Cardiovascular History Taking | Key Symptoms | OSCE Guide | SCA | UKMLA | CPSA

Summary

Lewis, the founder of Geeky Medics, introduces a new format for discussing essential cardiovascular symptoms in patient history-taking. He covers chest pain, shortness of breath, palpitations, syncope, edema, intermittent claudication, and systemic symptoms, using the acronym SOCRATES for chest pain assessment. The video aims to improve understanding of cardiovascular conditions and seeks feedback for future content.

Takeaways

• 📝 The video discusses key cardiovascular symptoms for medical history taking, emphasizing the importance of covering chest pain, shortness of breath, palpitations, syncope, edema, intermittent claudication, and systemic symptoms.
• 🔍 The acronym SOCRATES is introduced as a tool to gather detailed information about chest pain, applicable to any type of pain and useful for differentiating between various cardiovascular conditions.
• 📍 Cardiac chest pain is typically described as left-sided or central and can be sharp, often radiating to the left arm, neck, and jaw.
• 🕒 The onset, duration, and time course of chest pain are crucial for distinguishing between conditions like stable angina and myocardial infarction (MI), with angina pain usually lasting less than 20 minutes.
• 🏋️‍♂️ Exacerbating and relieving factors of chest pain, such as exertion for angina and positional changes for pericarditis, help in diagnosing the underlying cause.
• 🌡 Dyspnea, or shortness of breath, is associated with various cardiovascular issues and can be explored through questions about recent changes in breathing, walking distance, and activities affected by the symptom.
• 🛌 Orthopnea, waking up gasping for air, and paroxysmal nocturnal dyspnea (PND) are specific types of dyspnea indicative of heart failure.
• 💓 Palpitations, a sensation of a fast or fluttering heartbeat, can be regular or irregular and have various causes, including anxiety and arrhythmias.
• 😵 Syncope, a rapid loss of consciousness due to reduced cerebral perfusion, is differentiated from seizures by its short duration and quick recovery without a post-ictal phase.
• 🦶 Edema, or fluid retention, manifests differently based on location: peripheral (pedal edema), abdominal (ascites), and pulmonary edema, each suggesting specific cardiovascular issues.
• 🚶‍♂️ Intermittent claudication, muscle pain during exertion that resolves with rest, is a sign of peripheral vascular disease (PVD) and a risk factor for other cardiovascular conditions.
• 🌐 Systemic symptoms like fatigue, fever, weight loss, and weight gain, though not directly cardiovascular, can be relevant in the context of heart failure, infective endocarditis, or atrial myxoma.

Q & A

What is the purpose of the video by Lewis from Geeky Medics?

The purpose of the video is to discuss the key cardiovascular symptoms that should be covered when taking a cardiovascular history.

What is the acronym SOCRATES used for in the context of the video?

The acronym SOCRATES is used to gather more details about chest pain, and it can be applied to any type of pain, making it a useful tool in medical history taking.

What does the acronym SOCRATES stand for?

The specific meaning of SOCRATES is not provided in the script, but it is used as a mnemonic for various aspects of pain assessment.

What are the typical locations for cardiac chest pain according to the video?

Cardiac chest pain is typically left-sided or central in location.

How does the onset of pain in myocardial infarction differ from that in pericarditis?

The pain of myocardial infarction typically develops suddenly over seconds to minutes, whereas the pain associated with pericarditis might evolve over several days.

What does the video suggest asking patients to help determine the character of their chest pain?

The video suggests asking patients to describe their pain, whether it is sharp or more of a dull ache, to help determine the character of chest pain.

What symptom associated with myocardial infarction typically radiates to the left arm, neck, and jaw?

Chest pain associated with myocardial infarction typically radiates to the left arm, neck, and jaw.

How can the time course of chest pain help differentiate between stable angina and myocardial infarction?

The time course of chest pain can help differentiate between conditions as chest pain from angina typically lasts less than 20 minutes, while myocardial infarction has a different time course and associated symptoms.

What are some examples of exacerbating and relieving factors for chest pain in different conditions mentioned in the video?

In angina, chest pain is typically exacerbated by exertion and relieved by rest or the use of GTN spray. In pericarditis, chest pain is exacerbated by lying flat and relieved by leaning forwards.

What is the significance of asking patients to grade their pain on a scale of zero to ten?

