SOB History

• CC:
  • Onset: first time? When? Sudden\gradual? Continuous\intermittent? What were you doing?
  • Duration: how long does it last?
  • Timing: specific time of the day\night? How frequent?
  • Aggravating\relieving factors: rest vs exertion? Medications?
  • Severity: 1-10 scale? Wakes you up from sleep? Interfering w\ ADL? Able to lay flat? How may pillows do you use at night? How far can you walk before you get SOB?

• Associated sx:
  • Constitutional: fever, wt loss, loss of appetite, night sweats, chills, lymphadenopathy?
  • Resp: orthopnea, PND, cough, chest pain?
  • Cardiac: sweating, palpitation, loss of consciousness?
  • VTE: history of immobilization, leg swelling?
  • GI: abdominal pain, N\V, heartburn, change of BM?

• PMHx:
  • Diseases:
    • Chronic ds (HTN, DM, DLP)
    • Heart or lung diseases
    • Prev heart attacks or strokes
    • Infections, malignancy
  • Medications: antihypertensive agents (diuretics), anticoagulants, home oxygen\inhalers
  • Surgery (prev cath or CABG), hospitalization, trauma
  • Blood transfusions, IV drug use, tattoos
  • Allergies

• FMHx:
  • Similar complaint?
  • Same diseases as in PMHx?
  • Family Hx of premature CAD?
  • Family Hx of sudden cardiac death?

• Social Hx:
  • Occupation, marital status, children?
  • Smoking, alcohol, recreational drugs?
  • Travel Hx, contact with sick pts
  • Diet, exercise
    • If already on heart failure meds, ask about compliance to fluid and salt intake

Question: The patient is taking ACEI and diuretics, if the patient presented with elevated BUN and hyperkalemia, what medication changes will you consider?

• Change the ACEI to hydralazine and nitrates

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