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Introduction to the Approach to the Cardiac Patient

By

Jessica I. Gupta

, MD, Michigan Medicine at the University of Michigan;


Michael J. Shea

, MD, Michigan Medicine at the University of Michigan

Last full review/revision Apr 2021| Content last modified Apr 2021
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Symptoms or the physical examination may suggest a cardiovascular disorder. For confirmation, selected noninvasive and invasive cardiac tests are usually done.

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, 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 elsewhere. 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 the cost of a formal imaging test. Clinician-operated bedside devices, such as the sphygmomanometer and the stethoscope, have long been a part of the physical examination. More recently, point-of-care ultrasonography done by the clinician at the bedside has come to be considered an extension of the physical examination.

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