Asking patients to grade their pain helps gauge the initial pain severity and a patient's response to treatment, providing valuable information for diagnosis and treatment planning.

What are some key questions to explore dyspnea or shortness of breath as mentioned in the video?

Key questions to explore dyspnea include asking if the patient has felt more short of breath recently, how far they can walk before feeling short of breath, and if there are activities they are unable to do because of it.

What is orthopnea and how is it related to heart failure?

Orthopnea is shortness of breath when lying flat, a common symptom of heart failure. Patients often use multiple pillows to prop themselves up to reduce this symptom.

What is paroxysmal nocturnal dyspnea (PND) and how is it associated with heart failure?

Paroxysmal nocturnal dyspnea (PND) is the experience of waking at night gasping for air, often necessitating getting out of bed to a nearby window for breath. It is strongly associated with heart failure.

How can palpitations be described by patients and what does it indicate?

Palpitations can be described by patients as a sense of a fast, beating, fluttering, or pounding heart. They might describe the rhythm as regular or irregular, indicating a wide range of causes including anxiety, atrial fibrillation, and other arrhythmias.

What is the difference between syncope and seizures in terms of loss of consciousness?

Syncope involves a rapid loss of consciousness due to reduced cerebral perfusion, with quick recovery, unlike seizures, which have a longer duration of unconsciousness followed by a post-ictal phase of drowsiness, confusion, and memory loss.

Why is it important to clarify the terminology used by patients when they refer to syncopal episodes?

Clarifying the terminology is important because patients may use a range of terms like dizzy spells, funny turn, faints, or blackouts, which can indicate different underlying conditions and help in accurate diagnosis.

What are the different names for edema depending on its location in the body?

Edema is called pedal edema when it affects the lower limbs, ascites when it's in the abdomen, and pulmonary edema when it's in the lungs.

What are some useful questions to identify and explore pedal edema?

Useful questions include asking if the patient has noticed more swollen ankles than usual, if the swelling worsens as the day goes on, and if medications like amlodipine have worsened peripheral edema.

What is intermittent claudication and how does it present?

Intermittent claudication refers to muscle pain that develops during mild exertion and resolves with rest due to inadequate perfusion from peripheral vascular disease. Patients complain of specific leg pain during exertion that settles with rest.

What does the presence of intermittent claudication suggest about the patient's cardiovascular health?

The presence of intermittent claudication suggests underlying peripheral vascular disease or PVD, which is a significant risk factor for other cardiovascular pathologies such as angina and myocardial infarction.

What are some systemic symptoms that may be relevant to cardiovascular health despite not seeming obviously connected?

Systemic symptoms such as fatigue, fever, weight loss, and weight gain may be relevant to cardiovascular health in contexts like heart failure, infective endocarditis, pericarditis, and atrial myxoma.

Outlines

00:00

📝 Key Cardiovascular Symptoms Overview

Lewis, the founder of Geeky Medics, introduces a new video format to discuss essential cardiovascular symptoms for medical history taking. He invites feedback on the format's helpfulness and improvement suggestions. The video covers chest pain, shortness of breath, palpitations, syncope, edema, intermittent claudication, and systemic symptoms. Chest pain is explored in-depth using the SOCRATES acronym to guide detailed questioning about the pain's characteristics, onset, radiation, associated symptoms, time course, exacerbating/relieving factors, and severity. The segment emphasizes the importance of understanding chest pain's nuances to differentiate conditions like stable angina and myocardial infarction.

05:01

💬 In-Depth Analysis of Cardiovascular Symptoms

This paragraph delves deeper into specific cardiovascular symptoms, starting with dyspnea (shortness of breath) and its association with conditions like myocardial infarction and congestive heart failure. It describes orthopnea and paroxysmal nocturnal dyspnea as indicators of heart failure. Palpitations are discussed next, highlighting their connection to various arrhythmias and the importance of rhythm assessment. Syncope is examined, distinguishing it from seizures and emphasizing the need to clarify triggers and the circumstances preceding the episode. Edema is broken down by location, with pedal edema and pulmonary edema pointing to heart failure, while ascites may suggest liver issues. Intermittent claudication, indicative of peripheral vascular disease, is characterized by muscle pain during exertion that resolves with rest. Systemic symptoms like fever, weight changes, and fatigue are also considered relevant to cardiovascular health, with examples provided for each.

