Evaluation of the patient



The History and Physical Examination

The approach to the patient with known or suspected cardiovascular disease begins with a directed history and targeted physical examination, the scope of which depends on the clinical context at the time of presentation.The major symptoms associated with cardiac disease include chest discomfort, dyspnea, fatigue, edema, palpitations, and syncope. Cough, hemoptysis, and cyanosis are additional examples. Claudication, limb pain, edema, and skin discoloration can indicate a vascular disorder. The differential diagnosis of chest discomfort can be narrowed by careful attention to its location, radiation, triggers, mode of onset, duration, alleviating factors, and associated symptoms. Angina pectoris must be distinguished from the pain associated with pulmonary embolism, pericarditis, aortic dissection, esophageal reflux, and costochondritis.The physical examination can help determine the cause of a given symptom, assess disease severity and progression, and evaluate the impact of specific therapies.



Physical examination


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