathlessness, and palpitations can stem from both cardiovascular and non-cardiovascular origins, necessitating careful differential diagnosis. Chest discomfort, for example, must be evaluated for life-threatening cardiac causes like Myocardial Infarction (MI) and Aortic Dissection, alongside non-cardiac issues such as oesophageal spasm or musculoskeletal pain. Similarly, breathlessness may indicate Heart Failure (HF) or Pulmonary Embolism (PE), but also respiratory disease or anxiety. Palpitations, while often due to tachyarrhythmias, can also be triggered by hyperthyroidism or drug use, requiring a systematic approach to pinpoint the underlying etiology.
- Chest Discomfort Causes: Cardiovascular causes include Myocardial Infarction (MI), Angina, Pericarditis, and Aortic Dissection. Other causes include Oesophageal spasm (gripping, tight, burning character), Pneumothorax, and Musculoskeletal (MSK) pain.
- Breathlessness Causes: Cardiovascular causes include Heart Failure (HF), Valvular Disease, Anemia, and Pulmonary Embolism (PE). Other causes include Respiratory disease, Anxiety, Obesity, and Panic Attack.
- Palpitation Causes: Cardiovascular causes include Tachyarrhythmia and Ectopic beats. Other causes include Hyperthyroidism (Thyrotoxicosis), drug abuse (e.g., Cocaine), and Anxiety.
Frequently Asked Questions
What distinguishes stable angina from unstable angina?
Stable angina is caused by a fixed obstruction, lasts less than 10 minutes, and is relieved by rest or nitroglycerine. Unstable angina involves worsening symptoms, severe pain, and occurs at rest or with mild exertion, often lasting longer than 10 minutes.
What are the three most critical acute cardiovascular causes of chest pain?
The three most critical causes are Myocardial Infarction (MI), identified by high cardiac enzymes; Aortic Dissection, characterized by sudden, severe, tearing pain radiating to the interscapular area; and Pericardial Chest Pain, which is stabbing and relieved by leaning forward.
When should palpitations be considered high-risk for a life-threatening arrhythmia?
Palpitations are high-risk if associated with syncope, severe chest pain, or if the patient has a history of prior MI, cardiac surgery, or significant structural heart disease like Hypertrophic Cardiomyopathy (HCM) or Aortic Stenosis.
