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Introduction to the Approach to the Cardiac Patient

By Michael J. Shea, MD, Professor of Internal Medicine, Michigan Medicine at the University of Michigan

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Patient Education

Symptoms or the physical examination may suggest a cardiovascular disorder. For confirmation, selected noninvasive and invasive cardiac tests are usually done.


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, dyspnea, weakness, fatigue, palpitations, light-headedness, sense of an impending faint, syncope, and edema. These symptoms commonly occur in more than one cardiac disorder and in noncardiac disorders.

Physical Examination

The general cardiovascular examination and cardiac auscultation are discussed in other topics. Despite the ever-increasing use of cardiac imaging, bedside examination remains useful as it is always available and can be repeated as often as desired without cost.