13.9: Assessment of the Cardiovascular System I: Subjective Data

A thorough health history and physical assessment are essential for identifying cardiovascular disease (CVD) symptoms and distinguishing them from other health issues.

Initial Enquiry

Ask the patient about their primary concern and thoroughly explore all reported symptoms.

Medical History

Investigate past illnesses affecting the cardiovascular system, such as angina, anemia, rheumatic fever, congenital heart disease, stroke, thrombophlebitis, dysrhythmias, varicosities

Inquire about symptoms such as shortness of breath (dyspnea), fatigue, dizziness when changing positions, syncope, edema, leg pain during exercise (intermittent claudication), palpitations

Check for allergies to drugs, food, or the environment and any history of drug reactions, especially to contrast media.

Medications

Assess current and past medication use, including:

1. Over-the-counter (OTC) drugs
2. Prescription drugs
3. Herbal supplements

Note any non-cardiac drugs impacting the cardiovascular system. Ask about specific treatments, surgeries, or hospital admissions related to cardiovascular problems, and record any procedures performed, including ECGs or chest x-rays.

Risk Factors

Investigate major cardiovascular risk factors, such as:

1. High cholesterol (abnormal serum lipids)
2. High blood pressure (hypertension)
3. Lack of physical activity
4. Diabetes
5. Obesity
6. Smoking

Estimate tobacco use in pack-years and record alcohol use, including type, amount, and frequency. Ask about recreational or habit-forming substances. Note genetic or familial tendencies toward cardiovascular issues and the age of onset in family members. Assess weight history and dietary habits, particularly salt and saturated fat intake. Discuss their attitudes and plans for diet and weight management.

Lifestyle and Habits

Ask about urinary habits, especially if taking diuretics, and any issues with incontinence or constipation. Teach patients with heart problems to avoid straining during bowel movements. Check for swelling in the lower extremities and if it resolves with elevation. Record exercise types, duration, intensity, and frequency.

Functional Health Patterns in Cardiovascular Assessment

Evaluating functional health patterns provides a holistic view of cardiovascular health. Key areas include:

Health Perception-Health Management:

1. Ask the patient about their views on cardiovascular health, their understanding of risk factors to understand their perception, and the patient's usual health practices to maintain or improve cardiovascular health.
2. Ask if the patient consistently follows medical advice, including taking medications as prescribed and adhering to lifestyle modifications and the patient's ability to manage their cardiovascular condition at home.

Activity-Exercise:

1. Ask about the type, frequency, and duration of the patient's physical activities and their ability to engage in physical activities without adverse symptoms.
2. Ask about the patient's ability to perform daily activities and how cardiovascular symptoms impact these.

Sleep-Rest:

1. Note any sleep disturbances and check for sleep apnea and nocturia.
2. Ask about the patient's rest habits and daytime rest periods.

Cognitive-Perceptual:

1. Ask about changes in cognitive function, including memory problems or confusion.
2. Inquire about any pain related to the cardiovascular system, including chest pain.

Role-Relationship:

1. Assess how cardiovascular health affects the patient's roles in personal and professional life.
2. Explore the effects of cardiovascular health on family relationships.

Stress and Coping:

1. Identify sources of stress and coping methods.
2. Discuss the patient's usual coping strategies.

Sexual Activity:

1. Inquire about the impact of cardiovascular problems on sexual activity.