If you experience any symptoms that might be indicators of a heart problem—such as chest pain, shortness of breath, or a pounding heart—see your doctor immediately. He or she will interview you thoroughly about your medical history and symptoms and then do a physical examination to try to detect what might be causing the symptoms. Depending on what the examination reveals, he or she may order further testing to diagnose the problem. If you know what to expect, you will probably feel more relaxed about the exam, and you can be better prepared to answer questions. It will be very helpful if you can bring in notes with speci?c details about when you experienced a symptom, how often it recurred, and how long it lasted.

Medical History

If you are seeing a doctor for the ?rst time, he or she will ask some gen- eral questions about your medical history. If you are reporting a speci?c event, the questions will focus on that event. Here is a general outline of what to expect:
• Questions about your chief complaint. Your doctor will want to know what brought you into the of?ce. He or she will ask speci?c questions such as how it felt, when it occurred, what you were doing when it occurred, or what seemed to relieve it. Be as thor- ough and speci?c as you can be. Do not hesitate to volunteer information beyond the questions.
• Questions about your medical history. Information about other medical conditions you have or have had can help indicate possi- ble causes for your symptoms and rule out unnecessary tests or inappropriate treatments. Again, written notes may help you remember illnesses, tests, or surgery that you have had. If you are seeing a specialist, your other doctor or doctors may be able to send medical records and test results in advance of your appoint- ment. If you are referred to a spe- cialist, ask the referring doctor for pertinent test results to take with you to the appointment.
• Medications. Your doctor will want to review all the medications you are taking; bring a list that includes dosages to the appointment. It is important to include herbal prepa- rations and nonprescription med- ications, because they may interact with other drugs. Also, know and remember your drug allergies.
• Family history. Be prepared to answer questions about the medical history of your parents, siblings, and children. This information gives the doctor clues about hereditary aspects of some conditions and your overall risk.
• Lifestyle. Information about habits such as smoking or drinking, diet, and exercise are important. Some of these factors may help explain a symptom; for instance, caffeine can cause an irregular heartbeat in some people. Do not worry about looking bad or being embarrassed by your habits. This information can help a great deal with diagnosis and treatment. You may also be asked questions about your workplace and about stress.
• Other organ systems. Your doctor may systematically review other body systems to make sure nothing is overlooked.

A Physical Examination in Detail

A cardiovascular physical examination will include taking your blood pressure (see page 43), measuring your heart rate and rhythm by check- ing your pulses, inspecting the veins in your neck, checking your body for swellings, and listening to the sounds of your breath, heart, and

blood vessels. You will probably be asked to change out of your clothes into a hospital gown and sit or lie on an examining table.
• Measuring your heart rate and rhythm. Your doctor will check the pulse at your wrist, in the carotid arteries in your neck, or in the femoral arteries in your groin. The pulses enable him or her to measure your heart rate and to determine if your heart- beat is regular, skips beats, or has extra beats. An absent or reduced pulse at one of the sites may indicate a blockage in a blood vessel.
• Veins in your neck. The doctor will look at (not feel) the jugular vein in your neck to observe the pulse. The location and size of the pulse indicates the pressure on the right side of the heart and the possible presence of excess ?uid in your system.
• Swelling. Swellings in parts of your body such as your legs and ankles can indicate excess ?uid or a blockage in a vein.
• Listening to your breath. Listening to your breath sounds by placing a stethoscope on your chest can reveal ?uid building up in your lungs (which makes a crackling sound) or scarred tissue in your lungs. Thumping on your chest can help locate where the ?uid is; a ?uid-?lled area sounds dull instead of hollow.
• Listening to your heart. Putting the stethoscope on four distinct sites over your heart, your doctor can listen to blood ?owing through your heart and heart valves. A heart murmur is the sound of turbulence caused by a problem with a valve or another heart structure. You may be asked to stand up, squat, or lie back, because murmurs change when you are in different positions. Extra sounds, called gallops, or other types of sounds may indicate vari- ous types of heart problems. Some unusual sounds are completely harmless.
• Listening to blood vessels. Your doctor can evaluate blood ?ow in large blood vessels by listening at different points in your neck, abdomen, and groin. Turbulence in these vessels makes a sound called a bruit, which may indicate blockage.
Depending on what the doctor learns from this basic examination, or “cardiac workup,” he or she may order blood tests, imaging procedures, or other tests of cardiac function in order to diagnose more speci?cally and plan treatment.

After a physical examination including listening to your heart and lungs with a stethoscope—your doctor will need more detailed infor- mation about your heart. The doctor will ask questions about diseases you have been diagnosed with, any persistent symptoms you have noticed, and your family medical history. A variety of tests are available to examine the structure of your heart, how well it functions, whether it is damaged or diseased, and the nature or extent of the disease.
Which tests you take depend on your symptoms, your medical history, your general cardiac condition, and your doctor’s assessment. Usually you will have some simple tests ?rst, such as an ECG (an electrocardiogram, which records your heart’s electrical activity), and then additional tests as needed to assess your particular problem. In addition to electrocardiography, other means of testing include blood tests; echocardiography (which uses sound waves to examine the heart valves and chambers); different types of stress tests (to study the heart while it is working harder); nuclear imaging (using safe amounts of radioactive materials to study heart function); other imaging tech- niques; and in some cases, more invasive tests that are done in a hospi- tal setting.
The tests can reveal useful information speci?c to your heart symp- tom or problem that will help guide your treatment. Many of the tests are noninvasive, meaning that they do not involve a needle stick or the introduction of any catheters (tubes) into your body. Knowing how and why a test is performed will help you feel more comfortable, and under- standing something about the possible results will help you learn about your heart along with your doctor. Don’t hesitate to ask questions before or after any test. Many tests require your permission or informed consent, and your doctor should fully explain beforehand any risks from the tests.