OSCE Cardiac History Taking
Related Subjects:
|Cardiac Examination
|Cardiac History Taking
|Respiratory Examination
|Gastroenterology Examination
|Cardiac AP
|Coronary Artery AP
|Cardiac Electrophysiology
|Cardiac Embryology
❤️ Cardiac arrest can be the first manifestation of ischaemic heart disease, hypertrophic cardiomyopathy, or other causes of sudden cardiac death. ⚡ Defibrillation for VF/VT can be lifesaving.
📋 Introduction
- Take a detailed history of presenting complaints. ⏱️ Always quantify (e.g., distance walked, no. of cigarettes/day, no. of pillows at night).
- Clarify vague timelines: ❓ Ask “Is that a day, a week, or a month?”
- Risk factors: 🚬 smoking, ⬆️ BP, 🧬 family history, 🍩 diabetes, 🧈 hyperlipidaemia, 🤒 rheumatic fever, 🍺 alcohol.
- Assess daily activity limitation (stairs, housework, self-care). Ask about dependence on help.
- Always link chest pain + risk factors: e.g., same pain in a 25yo woman 🚺 vs a 60yo smoker with HTN + diabetes 🚹 gives very different likelihood of CAD.
- Key cardiac symptoms: 💔 chest pain, 😮💨 breathlessness, 🔄 palpitations, 😵 syncope/presyncope, 😫 fatigue.
💔 Chest Pain
- Differentials:
- 🫀 Acute Coronary Syndrome (ACS) → ECG, troponin, echo.
- 🫁 Pulmonary Embolism (PE) → D-dimer, CTPA.
- 🩻 Aortic Dissection → CXR, CT/TOE.
- 🩸 Oesophageal Rupture → CXR, history.
- 🌬️ Pneumothorax → expiratory CXR.
- 🤧 Pneumonia/Pleurisy → fever + CXR.
- 🔥 Shingles → dermatomal rash + pain.
- 🤕 Rib/sternal fracture → trauma history.
- Cardiac pain: heavy, central, crushing → “Levine’s sign” ✊.
- 💊 Relieved by rest or GTN → angina. Persistent → MI.
- MI pain: severe, with pallor, sweat, nausea 🤢.
- Atypical: elderly & diabetics may only present with 💨 dyspnoea or fatigue.
- Pericarditis: 🔥 sharp, pleuritic, relieved leaning forward. May hear a rub.
- Aortic dissection: ⛓️ tearing pain → back radiation.
😮💨 Breathlessness
- Suggests heart failure (fluid overload + pulmonary oedema).
- 🏔️ Orthopnoea: breathless lying flat → “How many pillows at night?”
- 🌙 Paroxysmal Nocturnal Dyspnoea (PND): wakes suddenly, gasping, needing to sit up.
- 🦶 Oedema: ankles → legs → ascites + scrotal swelling. May also get hepatomegaly, pleural effusion.
😫 Fatigue
- Common in 💔 heart failure, but also in anaemia, hypothyroidism, malignancy, viral illness.
- Ask: “How has this changed your daily stamina vs before?”
🔄 Palpitations
- Patient awareness of heartbeat. Ask them to tap rhythm to assess rate/regularity.
- ⚡ Sudden fast → stops abruptly → + polyuria → suggests SVT.
- “Thump” → post-ectopic beat (benign, but record).
😵 Syncope / Presyncope
- Always serious. Investigate murmurs + arrhythmias.
- History: what happened before, during, after? 🧑🤝🧑 Witness reports are vital.
- Tests: ECG, echo, 24h Holter if cardiac cause suspected.
- Cardiac causes:
- Severe aortic stenosis 🚫
- Severe bradycardia (complete heart block, sinus pause)
- 💉 Vasovagal (often medication-linked)
- ⚡ Ventricular Tachycardia (VT)
- 🧠 Stokes-Adams attacks
⚡ Cardiac Arrest
- No cardiac output → no pulse, no breathing.
- Causes:
- 🚨 Pulseless VT
- 🌩️ VF
- 📉 Asystole
- 📺 Pulseless Electrical Activity (PEA/EMD)
