The approach to the patient with known or suspected cardiovascular disease begins with a directed history and targeted physical examination, the scope of which depends on the clinical context at the time of presentation. Elective ambulatory encounters allow comparatively more time for the development of a comprehensive assessment, whereas emergency department visits and urgent bedside consultations require a more focused strategy. The elicitation of the history should not be delegated to a trainee or other health care provider. The history often provides clues linking seemingly disparate aspects of the patient's …