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Part III – Evaluation of the Patient

Chapter 12 – The History and Physical Examination  :  An Evidence-Based Approach

James C. Fang,
Patrick T. O’Gara

  HISTORY, 107
  PHYSICAL EXAMINATION, 108
  General Appearance, 108
  Cardiovascular Examination, 110

  INTEGRATED EVIDENCE-BASED APPROACH, 118
  Heart Failure, 118
  Valvular Heart Disease, 121
  Pericardial Disease, 124

  FUTURE PERSPECTIVES, 124
  REFERENCES, 124

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 …