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.
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.