History and Physical Exam for Heart Failure
Your medical history includes anything about your past and present health—conditions you used to have or conditions you have now. Tell your doctor about medical problems of any type, including any surgery that you have had. When giving your doctor your medical history, be complete and detailed in your descriptions. Even if an illness is completely gone or does not seem important to you, knowing about that problem may help your doctor diagnose heart failure. Also, knowing all of your past and present medical problems will help your doctor decide the best way to care for your condition.
As part of your medical history, you should also review with your doctor the medicines that you currently are taking. This is best done by bringing an updated list of the names and dosages of all the medicines that you are taking.
In addition to the medical conditions that you have had or now have, your doctor will want to know about several factors that increase your risk for developing heart failure. Since coronary artery disease (CAD) is a cause of heart failure, risk factors for heart failure include the major risk factors for CAD, such as smoking, diabetes, high total cholesterol or LDL cholesterol, high blood pressure, advanced age, and being male. Drinking too much alcohol is also a risk factor for heart failure. Your doctor will take into account all of the risk factors you have when trying to determine whether you have heart failure. The more risk factors you have and the more severe they are, the greater your chance of having heart failure.
If other members of your family have developed heart failure at a young age, you may be at risk for developing a genetic form of heart failure. In addition, if several members of your family also have had diseases that are risk factors for heart failure, such as hypertension or diabetes, you may be at increased risk for those diseases, which also increases your risk for developing heart failure.
During a medical history and physical exam, the doctor will ask about symptoms (such as shortness of breath, swelling, and coughing), recent or past illnesses (such as heart attack, viral illness, high blood pressure, and diabetes), physical activity, breathing, sleeping, eating, and other routine activities.
The parts of the physical exam that are most helpful in diagnosing heart failure are:
Why It Is Done
The physical exam is a regular part of almost any visit for heart problems.
Usually, signs of some heart condition are present, such as high blood pressure or a heart murmur that means heart valve disease.
If you have symptoms typical of heart failure, the physical exam may be all that your doctor needs to make the diagnosis. But you will have additional tests to determine the specific cause and type of heart failure so that you can receive appropriate treatment.
During the history and physical exam, the doctor will look for signs of heart failure, including bubbling or crackling sounds in the chest (pulmonary rales) that are heard through a stethoscope. This indicates fluid buildup in the lungs. The doctor may detect an extra heart sound (called an S3), find that the veins in the neck bulge out, detect a rapid heart rate, or find evidence of fluid buildup (edema) in the extremities. The liver may be enlarged and tender to the touch.
Abnormal findings that suggest heart failure
Some people with early symptoms of heart failure have no physical findings.
What To Think About
A diagnosis of heart failure depends on the whole picture of physical findings, symptoms, and tests.
If physical findings and your medical history strongly suggest heart failure, you most likely will have a chest X-ray, an echocardiogram, and electrocardiography to evaluate the heart size, shape, and function and to evaluate the lungs for signs of fluid buildup.
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