The Medical History and Symptoms of Heart Disease

The medical history and physical examination provide the most fundamental information regarding personal health and the need for specific medical care. It is the purpose of this chapter, first, to restate and underscore the objective of the taking of a medical history in general, and then to consider the nature of complaints that may be associated with cardiovascular disease in the adult patient. Specific symptom profiles and presentations are best discussed in association with specific clinical entities, including the chapters on ischemic heart disease, acute myocardial infarction, and congestive heart failure. Symptoms related to congenital malformations with associated cardiac lesions, including “failure to thrive,” cyanosis, and heart failure in the neonate will not be considered in this chapter. The principal symptoms are summarized in tables, followed by a short comment on general issues. The onset and severity of a principal complaint may dominate the initial history taking, and relief of distressing symptoms becomes a first priority. However, it is then essential to return to obtain a complete and comprehensive medical and cardiac history. Because of the overall primacy of atherosclerosis (1,2) as a cause of vascular and heart disease, specific inquiries must be made to include a risk evaluation for atherosclerosis, not only for the coronary arteries but also for the aorta and its principal branches. (The factors currently deemed most important are listed in Table 1.) Gender offers no specific protection, as heart disease is the most frequent cause of death in women although later in life than men. Women are equally prone to congenital and rheumatic heart disease, arrythmias, and the less common diseases such as cardiac tumor.