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Introduction to the Approach to the Cardiac Patient

by Michael J. Shea, MD

Symptoms or the physical examination may suggest a cardiovascular disorder. For confirmation, selected noninvasive and invasive tests are usually done (see Overview of Cardiovascular Tests and Procedures).

History

A thorough history is fundamental; it cannot be replaced by testing. The history must include a thorough systems review because many symptoms apparently occurring in other systems (eg, dyspnea, indigestion) are often caused by cardiac disease. A family history is taken because many cardiac disorders (eg, coronary artery disease, systemic hypertension, bicuspid aortic valve, hypertrophic cardiomyopathy, mitral valve prolapse) have a heritable basis.

Serious cardiac symptoms include chest pain or discomfort (see Chest Pain), dyspnea (see Dyspnea), weakness (see Weakness), fatigue, palpitations (see Palpitations), light-headedness, sense of an impending faint, syncope (see Syncope), and edema (see Edema). These symptoms commonly occur in more than one cardiac disorder and in noncardiac disorders.

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