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The cardiac work-up of a heart patient begins with a series of questions during which important information is gathered. This may cover some, or all, of the following areas:

Chief or predominant complaint
Other heart related complaints
Past illness or history
Family history
Review of systems or non-cardiac complaints
Social history

 
CHIEF COMPLAINT:

   This medical evaluation of a person with suspected heart disease begins with an interview about the patient's major or "chief " complaint. The physician begins the process by asking specific questions about the complaint. For example, if the patient presents with chest pain, the physician will inquire about the character, location, severity and duration of the pain. What brought it on? What relieved it? Did it move to the shoulder, arms, jaw, back or other parts of the body? Were there associated symptoms like shortness of breath, sweating, dizziness, weakness, nausea, vomiting, etc.? When did it first start? How often does it occur? If it was initially brought on by exertion, is the pattern changing? Is it brought on by lesser amounts of exertion? Is it becoming more frequent with time? Are the symptoms lasting longer? Do they appear at rest or has it awakened the patient from a sound sleep? Answers to these questions are analyzed by the physician and help him or her determine the cause of the pain and the seriousness of the problem.

Other cardiac chief complaints can consist of shortness of breath, dizziness, blackout spells, palpitations (a sensation of skipped, forceful, or fast heartbeats), weakness, swelling of the legs, etc. Each of these will prompt a series of specific questions that will help the physician arrive at a preliminary single diagnosis, or a group of different diagnoses. The latter is known as a "differential diagnosis" A HISTORY obtained by a physician is similar to a detective interviewing a victim. The goal is to identify the criminal (disease) that is responsible for the victim's (patient's) problem.

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PAST HISTORY:
   After obtaining information about the chief complaint, the physician will inquire about the past history. This will include questions about diseases such as diabetes, high blood pressure, elevated cholesterol levels, prior surgery, asthma, stroke, cancer, allergies, etc. This information may also strengthen a suspected diagnosis. For example, the presence of diabetes, high blood pressure and high cholesterol is known to increase the risk of heart disease.

FAMILY HISTORY:
 Certain cardiac illnesses such as coronary artery disease and high blood pressure may occur in more than one member of a family. Therefore, the physician will inquire about the health of the patient's parents, brothers, sisters and children. Similarly, risk factors for coronary artery disease, such as diabetes, high cholesterol, etc., may be prevalent in the same family. 

 SOCIAL HISTORY:
   Information about smoking and drinking is sought because of tobacco's undeniable link to coronary artery disease. Similarly alcohol can weaken the heart muscle in susceptible individuals, and caffeine can provoke irregular heartbeats. The physician will also inquire about the patient's work and family if he or she feels that stress is contributing to, or aggravating the patient's illness.

REVIEW OF SYSTEMS:
This is a "laundry list" of symptoms related to various organs of the body. A series of questions are designed to seek out information that the patient may have neglected to provide the physician. A history of asthma during childhood, for example, may be discovered this way and keep the physician from prescribing certain heart medicines that may provoke an asthmatic attack.

The history dictates whether or not the patient needs further work-up or testing, and the urgency with which they should be carried out. Should the patient be hospitalized because there is a threat of an impending heart attack? Is the likelihood of disease low enough that testing can be obtained at a more leisurely pace? Subsequent testing helps to identify the patient's problem, or exclude different parts of the differential diagnosis.

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This Page was Last reviewed on December 18, 2013

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