Patient History: Heart Sounds & Murmurs

Palpitations and Arrhythmias

• Onset and termination - abrupt or insidious
• Duration
• Rate
• Regular or irregular rhythm
• Any associated symptoms of dyspnea, syncope, chest pain?

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CHF

• Acute
  • Hypotension
  • Anxiety
• Chronic
  • Edema
  • Dyspnea
  • Weight gain
  • Chest pain

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Dyspnea

• Shortness of breath at rest
• Amount of exertion needed to cause dyspnea
• Wake up gasping for bed and get up to relieve it (Paroxysmal Nocturnal Dyspnea)
• Unable to lie flat (orthopnea), especially a change, measured by number of pillows needed
• Associated wheezing or coughing

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Angina

• Typically substernal crushing chest pain
• Worse with exertion
• Pain quickly relieved or significantly decreased with nitroglycerin
  
  Associated Signs:
  • Pallor
  • Dyspnea
  • Diaphoresis
  • Nausea, vomiting
  • Radiation of pain to neck or arm(s)
  • Syncope

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