6. The History and Physical Examination of the Cardiovascular System

In this chapter, we outline the general approach to the patient with known or suspected cardiovascular disease with specific emphasis on the history and physical examination. Time constraints challenge the development of a detailed history, yet a properly obtained patient narrative can serve to guide the examination and subsequent diagnostic testing. Special attention should be given to the family history as genetic testing and personalized medicine grow in importance. A general examination that includes assessment of the major organ systems, coupled with specific attention to the venous and arterial waveforms, as well as inspection, palpation, and auscultation of the heart, makes for a complete cardiovascular evaluation. This chapter provides a guide to recognizing and applying the findings on physical examination to the diagnosis and assessment of a variety of cardiovascular disorders. The history and physical examination constitute the foundation of the doctor-patient relationship and should serve as the springboard for diagnosis and management.