THIS PPT CONTAINS DESCRIPTION ABOUT HISTORY TAKING IN PATIENTS WITH CARDIORESPIRATORY DISEASES, EXPLAINED IN DETAILS ABOUT ALL SYMPTOMS & ITS DETAILED HISTORY.

1. HISTORY TAKING
(CARDIO-RESPIRATORY DISEASES)
DR. MEGHAN A. PHUTANE (PT)

2.  Demographic data
 Chief complaint
 History of present illness
 Past medical history
 Surgical history
 Family history
 Occupational history
 Drug history
 Social history
 Personal history

3.  Name – To address the patient
 Age – To rule out age related disorders; anatomical &
physiological status of patient.
 Gender – gender specific diseases
 Address – for feasibility of patient to come to the
hospital for regular visits
 Occupation – occupational hazards
 Date of admission
 Date of evaluation
Demographic data

4.  Cough
 Sputum production
 breathlessness
 Chest Pain
 Hemoptysis
 Wheeze / Stridor
 Palpitations
[ MENTION THE DURATION OF EACH COMPLAINT ]
Chief complaints

5.  History of present illness
 Explain in detail about each & every symptom for
current episode
 About investigations done
 Admission to the hospital (if any)
HOPI

6. Cough
 Reflex act of forceful expiration against a closed
glottis – generating positive intrathoracic pressure.
 Aim is to clear the airways.

8. Acute cough (<3 wks)
 Upper respiratory tract infections
 Pneumonia
 Pulmonary embolism
 Congestive Cardiac Failure

9. Subacute cough (3- 8 weeks)
 Viral infections
 Post infective
 Post nasal drip
 GERD

10. Chronic cough (>8 wks)
 Pulmonary Tuberculosis
 Bronchial Asthma
 COPD
 Bronchogenic carcinoma
 Eosinophilic bronchitis
 Post nasal drip
 GERD
 Drugs like ACE inhibitors
 Congestive cardiac failure

11. Nocturnal cough
 GERD
 Chronic brochitis.
 Bronchial asthma.
 Obstructive sleep apnea
 Left Ventricular Failure
 Aspiration

12. Sputum
 Consistency
 Amount
 Color
 Postural variation
 Smell

13. Consistency
 Serous - Upper Respiratory tract Infection,
Bronchoalvelolar carcinoma
 Mucoid - Chronic bronchitis, Bronchial Asthma
 Mucopurulent - Bacterial infection

14. Amount
Copious Amount
 Bronchiectasis
 Lung Abscess
 Necrotizing pneumonia
 Alveolar cell carcinoma
 Empyema rupturing into bronchus
(Bronchorrhoea - >100ml sptum/day)

15. Color of sputum
 Yellow / Green — Bacterial infection
 Black — coal worker pneumoconiosis
 Pink frothy sputum — Pulmonary edema
 Rusty sputum- pneumococcal pneumonia
 Red currant jelly sputum- klebsiella
 Blood tinged / streaking of sputum- tuberculosis

16. Postural variation
 Lung Abscess
 Bronchiectasis

17. Foul Smell
 Lung abscess
 Bronchiectasis
 Anaerobic bacterial infection

18. “Subjective experience of breathing discomfort that
consists of qualitatively distinct sensations that vary
in intensity. The experience derives from interactions
among multiple physiological, psychological, social,
and environmental factors that may induce secondary
physiological and behavioural responses.”
(The American Thoracic Society)
Dyspnea

19.  Physiological – (mountaineers, exercise,
hyperpyrexia, anemia)
 Respiratory – (airway obstruction, bronchial asthma,
COPD; pulmonary infection, edema or embolism;
cacinoma, pleural effusion, pneumothorax, etc.)
 Cardiac – (acute MI, valvular heart disease, left
ventricular failure, congenital cyanotic heart disease)
 Metabolic – (DM, hypokalemia)
 Neurological –(respiratory center depression, MND,
GBS, myasthenia gravis)
 Psychogenic
Causes

20.  Onset
 Duration
 Severity
 Aggravating and relieving factors
 Postural variation
 Diurnal variation

21. Onset
Within minutes
 Pneumothorax
 Pulmonary embolism
 Inhalation of foreign body
 Larygeal edema
 Left heart failure
Hours to Days
 Acute Respiratory Distress Syndrome
 Bronchial Asthma
 Pneumonia
 Left heart failure

22. Weeks to Months
 COPD
 ILD
 Pleural effusion
 Anemia
 Thyrotoxicosis
 Left ventricular failure

23. Grading of Dysponea (MMRC scale)
Grade Description of Breathlessness
0 I only get breathless with strenuous exercise.
1 I get short of breath when hurrying on level ground or walking up a slight
hill.
2 On level ground, I walk slower than people of the same age because of
breathlessness, or have to stop for breath when walking at my own pace.
3 I stop for breath after walking about 100 yards or after a few minutes on
level ground.
4 I am too breathless to leave the house or I am breathless when dressing.

