History taking in Cardiac cases
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History taking in Cardiac cases

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History taking in Cardiac cases Presentation Transcript

  • 1. History Taking in Cardiac Cases Shahid Abbas Interventional cardiologist and Physician
  • 2. Introduction ?
  • 3. Introduction Name Age Occupation Residence
  • 4. Presenting Complaints 1 or 2 How to ask ?
  • 5. H/o present Illness • How to start ? • Detail of PC and all the pertaining Issues Missed D/D
  • 6. Chest Pain ?
  • 7. Chest Pain • • • • • • • • • Intensity Associations Pattern • Sweating Location • ACS Duration • Palpitations • Pneumonia Radiation • Fever • PE Aggravating/ relieving F • Breathlessness • Dissection of Aorta Frequency • vomiting • APD GERD Progression • Costochondritis D/D
  • 8. Breathlessness ?
  • 9. Breathlessness • • • • • • • • • • NYHA Orthopnia /PND (No of Pillows) Palpitations Oedema feet Abd Distension Otners Life style modification Fever Hemoptysis D/D • LVF • COAD/ Br Asthma • Infections/TB • PEmbolism
  • 10. Palpitation ?
  • 11. Palpitation • • • • • • Frequency Rhythem Micturtion reflex DC cardioversion Embolic Drugs • • • • CVA Kid Gut Limb
  • 12. MI ?
  • 13. H/o MI • • • • • • • • • DDT SK Door to Needle/ balloon time DC Shock LV dysfunction Shock Rehabilitation TLC Education
  • 14. Risk Factors • • • • • • DM HTN Smoking Dyslipedemia Family History Menopause CAD equivalents • DM • Abd Aortic aneurysm • PVD • Symptomatic Carotid Artery disease
  • 15. Cardinal points • • • • • • • • • Dizziness Syncope CVA Carotid Artery Disease Chest Pain Breathlessness Palpitations MI Intermittent Claudication Oedema Feet
  • 16. Systemic review Co-Morbidity COAD Br Astma CLD CKD Contraindications to stenting
  • 17. Investigations Results
  • 18. Treatment Compliance Response to medications Side effects Admissions Drug Allergies
  • 19. Personal / family History Exercise Smoking Alcohol Marital Status Kids Socioeconomic Bracket
  • 20. Pace Makers • • • • • • • • Old Documents 1 Lead or 2 Leads Syncope Pus discharge from pocket - I/v Drugs Antibiotics Pace Maker follow up trouble shooting Threshold Sensing not possible in demand mode Anticoagulation (AF + Pacing)
  • 21. Pace Maker (Cont) • • • • Hysteresis Bipolar pacing Magnet VOO Over sensing/ under sensing
  • 22. VHD Presenting Symptoms • decompensation First symptom Breathlessness • • • • • Orthopnia Life style modification Otners synd Wheeze Palpitation
  • 23. VHD (cont ) Chest Pain • Angina • IHD risk Factor Hemoptysis • Fever • Pulm oedema • Chest Pain (infarction/ Embolism)
  • 24. VHD (cont ) IE • Fever duration response to Medications • Admission Thrombo-Embolism • • • • • Palpitations KID CVA Gut Limbs
  • 25. VHD (cont ) Progression of Disease Rehumatic Fever Child hood • Sore throat • Joint pains • Monthly painful Inj Admissions in the Past Investigations • Xray Chest • ECG, ECHO
  • 26. VHD (cont ) Treatment • Compliance • Response • Side effects
  • 27. Diagnosis Expected Patient is a case of Coronary Artery Disease having RATAFICATION Angina CCS II and breathlessness NYHA Class II SIR With no clinical evidence of LV de-compensation IHD ka Case ha And has Functional disability Class II/IV Meriting Coronary evaluation and possible Intervention
  • 28. Diagnosis Expected Patient is a case RATAFICATION of Post Rehumatic Mitral Valve Disease with predominant Mitral Stenosis SIR complicated by severe Pulmonary hypertension; RHD ha sath MS aur AR ha In Sinus rhythm With compensated heart with no clinical stigmata of Infective endocarditis And has Functional disability Class II/IV
  • 29. Diagnosis Expected Patient is a case of Post Rehumatic Mitral Valve Disease with predominant Mitral Stenosis complicated by severe Pulmonary hypertension; Decompensated by Atrial Fibrillation but there are no clinical stigmata of Infective endocarditis And has Functional disability Class III/IV Meriting intervention
  • 30. Functional Disabilty Class 0 Class I ClassII Class III Class IV • • • • • Transfer Dressing Wash room utility Ablation Eating
  • 31. Thank You