This document outlines the components of a thorough medical history and examination for a patient presenting with cardiac issues. It includes sections for collecting information on the patient's chief complaints, medical history, medications, lifestyle, family history, physical examination findings, and cardiovascular exam. The physical exam section details assessing vital signs, jugular venous pressure, heart sounds, murmurs, pulses, and other relevant physical signs.

1. Dr VISHESH ROHATGI
MD, Dip Cardiology

2. • Name
• Age
• Sex
• Marital status
• Education
• Occupation
• Address

3. • Chief complaints
• History of presenting illness
• Angina – onset, position, nature, radiation, duration, progression,
NYHA class, aggravating and relieving factors
• Dyspnoea – orthopnoea and PND
• Syncope
• Fatigue
• Palpitations – onset, duration, rate, rhythm, associated chest pain
or pre syncope

4. • Associated features – ask for
1. Oliguria
2. Cerebrovascular
accident
3. Sweating
4. Fever
5. Arrhythmia
6. Nausea, vomiting
7. Peripheral vascular
disease
8. Cough
9. Hemoptysis
10. Headache
11. Dysphagia
12. Hoarseness of voice
13. Impotence
14. Nocturnal cramps

5. • Ischaemic heart disease
• Asthma
• COPD
• Diabetes mellitus
• Hypertension
• Dyslipidemia
• Acid peptic disease
• Cardiac surgery
• Chronic renal failure
• Thyroid disease

6. • Coronary artery disease
• Obesity

7. • Any previous medications should be mentioned

8. • Smoking
• Alcohol
• Bowel and bladder movements
• Sleep
• Diet

9. • Age of menarche
• Duration, regular
• Volume, clot
• Menopause attained

10. • Conceived
• Term
• Living
• Delivery mode
• Hypertension
• Edema / seizures developed in the antenatal or postnatal
period - PIH

11. • History of cyanosis (peripheral / central)
• Difficulty in feeding – slow, small volume feed, tiring
easily, rest during feed
• Poor growth
• Difficulty in breathing
• Respiratory infections
• Squatting episodes

12. • Consanguinity – yes / no
• Age of father
• Age of mother
• No of siblings
• Rank of child
• History of sibling with CHD / chromosomal abnormality

13. • Birth weight
• Milestones

14. • Conscious, co-operative, well-oriented, lying comfortable
• Height, weight, BMI
• Teeth, Thyroid
• Pallor, icterus, cyanosis, clubbing, lymphadenopathy,
edema
• RF – joint swelling
• IE – clubbing, splinter hemorrhages, osler nodes,
Janeway lesions, Petechiae
• Fundus – for IE, HTN signs
• Signs of chromosomal anamoly- webbed neck,
Hypertelorism, low-set ears, high arched palate

15. • Pulse rate – rate, rhythm, volume, character, peripheral
pulses, radio-radial delay, radio-femoral delay, condition
of arteries, bruit over peripheral pulses
• Heart rate – to find PR-HR deficit
• BP – sitting, lying, standing, upper limb and lower limb
• Temperature
• Respiratory rate – rate and type

16. • Jugular venous pressure – waves, respiratory change
• Abdomino-jugular reflex

17. • Inspection
• Chest wall defects like excavatum, carinatum, symmetrical, B/L
moves with respiration
• Precordial bulge
• Apical impulse seen and position
• Other pulsations seen including epigastric, carotid pulsations etc
• Previous operation scar
• Intercostal retractions in congenital

18. • Palpation
• Tracheal position
• Apical impulse – position, character
• Parasternal heave
• Thrills including carotid
Percussion in PE, DCM

19. • Auscultation
• First and second heart sound
• Murmur
• Area best heard
• Systolic or diastolic
• Timing and character (MDM, PSM etc)
• Grading
• Pitch – high or low
• Bell or diaphragm
• Conduction
• Variation with respiration
• Posture – best heard
• Dynamic auscultation – exercise, Valsalva, standing

20. • Auscultate in other areas
• Carotid
• Inter and infra scapular
• Axilla
• Supra and infra clavicular
Added sounds – S3, S4, OS, rub, Diastolic
knock, Prosthetic valve sound, Tumor plop

21. THANK YOU