24. GRADE DESCRIPTION
I No limitation to physical activity. Ordinary physical activity does not cause
undue dysponea, fatigue, palpitations or anginal pain.
II Slight limitation to physical activity. Comfortable at rest. Ordinary physical
activity results in dysponea, fatigue, palpitations or anginal pain.
III Marked limitation to physical activity. Comfortable at rest. Less than
ordinary physical activity causes dysponea, fatigue, palpitations or anginal
pain.
IV Symptoms at rest. Inability to carry out any physical activity without
discomfort. Symptoms of dysponea, fatigue, palpitations or anginal pain
may be present even at rest.
Grading of Dysponea (NYHA scale)

25. GRADE DEGREE DESCRIPTION
0 None Not troubled by shortness of breath on level or uphill
1 Mild Troubled by shortness of breath on level or uphill
2 Moderate Walks slower than person of same age
3 Severe Stops after walking 100yards
4 Very severe Breathlessness at rest
Grading of Dysponea (ATS scale)

26. Aggravating factors
 Exposure to allergen
 Exercise
 Drugs
 Cold whether
Relieving factors
 Medication
 Rest
 Removal of allergen

27. Diurnal and postural variation
 Bronchial asthma
 Lung abscess
 Bronchiectasis

28.  Site
 Onset
 Duration
 Severity
 Character
 Radiation
 Associated symptoms
 Aggravating/Relieving factor
 Diurnal /seasonal variation
 Retrosternal Pain
Chest Pain

29.  Cardiac – (IHD, pericarditis, infective endocarditis,
cardiomyopathy, valvular heart diseases, dissecting
aneurysm of aorta)
 Respiratory – (pleurisy, pnumothorax, pulmonary
embolism, pulmonary hypertension, malignancy)
 Musculoskeletal – (rib fracture, vertebral collapse,
costochondritis, myositis of pectoral muscles)
 Functional –
 Miscellaneous – (herpes zoster, esophagitis,
pancreatitis, peptic ulcer, cholecystitis,etc.)
Causes

30. Haemoptysis
Types
 Frank- expectoration of blood only
 Spurious- secondary to upper respiratory tract
infection above the level of larynx
 Pseudo hemoptysis- due to pigment produced by
gram negative bacteria, Serratia marcescens

31. Severity
 Mild <100ml /day
 Moderate 100-150ml/day
 Severe upto 200 ml/day
 Massive > 600ml /day or 100ml/day for more than 3
days or 150 ml/hr.

32. HAEMOPTYSIS HAEMATEMESIS
Cough precedes Nausea & vomiting precedes
Frothy, may be mixed with sputum No air, mixed with food particles
pH alkaline pH acidic
Bright red Dark brown
H/o respiratory disease h/o peptic ulcer or chronic liver disease
Investigation: bronchoscopy Investigation: endoscopy

33. Causes of hemoptysis
 Infection- (TB, Lung Abscess, Bronchiectasis, Pneumonia,
Fungal infection)
 Neoplasm- (Bronchogenic ca,Bronchial adenoma,
Metastatic tumour)
 CVS- (MS, PHT, Pulmonary embolism, AV malfromation )
 Collagen vascular disorder- (Vasculitis, Wegener’ s
granulomatosis, Microscopic polyangitis, Churgstrasuss
syndrome, Goodpastures’s syndrome)
 Traumatic
 Iatrogenic.
 Bleeding disorder

34. Stridor –
 Characterised by prolonged inspiration through an
obstructed upper airways, which produces
characteristic sound.
 Causes –
 Laryngeal or tracheal obstruction
 Laryngeal diphtheria
 Mediastinal growth
Wheeze & stridor

35.  Wheezing –
 Characterised by prolonged expiration through an
obstructed lower airways, bronchi, bronchioles, etc.
 This can also occur in cardiac & renal problems.

36. STRIDOR WHEEZE
Inspiratory Expiratory
Upper airways Lower airways
Cause – foreign body Cause – asthma
Difference in stridor & wheeze

37.  Physiological – exercise, emotional
 Excessive intake of tea, coffee, tobacco, alcohol
consumption
 Anxiety state
 High output state – anemia, beriberi, thyrotoxicosis, A-V
fistula, etc.
 Cardiac arrhythmias – heart block, atrial fibrilation,
extrasystole, paroxysmal tachycardia.
 Drugs – sympathomimetics, nitrates, overdose of insulin or
digoxin
 Miscellaneous – pheochromocytoma, hypoglycemia.
Palpitation

38.  Any relevant same episodes in past
 Medical history – if any
 Surgical history – if any
Past history

39.  Same disease to any other family members
 Inherited diseses
Family history

40.  Sleep
 Appetite
 Bowel
 Bladder
 Addictions –
 Smoking (type of cigarettes, no. a day)
 Tobacco chewing (type, how many times a day)
 Alcohol intake (type, quantity per time, frequency)
Personal history

41.  Type of work
 Type of posture maintained
 Hours of work per day
 Travel for the job (hours/day)
Occupational history

42.  Detailed home address
 Environment surrounding house
 Factories nearby house
 Stairs to climb at home
Environmental history

43.  How many members in family
 Earning members of family
 Color of ration card
Socioeconomic status