The ESC Textbook of Cardiovascular Medicine (2 edn)
1 The Cardiovascular History and Physical Examination
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Published:August 2009
Extract
Summary
A cardiovascular history and examination are fundamental to accurate diagnosis
and the subsequent delivery of appropriate care for an individual patient. Time
spent on a thorough history and examination is rarely wasted and goes beyond
the gathering of basic clinical information as it is also an opportunity to put
the patient at ease and build confidence in the physician’s ability to provide
a holistic and confidential approach to their care. This chapter covers the
basics of history taking and physical examination of the cardiology patient but
then takes it to a higher level by trying to analyse the strengths and
weaknesses of individual signs in clinical examination and to put them into the
context of common clinical scenarios. In an ideal world there would always be
time for a full clinical history and examination, but clinical urgency may
dictate that this is impossible or indeed, when time critical treatment needs
to be delivered, it may be inappropriate. This chapter provides an insight into
delivering a tailored approach in certain, common clinical situations. Skills
in clinical history and examination evolve with time and experience and this
chapter provides a structured approach to clinical cardiovascular history and
examination which should be seen as a framework on which to build clinical
experience. It also provides a hierarchical approach to the importance of
certain symptoms and signs in a variety of cardiovascular conditions. Clinical
history and examination has changed with modern advances in cardiology and the
development of sophisticated imaging techniques. Eponymous signs beloved of the
‘Old Masters of Examination’ are now of historical interest but are listed in 
Table 1.20 for information.
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