Part 2: GENERAL EVALUATION OF THE PATIENT Chapter 10:
In the assessment of patients with definite or suspected heart disease, relevant information can be acquired from the history, physical examination, chest roentgenogram, electrocardiogram, and other routine laboratory tests. These data, when integrated properly, result in an accurate diagnosis and appropriate decisions regarding therapy in many patients. In other patients, more information is necessary, and additional, more technical, and usually more expensive noninvasive cardiac tests such as echocardiography or radionuclide studies are needed. In some patients, the general assessment indicates the need for cardiac catheterization and contrast angiography, with or without additional noninvasive cardiac testing. For example, the proper approach to certain patients with symptomatic coronary artery disease may include both coronary arteriography and cardiac catheterization (anatomy and hemodynamics), as well as myocardial perfusion imaging with thallium or technetium sestamibi (extent of inducible ischemia).
Not all patients need every test, and the skillful use of low-technology approaches, including the history and general examination, may preclude the need for additional studies or may determine which of a wide variety of available sophisticated tests should be chosen for a particular patient. This chapter is divided into three sections. The first section concerns the proper application of the history and its use to delineate the differential diagnosis in patients who present with certain common cardiovascular symptoms. The second section details the essential components of the physical examination and their usefulness in establishing a likely diagnosis when specific abnormal findings are detected. Finally, the third section focuses on cardiac auscultation.
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