Approach to Cardiac Disease Diagnosis

General Considerations

The patient’s history is a critical feature in the evaluation of suspected or overt heart disease. It includes  information about the present illness, past illnesses, and the patient’s family. From this information, a  chronology of the patient’s disease process should be constructed. Determining what information in the history is useful requires a detailed knowledge of the path physiology of cardiac disease. The effort spent on listening to the patient is time will invested because the cause of cardiac disease is often discernible from the history.

A. Common Symptoms

1. chest pain Chest pain is one of the cardinal symptoms of ischemic heart disease, but it can also occur with other forms of heart discase. The five characteristics of ischemic chest pain , or angina pectoris , are

Anginal pain usually has a substantial location but may extend to the left or right chest, the shoulders, the neck, jaw, arms, epigastria and , occasionally, the upper back.

The pain is deep, visceral, and intense; it makes the patient pay attention but is not excruciating.

Many patients describe it as a pressure like sensation.

The duration of the pain is minutes, not seconds.

The pain tends to be precipitated by exercise or rotational stress.

The pain is relieved by resting or taking sublingual nitroglycerin.

2. Dyspnea A frequent complain to patients with a variety of cardiac diseases, dispend is ordinarily one of four types. The most common is exertional dispend, which usually means that the underlying condition is mild because it requires the increased demand of exertion to precipitate symptoms. The next most common is paroxysmal nocturnal dyspnea, characterized by the patient awakening after being asleep or recumbent for an hour or more. This symptom is caused by the redistribution of body fluids from the lower extremities into the vascular space and back to the heart, resulting in volume overload; it suggests a more server condition. Third is orthopnea, a dyspnea that occurs immediately on assuming the recumbent position. The mild increase in venous return (caused by lying down) before any  fluid is mobilized from interstitial spaces in the lower extremities is responsible for the symptom, which suggests even more severe disease. Finally, dyspnea at rest suggests severe cardiac disease.