HISTORY TAKING IN CARDIAC EVALUATION

MUHAMMAD ALI

HISTORY TAKING
HISTORY & PHYSICAL EXAMINATION ARE ALL THE CORE OF EVALUATING CHILDRENS WITH SUSPECTED HEART DISEASE (HUGH D. ALLEN)
-TO OBTAIN AN ACCURATE HISTORY: ESTABLISH A RELATIONSHIP WITH WITH THE PATIENT & PARENTS -THE HISTORY IS THE PREDOMINANT VEHICLE THAT DEFINES THE FIRST ENCOUNTER - PARENTS OFTEN RESEARCH THEIR CHILDS ILLNESS ON THE INTERNET OR MEDIA

OPINIONATED OR ANECDOTAL INFORMATION ?

EXAMINER MUST BE PREPARED

SELECTED ASPECTS OF HISTORY TAKING

GESTATIONAL AND NATAL HISTORY
Infections, medications, excessive smoking or alcohol intake during pregnancy Birth weight

POSTNATAL (OR PAST) HISTORY

Weight gain, development, and feeding pattern Cyanosis, cyanotic spells, and squatting Tachypnea, dyspnea, puffy eyelids Frequency of respiratory infection Exercise intolerance Heart murmur Chest pain Joint symptoms Neurologic symptoms Medications

FAMILY HISTORY
Hereditary disease CHD Rheumatic fever Sudden unexpected death Diabetes mellitus, arteriosclerotic heart disease, hypertension, and so on

NEONATUS & INFANTS IMPORTANT TO OBTEIN DETAILS ABOUT THE PREGNANCY * GESTATIONAL DIABETES : RISK OF CARDIAC DEFECTS

* MATERNAL HERPES : CONGENITAL HEART BLOCK

* MATERNAL EXPOSURE TO TERATOGENS : ASSOCIATED WITH CARDIAC DEFECTS * SMOOKING: NOT SPECIFIC CARDIAC DISEASE * CONGENITAL INFECTION ; RUBELLA: PDA, PS FAMILY HISTORYOF RELATIVES, ESPECIALLY SIBLINGS HLHS : THE RISK OF CHD IN SUBSEQUENT OFFSPRING TO APPROXIMATELY 10%

ABSENT ON PRESENT SYNDROME ASSOCIATED WITH CHD: MARFAN, HOLT-ORAM, LONG QT

PERINATAL HISTORY - ANEMIA , ASPHYXIA, FETAL DISTRESS, LBW MAY RESULT IN PERINATAL INSULT TO MYOCARDIUM LEADING TO A GENERALIZED CARDIOMYOPATHY

THE TIME OF SIGN & SYMPTOMS BEGIN : TYPE OF CARDIAC LESION

MURMUR DETECTED EARLY IN NEONATED PERIOD : ORIGINATE FROM AV VALVE REGURGITATION MOST NEWBORN WITH CHD : ASYMPTOMATIC AT BIRT BABY WITH SIGNIFICANT L-R SHUNT DEFECTS : ASYMPTOMATIC UNTIL 4 WEEKS OF AGE WHEN PVR TO NEAR NORMAL LEVEL

 FEEDING HISTORY

- FREGNANCY - AMOUNT - LENGTH OF TIME TO FINISH A FEEDING

CHF ON POOR CARDIAC OUTPUT : - EXCESSIVE DIAPHORESIS - DYSPNOE WITH FEEDING PRESENCE OF CYANOSIS -EVANESCENT ACROCYANOSIS IS NORMAL -CENTRAL CYANOSIS : BLUENESS OF TONGUE & ORAL MUCOSA

CARDIAC OR RESPIRATORY ORIGIN?

CARDIAC : CONSTANT BLUENESS

BREATHING PATTERNS :
-HAPPY TACHYPNEA: CHD - GRUNTING& DYSPNEA : RESP. ILLNESS OR LEFT HEART SIDED OBSTRUCTIVE LESIONS POOR GROWTHS & DEVELOPMENT : CARDIAC PATHOLOGY POOR ACTIVITY LEVEL

CHILDREN & ADOLESCENT

THE PRIMARY HISTORIAN SHOULD BE THE PATIENT

PARENT SHOULD BE ASKED ADDITIONAL PERTINENT HISTORICAL INFORMATION

CHEST PAIN : COMMON REASON FOR REFERRAL & ANXIETY THE PAST MEDICAL HISTORY A REVIEW OF SYSTEMIC & SOCIAL HISTORY SCHOOL PERFORMANCE & PARTICIPATION FAMILY HISTORY : EARLY MYOCARDIAL INFECTION HYPERCHOLESTEROLEMIA

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