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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 Complaint or CC
History of Present Illness or HPI
Past illness or history
Review of systems or non-cardiac complaints
This medical evaluation of a person with suspected heart disease begins with an interview about the patient's major or "chief " complaint. This is the major or primary complaint that prompted the visit to the provider. Chief cardiac complaints may consist of chest iscomfort, shortness of breath, swelling of the legs and feet, skipped heart beats or palpitations, dizziness, blackout or syncope, etc.
The physician begins the process by asking specific questions about the complaint. For example, if the patient presents with chest pain, the Health care provider will inquire about when it started? How often does it occur? Obtain details 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.? 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 provider and helps him or her determine the cause of the pain and the seriousness of the problem.
As noted above, other cardiac complaints may 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.
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.
Certain cardiac illnesses such as coronary artery disease and siabetes mellitus may occur in more than one member of a family. Therefore, the physician will inquire about the health of the patient's immediate family or "first degree relatives" such as 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.
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.
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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