History taking in any branch of medicine is the single most important exercise. Most clinical books open with the idea of history taking. In the initial part of medical training students sometimes fail to understand the importance of history taking. But as we go higher in our training we understand the importance of history gradually.
Why a good history is important?
A good history gives the diagnosis, or a list of differential diagnosis in most of the cases. Then you can channelize your investigations in that direction. Another practical need is for facing your clinical assessments and exams. The more you learn of a subject the more you understand about the history. History taking is a difficult job for the beginner. The skill improves with your knowledge in a field of medicine. These posts on “history taking in cardiology” will be an honest attempt by me to discuss the beauty and depth of history taking in cardiology.
How to take history in cardiology?
It is always safer to follow the standard format of history taking.
- Educational status of the patient
- History given by self or parents/relatives
- If history given by relatives what do you think of the reliability of information given
When presenting your case in exams make this part of presentation sound like well-articulated sentences, e.g. the patient mr./mrs x.. ,is a 55… years old male/female. He/she is a resident of y.. he is educated upto … and he/she works as ….history has been given by self/relative.
Make your presentation in a calm and composed manner, don’t sound haphazard and disorganized.
Write the presenting complains in the proper chronological order. All of you might be aware of the chronological order in which symptoms are written. Usually the longest duration symptoms are mentioned first, followed by the second and so on.
Then comes history of present illness (HOPI)
In HOPI you should try to be systematic and proceeding in a well-directed manner. Now is the time to elaborate your presenting complains. It’s like what you want to keep as your diagnosis and differential diagnosis you talk more about them.
Those points we will discuss subsequently.
Basically history of present illness is analysis of symptoms.
What are symptoms of cardiovascular disease?
The presenting symptoms of cardiovascular disorders are
- Chest pain
- Pedal edema
- Neck pulsations
- Chest bulging, stunted growth, cyanotic spell – in paediatric cases
We will discuss about these symptoms one by one and how to analyse them
Past history should include information about relevant diseases and conditions like diabetes mellitus, hypertension, bronchial asthma, tuberculosis, and other past medical and surgical conditions. In Indian setup history of rheumatic fever and treatment for same like penicillin prophylaxis should be sought.
Family history (Socio-economic history):
Is very important for cardiovascular diseases.
It includes questions about diet, addictions and substance abuse, etc.
Ask about all previous investigations, drugs taken, procedures done
Summary of the entire history
Analysis of history
Differential diagnosis from history
Then proceed to physical examination
I will describe each component of the above outline in my subsequent posts
So keep reading. Any feedback or suggestion is welcome