Heart Attack (cont.)
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Heart Attack Diagnosis: Medical History and Physical Exam
Diagnosis and treatment tend to occur at the same time in patients who are experiencing chest pain. If there is concern that heart muscle is at risk, delays need to be minimized so that blood supply to that muscle can be restored.
The diagnosis of angina is made by history of the patient. If the story that the patient tells is suggestive of cardiac ischemia (cardiac= heart + ischemia= decreased blood supply), then the health care practitioner will continue on the path to determine whether a heart attack has occurred.
Important questions include:
The medical history also includes assessing risk factors for heart disease, including:
Questions may be asked about changes in exercise tolerance that might provide clues as to whether heart disease is present:
The questions may try to distinguish between stable angina and unstable angina. Stable angina tends to be predictable. For example, it may occur after climbing a flight of stairs or walking a couple of blocks and then resolves quickly with rest. Unstable angina may occur without warning when the body is at rest and the heart is not stressed, for example while sitting or sleeping.
Anginal symptoms that change and occur with less activity or sound unstable are worrisome and may be due to increased narrowing of a coronary artery.
Since other diagnoses will be considered, some questions may be asked to identify potential symptoms of conditions such as reflux esophagitis (GERD), gastritis, trauma, pulmonary embolus (blood clot in the lung), or pneumonia.
While the diagnosis is based on history, the physical exam can give some clues.
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