10:03

🔚 Conclusion and Resource Sharing

In the concluding paragraph, Lewis wraps up the discussion on cardiovascular symptoms and encourages viewers to check out the guide on the Geeky Medics website for more information on taking a cardiovascular history. He expresses gratitude for the viewers' time and seeks their feedback on the video's helpfulness and areas for improvement, aiming to enhance future content.

Keywords

💡Cardiovascular Symptoms

Cardiovascular symptoms refer to the indications or signs that suggest a problem with the heart or blood vessels. In the video, these symptoms are the central focus, as they are essential for diagnosing various heart conditions. Examples from the script include chest pain, shortness of breath, and palpitations, which are all discussed in detail as part of a cardiovascular history.

💡Chest Pain

Chest pain is a common symptom that can be indicative of cardiovascular issues. The video script uses the acronym SOCRATES to explore different aspects of chest pain, such as its site, onset, character, and radiation. It is mentioned as one of the most frequent symptoms in a cardiovascular OSCAR scenario, highlighting its importance in diagnosis.

💡Shortness of Breath (Dyspnea)

Shortness of breath, also known as dyspnea, is a sensation of not being able to get enough air and is associated with various heart conditions. The script discusses how to explore this symptom, including questions about its onset, severity, and activities that may exacerbate it. It is used as an example to illustrate the wide range of cardiovascular pathologies it can be linked to.

💡Palpitations

Palpitations are the sensation of a fast, fluttering, or pounding heart. The video explains that patients might describe them as regular or irregular, and it suggests asking patients to tap out the rhythm on their hand to determine regularity. Palpitations are a key symptom that can be caused by a range of conditions, including anxiety and arrhythmias.

💡Syncope

Syncope is a sudden loss of consciousness due to reduced cerebral perfusion. The video script differentiates it from other causes of loss of consciousness, such as seizures, by noting its short duration and quick recovery. It also emphasizes the importance of understanding the triggers and circumstances of a syncopal episode to aid in diagnosis.

💡Edema

Edema refers to the swelling caused by fluid retention in body tissues. The script explains that edema can occur in different parts of the body, such as the lower limbs (pedeoedema), the abdomen (ascites), or the lungs (pulmonary edema). It is a symptom that can indicate heart failure or other cardiovascular issues, and the video provides questions to explore its presence and severity.

💡Intermittent Claudication

Intermittent claudication is muscle pain that occurs during mild exertion and resolves with rest, typically due to peripheral vascular disease. The video script discusses how to identify this symptom by asking about walking distance before pain occurs and whether the pain resolves with rest, which is crucial for diagnosing underlying vascular conditions.

💡Systemic Symptoms

Systemic symptoms are those that affect the body as a whole and can include fatigue, fever, weight loss, and weight gain. Although not directly related to the cardiovascular system, these symptoms can be relevant in the context of heart conditions, as explained in the video. For instance, fatigue and weight gain can be associated with heart failure.

💡Myocardial Infarction

Myocardial infarction, commonly known as a heart attack, is a serious cardiovascular event where blood flow to the heart is blocked. The script describes the pain associated with it as typically sharp and sudden, often radiating to the left arm, neck, and jaw, which is crucial for timely diagnosis and treatment.

💡Pain Radiation

Pain radiation refers to the spreading of pain from its original site to other areas of the body. In the context of the video, it is used to describe how chest pain from a myocardial infarction can radiate to the left arm, neck, and jaw, which is an important diagnostic clue for healthcare professionals.

💡Arrhythmias

Arrhythmias are irregularities in the heart's rhythm and can cause symptoms like palpitations. The video script mentions them as one of the wide range of causes for palpitations, indicating the importance of understanding a patient's heart rhythm in cardiovascular assessments.

Highlights

Introduction of a new format for discussing cardiovascular symptoms.

Request for feedback on the new format's helpfulness and suggestions for improvement.

Listing of key cardiovascular symptoms: chest pain, shortness of breath, palpitations, syncope, edema, intermittent claudication, and systemic symptoms.

Explanation of the acronym SOCRATES for gathering detailed information about chest pain.

Description of the typical location of cardiac chest pain and its onset.

Differentiation between the sudden onset of myocardial infarction pain and the gradual onset of pericarditis pain.

Importance of understanding the character of chest pain and its radiation to other body parts.

Inquiry into associated symptoms with chest pain, such as nausea or fever.

