This is a draft cheat sheet. It is a work in progress and is not finished yet.
Introduction:
W |
Wash Hands |
I |
Introduce Yourself + Patient's Identity |
P |
Permission |
P |
Patient Position + Pain |
E |
Explaination |
Basic Patient Information:
Name |
Age |
Date of Birth |
Gender |
Date Seen |
Presenting Complaint:
Chest Pain |
Dyspnoea |
Orthopnea: |
Breathlessness on lying down (Number of pillows required) |
Paroxysmal Nocturnal Dyspnoea: |
Waking suddenly at night due to breathlessness, gasping for air |
Palpitations: |
Premature beats are felt by the patient as a pause followed by a forceful beat
Paroxysmal tachycardias start abruptly and may be felt as a sudden racing heartbeat
Bradycardias may be appreciated as slow, regular, heavy or forceful beats |
Syncope: |
Transient loss of consciousness due to inadequate cerebral blood flow: • Vascular (Orthostatic/autonomic) • Obstructive • Arrhythmic |
Fatigue: |
Symptom of inadequate systemic perfusion in heart failure |
Peripheral Oedema: |
• Heart failure (salt and water retention) • Renal underperfusion + activation of the renin-angiotensin-aldosterone system |
Angina: |
Squeezing, pressure, heaviness, tightness or pain in the chest |
History of Presenting Complaint:
Duration |
Associated Features |
Chest Pain: |
SOCRATES
Enquire about: • Back Pain • Shoulder Pain • Jaw Pain • Pain between the shoulder blades |
Orthopnea: |
Number of pillows |
Also enquire about: |
• Sputum • Fatigue • Exercise Intolerance • Weight Loss • Pallor |
Risk Factors:
Medications that may have side effects that affect cardiac function |
Age |
Gender |
Family History of Ischaemic Heart Disease: |
• Who was affected and at what age?
•Did they have a heart attack and are they still alive? |
Previoius Angina/MI/TIA/Stroke |
Smoking |
Alcohol |
Diabetes |
Hypertension |
High Cholesterol or triglycerides |
Lack of Exercise |
Stress |
Ask about risk conditions in first degree relatives: |
• Sudden or premature death • Hypertension • Diabetes • Cholesterol • Angina/MI/TIA/Stroke • Peripheral Vascular Disease •Abdominal Aortic Aneurysm |
Organic Solvents Exposure: |
• Arrythmias • Cardiomyopathy |
Potential Differential Diagnosises:
Myocardial Infarction |
Unstable Angina: |
Unexpcected/Unexplained angina with no pattern |
Stable Angina: |
Angina that has a trigger e.g. exercise, etc. |
Gastroenteritis |
Reflux |
Aortic Stenosis: |
Narrowing of the aortic valve opening |
Acute Pericarditis: |
Painful inflammation of the pericardium |
Anxiety Disorders |
Dilated Cardiomyopathy: |
Enlarged (particularly left) ventricles -Ventricles become stretched and thin |
Asthma |
Esophagitis: |
Inflammation of the esophagus |
Hypertensive Emergencies: |
Myocarditis: |
Inflammed Myocardium |
Additional Investigations:
ECG |
Chest X-ray |
Full Blood Count/Cholesterol/Fasting Blood Glucose |
Echocardiography |
Markers of Myocardial Necrosis: |
• Creatinine Kinase • Cardiac-specific Troponins |
Conclusion:
Ideas, Concerns, and Expectations |
Thank patient and ensure comfort |
|
|
|