Medical History And Physical Examination For A Heart Patient

Before going for a physical examination a doctor must first Take a full medical history from the patient. The Doctor will ask about the different symptoms that are being experienced by the patient. Symptoms which include shortness of breath, pain in the chest, palpitations and swelling observed in the feet, ankles and legs as well as the abdomen are often determined as symptoms of cardiac disorder. Other general symptoms such as weakness, fever, and feeling of fatigue, lack of appetite and the general experience of discomfort or illness might also suggest cardiac disorder. Doctors can often determine peripheral arterial disease in case the symptoms experienced by the patient include numbness, pain, cramps and the muscles of the leg. Peripheral arterial disease often affects the arteries located in the trunk, legs and arms. However the peripheral arterial disease does not affect the arteries which supply blood to the heart.

After examining the different symptoms experienced by the patient the doctor often asks the patient about infections experienced in the past as well as previous exposure to harmful chemicals and also about the use of tobacco, alcohol and drugs. The doctor might also ask whether any other family member has experienced a cardiac disorder in the past or has experienced any other disorder that affects the blood vessels or the heart.

During performance of the physical examination the doctor will note down the heart rate of the patient as well as overall appearance of the patient which includes checking for paleness, drowsiness and perspiration. Since these symptoms often indicate cardiac disorder. The doctors will also note the general feeling of overall well-being and the general mood of the patient.

During physical examination assessment of the color of the skin is extremely important since pale skin color or skin color that is purplish or bluish often indicates the presence of inadequate blood supply or anemia. The skin colors will tell the doctor that the skin has not been receiving the appropriate amount of oxygen from the blood because of any cardiovascular disorders such as cardiac failure, lung disorders or any other circulatory problem.

During physical examination the doctor must feel for pulse beneath the arms, in the arteries located in the neck, at the wrist, at the right and left elbow, in the abdomen, at the knees, in the groin and also in the feet and ankles to determine whether the blood supply to these parts of the body is adequate and also to determine whether the blood supply is equal on the right as well as on the left side of the body. Similarly the doctor will also check the body temperature and blood pressure of the patient. In case any abnormality is observed by checking the body temperature, blood pressure or blood supply then the patient is suffering from a blood vessel or cardiac disorder.

The veins located in the neck of the patient are inspected by the doctor when the patient is lying down and the trunk of the body is elevated at an angle of 45°. The veins located at the neck of the patient must be inspected since these veins are directly connected to the atrium on the right side of the heart, which receives blood flow from the rest of the body which contains high levels of carbon dioxide and other waste products and low levels of oxygen. Examination of the veins located in the neck of the patient will provide the doctor an indication of the pressure and volume of the blood supply entering the right-hand side atrium of the heart.

During physical examination the doctor also presses the skin over the legs and the ankles. The doctor might also press the skin over the lower back of the patient to check for accumulation of body fluids in the tissues located under the skin.

Often the doctor uses an ophthalmoscope to inspect the blood vessels located in the retina which is a light-sensitive membrane that is located on the inner surface of the back part of the eye. The retina is the only place in the human body where the doctor can directly view the arteries and veins. Abnormalities in the arteries and veins of the retina are clearly visible in case the patient is suffering from diabetes, high levels of blood pressure, bacterial infection in the valves of the heart and arteriosclerosis.

During physical examination the doctor will also observe the movements of the chest during normal breathing to determine whether the movements of the chest and the rate of breathing are normal. Often the doctor will also tap the chest of the patient with the fingers which is commonly known as percussion so that the doctor can determine if the lungs are being filled with air which is normal or if the patient is experiencing any abnormality of the lungs such as the lungs filling up with fluids. Percussion often helps the doctor to determine whether the membrane layers that cover the lungs (pleura) or the sac that envelope the human heart commonly known as the pericardium, contain fluid. This is determined by the doctor with the use of a stethoscope and by listening to sounds of breathing, also by determining whether the airflow is obstructed normal and hence whether the lungs are filled with fluid resulting from cardiac failure.

The doctors often place a hand on the chest of the patient to feel any palpitation of the heart and to determine the position of the heart by checking for the location where the palpitation is the strongest. By feeling the palpitation of the heart the doctor can also determine the size of the heart. Similarly the force and quality of the contractions during the different heartbeats can also be determined by the doctor by feeling the palpitation of the heart. The doctors also look for abnormalities such as disturbed flow of blood in the blood vessels located in the heart chambers. These abnormalities often cause a vibration which is known as a thrill and can be felt between the palms at the fingertips of the doctor that has been placed on the chest of the patient.

The doctor during physical examination also listens to the heart using a stethoscope which is known as auscultation. Using a stethoscope the doctor can listen to the distinctive sounds produced by the closing and opening of the valves of the heart. In case any abnormalities are present, the valves of the heart will create a disturbed blood flow that produce characteristic sounds during heart beat that are known as murmur. The disturbed blood flow usually occurs when the blood moves through valves that are leaking or that have become narrow.

However, not all murmurs indicate cardiac disorder and neither all cardiac disorders will produce murmurs during the heartbeats. For example doctors examining pregnant women will observe murmurs in the heart because during pregnancy the women often experience increased blood flow. Similarly murmurs of the heart which are harmless are also commonly observed in children and infants because the blood flow through the heart of the children and infants is usually rapid because of the small structure of their heart. Often murmurs in the heartbeats are also observe in aged people because as a person ages the walls of the blood vessels, tissues and valves of the heart of the aged percent begins to stiffen which disturbs the normal blood flow and hence the murmurs are produced even if there is no occurrence of a serious cardiac disorder. Hence the doctors often check for clicking sounds and snapping sounds produced by opening of the valves of the heart which are abnormal. The doctors similarly also check for a galloping rhythm which is the sound that resembles the galloping of a horse and is produced due to the extra heart sounds in the patient. The doctors check for the galloping rhythm to determine whether the patient is suffering from cardiac failure.

During physical examination the doctors also place a stethoscope over the veins and arteries of the patient in the different body parts. By doing so the doctors listen to the sound of disturbed blood supply blood is known as bruits. Disturbed blood supply is often caused when the blood vessels begin to narrow. Disturbed blood supply might also occur due to increase in the blood supply to a certain body part as well as due to an abnormal connection that occurs between a vein and an artery, a condition commonly known as arteriovenous fistula.

During physical examination the doctor also checks the abdomen of the patient to determine whether there is an enlargement of the liver since enlargement of the liver often indicates accumulation of blood in the major veins that provide blood supply to the heart. Similarly swelling in the abdominal area might also occur due to accumulation of fluids that might help the doctor determine whether the patient is suffering from cardiac failure. The doctors usually gently press the abdominal area and also check for pulse in the abdominal area which helps the doctor determine the width of the aorta located in the abdominal area.

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Yasser Elnahas

MD, PHD, Professor Of CardioVascular Surgery
Dr. Yasser Elnahas, Is an associate Professor of Cardiovascular Surgery. Dr. Elnahas was trained as a fellow At Texas Heart Institute And Mayo Clinic Foundation.Dr. Elnahas is dedicated to educating the general public about different disease conditions and simplifying the medical knowledge in an easy to understand terminology.

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