Significance of the time course of chest pain in differentiating between stable angina and myocardial infarction.

Discussion on exacerbating and relieving factors of chest pain, especially in relation to angina and pericarditis.

Assessment of pain severity using a zero to ten scale and its relevance to treatment response.

Exploration of dyspnea, its association with various cardiovascular conditions, and its impact on daily activities.

Identification of orthopnea and paroxysmal nocturnal dyspnea as indicators of heart failure.

Discussion on palpitations, their description, and potential causes including arrhythmias.

Differentiation between syncope and seizures, and the importance of clarifying patient descriptions of fainting episodes.

Explanation of edema, its types based on location, and its association with heart failure and other conditions.

Identification of intermittent claudication as a symptom of peripheral vascular disease and its implications.

Discussion on systemic symptoms like fatigue, fever, weight loss, and weight gain in the context of cardiovascular diseases.

Conclusion summarizing the importance of covering these key symptoms when taking a cardiovascular history.

Transcripts

[Music]

hey everyone

i'm lewis and i'm the founder of geeky

medics

today i'm going to discuss the key

cardiovascular symptoms you'd be

expected to cover

in the context of taking a

cardiovascular history

this is a new format that i've been

wanting to try out for some time

so i'd really love to hear your feedback

on whether you found this helpful

and how i might go about improving this

moving forwards

okay let's get started the key

cardiovascular symptoms

which you should try and cover in any

cardiovascular history

include chest pain shortness of breath

palpitations and syncope edema

intermittent claudication and systemic

symptoms

such as fever weight loss and weight

gain

let's start by discussing chest pain

because it is probably one of the most

common symptoms

in the context of a cardiovascular oscar

scenario

you can gather more details about chest

pain using the acronym

socrates now this acronym can actually

be applied to any type of pain

so it's a really useful tool to have in

your metaphorical or ski belt

to begin with we need to clarify the

site of the pain

we can do this by asking the patient

questions such as can you tell me where

the pain is

if the patient seems to be struggling to

describe the location of the pain

it can sometimes be helpful to ask them

to point to where it hurts

cardiac chest pain is typically

left-sided or central in location

next we need to clarify the onset of the

pain

and by that i mean how and when did the

pain start

some useful questions to elicit this

information might include

did the pain come on suddenly or

gradually

when did the pain first start what were

you doing when the pain started

the pain of a myocardial infarction will

typically develop suddenly

over the course of seconds to minutes

whereas the pain associated with

pericarditis for instance

might evolve over several days next up

we need to explore the character of the

pain so some useful questions to figure

this out might include

how would you describe the pain is the

pain

sharp or more of a dull ache chest pain

associated with myocardial infarction

is typically sharp in nature and is

often associated with a sense of

pressure on the chest

next we need to ask about radiation of

the pain

and by that i mean does the pain move

anywhere else

chest pain associated with myocardial

infarction typically radiates to the

left arm

neck and jaw next we need to ask if the

patient is experiencing

any symptoms that seem associated with

the pain some examples might include

nausea and vomiting in the context of mi

or

fever and malaise in the context of

pericarditis

next up we need to clarify the time

course including how long the symptom

has been going on

and whether it has changed over that

time period this is really important in

the context of chest pain

as it can help differentiate between key

conditions

such as stable angina and mi with the

chest pain from angina

typically lasting less than 20 minutes

next up we need to ask about

exacerbating and relieving factors

with questions such as have you noticed

anything that seems to make the pain

worse

or does anything seem to improve the

pain

in the context of angina chest pain is

typically exacerbated by exertion

and relieved by rest or the use of gtn

spray

in the context of pericarditis chest

pain is typically exacerbated by lying

flat

and relieved by leaning forwards finally

we need to determine the severity of the

pain

and to do this we need to ask patients

to grade their pain

on a scale of zero to ten with zero

being no pain

and ten being the worst pain they've

ever experienced clearly this is quite a

subjective way of measuring pain

but it can be really helpful to gauge

the initial pain severity

and also a patient's response to

treatment

so if a patient presents with acute

coronary syndrome

and they report their chest pain as

eight out of ten

and then you administer some morphine

and gtn and then report their pain as

two out of ten

that's helpful information the next

symptom we're going to cover

is dyspnea which is also known as

shortness of breath

shortness of breath is associated with a

wide range of cardiovascular pathology

