a very concise , palatable guide to clinical practice in patients with cardiovascular disease in no more than 37 slide with each slide taking no more than half minute reading , surely you well like it , please leave us your impressions bellow this will encourage us .
4. A- Introduction
History /
patients complain and Drs enquiry
about the complain , by the end of the
history you will obtain Symptoms
5. Continue…
History taking is an art .
It takes time and practice to master it .
communication skills is crucial in history
taking .
You have to be kind & gentle to the patient
.
6. Continue…
Examinations/
a set of techniques and skills performed
by a doctor on a patient required to
obtain informations about the health
status of that patient , by the end of
examination you will obtain the Signs .
7. Continue…
Component of clinical medicine :
1. History & examination:
signs& symptoms .
1. Investigation : laboratory & imaging.
2. Management : general & specific .
3. Complication .
4. Prognosis.
5. Counseling .
8. B-History taking in a patient with
a CVS complain
Component of the history (HX):9 items
1. Personal data (PD).
2. Presenting complain (PC) i.e. Symptoms .
3. Hx of presenting complain (HPC).
4. Review of systems (ROS).
5. Past medical Hx (PMHx).
6. Drug Hx .
7. Family Hx.
8. Social Hx .
9. Summary of your Hx.
9. 1-PD :
this mnemonics could help you
memorize the component of PD .
“NAS RIA”
1-Name. 4-Resident.
2-Age. 5-Informant.
3-Sex. 6-Admission date.
10. An example
I’m presenting …. … … 70 yrs old male
from “…… ”
Neighborhood informed by himself
Admitted on 15th of nov / 2020.
11. 2-PC in the CVS :
I. Chest pain .
II. Shortness of breath (SOB) .
III. Palpitation .
IV. Syncope .
V. Lower limb swelling/edema.
13. Important notes On PC
Write the patients own word .
Chronologically ordered from the
oldest to the newest as you saw
above .
The duration show you wither the
complain is a chronic or an acute one.
14. 3-HPC
Analyze the PC chronologically from
the oldest to the newest in a story like
literature.
It’s the most important step in Hx.
Exclude or include other PC in CVS.
15. Analysis of the common PC
i. Chest pain / any pain SOCRATES
ii. SOB / ODI ARTA .( onset, duration, intensity,
aggravating, reliving factor, timing , association).
iii. Lower limb edema / onset ,duration
,extent ,progression .
17. An example
The condition started 5 days prior to
admission with gradual onset of central
chest pain lasting no more than 5 minutes
patient describe it as if a tight band is
wrapped around his chest , radiating to
the left arm and to the jaws aggravated by
strenuous activity & relived upon resting ,
patient deny any associated symptoms
or severe restriction of his daily activity by
the pain .
18. 4- ROS
Enquire about a possible effect of the
cardiovascular illness on other
systems , or to obtain the cause .
It’s a quick review of all systems .
Yes or no questions .
19. An example
ROS :
1-Nervous system:
no symptoms suggestive of ICP , higher function , sensory or
motor affection , sphincteric control are maintained .
2-Gastrointestinal system :
Abdominal distension(hepatomegaly , ascites) , abdominal pain
(stretch of the liver capsule) .
3-Genietourinary systems :
Urine amount , frequency , color .
4-Musculoskeletal system : features of Rheumatic fever
Join pain , swelling , limitation of ambulation ,skin changes.
20. 5-PMHx
PMHx of similar condition .
Hx of Chronic illnesses ; DM , HTN.
PMHx of hospitalization .
PMHx of surgical operation .
PMHx of Blood transfusions .
21. 6-Drug Hx
Is the patient allergic to any drugs ?
List if there is any .
Chronic medication : DM, HTN.
Now on : e.g. Captoperil R 50mg /8h
22. 7-familay Hx
family Hx of similar condition .
Family Hx of chronic illnesses ; DM
,HTN .
Family Hx of sudden cardiac death .
23. 8-Social Hx
Living status .
Any health insurance .
Any past Hx or current Hx of illicit drug
, alcohol abuse .
24. 9-Summerize your Hx
Age group .
Sex
chief PC .
Use the medical terminology .
Important negatives .
Important positives .
25. An example
An elder male recently diagnosed with
DM , presented to the casualty with
chest pain for 5 days & Dyspnea for 3
days with no PMHx of similar condition
or in his family ,admitted for further
workup .
26. C-Examination(Ex)
General Ex :
-patient general look .
-decubitus ( lying , cardiac bed )
-Devices ( cannulas , oxygen )
-pallor , cyanosis .
-Hand : peripheral stigmata of infective
endocardtitis .
-Periphral cyanosis .
36. The above picture
A- auscultation for mitral stenosis is done
best while the patient is in Left
lateral decubitus.
B-murmer of aortic regurgitation patient is
best positioned setting , leaning forward
while exhaling (remember left heart murmer
during expiration ) .
37. Complete your Ex
By doing :
1-abdominal Ex :
Tender hepatomegaly , ascites .
2-lower limb for Edema .
3- Document and debrief the
patient .
