Physical Examination Overview
The initial evaluation of a cardiac patient consists of performing a physical examination and obtaining a medical history. During physical examination, the physician looks for an underlying cause for symptoms that have presented (chest pain, shortness of breath) and assesses heart function.
A stethoscope is used to detect abnormal heart sounds (murmurs) that may indicate a leaky or narrowed (stenotic) valve, and to detect fluid accumulation in the lungs. The physician will feel the thyroid gland in the neck to see if it is enlarged or nodular and will listen over the neck, abdomen, and groin area for sounds created by turbulent blood flow through diseased or blocked arteries.
The physician also looks for enlarged (distended) veins in the neck and for swelling (edema) in the legs (particularly the ankles and feet) and/or the abdomen; checks the blood pressure in both arms (rare conditions produce different blood pressures in each arm); and may also look at the back of the eyes with an ophthalmoscope, to examine the small blood vessels there for signs of damage (e.g., from chronic high blood pressure).
Obtaining a medical history requires the doctor or nurse to ask the patient for information. The doctor usually asks if there is a history of heart problems (such as heart attack) or chest pains (which might suggest coronary artery disease); if the patient has suddenly developed a sensation of shortness of breath and chest pains (which can suggest that a blood clot has broken off from a blood vessel in the legs and traveled to the lungs); if the patient is losing weight or feels hot all the time (symptoms of an overactive thyroid gland); and if the patient regularly consume alcohol.
When performing an evaluation, it's important for a physician to also know what medications are being taken (prescription drugs and over-the-counter medicines); if the patient has experienced symptoms such as sweating, palpitations, headaches, or dizziness; and if there are other medical conditions.
Laboratory tests can help the physician identify underlying ischemic heart disease and conditions that may contribute to its development. For example, urinalysisan analysis of a urine samplemay indicate diabetes mellitus or renal disease, both of which are associated with atherosclerosis.
Blood tests may show elevated lipid (fats) levels that indicate atherosclerosis and an elevated CPK (creatine phosphokinase) level. CPK is an enzyme released into the blood when heart tissue dies. Testing CPK blood levels in the emergency room and during the next 6 to 24 hours can determine with some certainty whether heart attack has occurred.