including myocardial infarction and

congestive heart failure

some questions that might be useful to

further explore dyspnea

include have you felt more short of

breath recently

how far are you able to walk before you

feel short of breath

is there anything you're unable to do

because of the shortness of breath

shortness of breath when lying flat is

known as orthopedia

now this is a common symptom of heart

failure and patients often use multiple

pillows

to prop themselves up to reduce this

symptom

as a result it can often be worth asking

patients

how many pillows they use to get an idea

of the severity

some patients may describe waking in the

night gasping for air

needing to get out of bed and to a

nearby window to catch their breath

this is known as paroxysmal nocturnal

dyspnea or pnd

and it is strongly associated with heart

failure

okay now let's talk about palpitations

another key cardiovascular symptom

palpitations are a sense of a fast

beating fluttering

or pounding heart patients might

describe

palpitations as feeling regular or

irregular

in their rhythm if patients aren't quite

sure

if their palpitations are regular or not

it can be useful to ask them to tap out

the rhythm on their hand

palpitations have a wide range of causes

including anxiety

atrial fibrillation and a range of other

arrhythmias

the next key symptom we're going to

discuss is syncope

syncope involves rapid loss of

consciousness secondary to reduced

cerebral perfusion

the loss of consciousness is typically

short in duration with the patient

recovering quite quickly

this is quite different to the loss of

consciousness associated with seizures

which is typically longer in duration

and followed by a period of drowsiness

confusion and memory loss

often referred to as a post-ictal phase

patients often refer to syncopal

episodes using a wide range of

terminology

such as dizzy spells funny turn faints

or blackouts

so it's really important that you

clarify exactly what they mean by those

terms

it's particularly important to ask about

triggers for the patient sinkable

episode

with questions such as did anything seem

to cause the blackout

what were you doing immediately before

the faint syncope

associated with a sudden change in

posture such as moving from a lying to a

standing position

is suggestive of postural hypotension

whereas syncope associated with exertion

may indicate an underlying diagnosis of

aortic stenosis

or an arrhythmia now let's discuss edema

so this refers to fluid retention in

various body tissues

and depending on the location of the

edema it has a different name

so if there is edema affecting the lower

limbs we call this

paedoedema if there is edema within the

abdomen

we often refer to this as ascites and if

there is edema within the lungs

themselves

we call this pulmonary edema patients

with pedal edema

typically complain of ankle swelling

that worsens as the day goes on

as a result of gravity drawing fluid

into the legs

patients may also report that their legs

feel heavier than usual

or that their skin feels tight and

comfortable questions that might be

useful to identify and explore pedal

edema

include have you noticed that your

ankles seem more swollen than usual

does the swelling in your ankles get

worse as the day goes on

medications such as amlodipine can also

worsen peripheral edema

patients with pulmonary edema often

present with shortness of breath

a rattly chest and reduced exercise

tolerance

pomona edema is typically caused by left

ventricular

failure whereas right ventricular

failure

typically causes peripheral edema

intermittent claudication refers to

muscle pain

that develops during mild exertion and

resolves with rest

and this occurs because of inadequate

perfusion to the affected muscle groups

as a result of peripheral vascular

disease

patients often complain of pain in a

specific leg that develops during

exertion

and then settles with rest some useful

questions to further explore

intermittent claudication include

how far are you able to walk before the

pain develops

does the pain go away when you rest have

you ever developed this pain whilst

at rest have you ever experienced any

change in sensation

or weakness of the leg the presence of

intermittent claudication

suggests underlying peripheral vascular

disease or pvd

this is important to know as the

presence of pvd

is a significant risk factor for other

cardiovascular pathology

such as angina and myocardial infarction

finally let's discuss systemic symptoms

so some examples of systemic symptoms

include fatigue

fever weight loss and weight gain

although these symptoms might not seem

obviously connected to the

cardiovascular system

they may still be relevant some examples

include

fatigue and weight gain in the context

of heart failure

fever in the context of infective

endocarditis or pericarditis

and weight loss and fatigue in the

context of atrial mixoma

and that's a wrap so we've now discussed

the key cardiovascular symptoms

you'd be expected to cover when taking a

cardiovascular history

to learn more about cardiovascular

history taking make sure to check out

the guide on the geeky medics website

i'd really appreciate it if you could

let me know if this was helpful and also

how i might go about improving

future videos and finally thanks for

tuning in