A medical history and physical exam are
always a part of evaluating a person who has symptoms of chest pain or risk
factors for coronary artery disease.
During the medical history,
the doctor will focus on areas such as:
- Chest pain or other symptoms of heart disease.
Your doctor will ask you to describe your pain. Also, he or she will want to
know where the pain starts and if it spreads to other parts of your body. Your
doctor will also ask when the pain happens. Tell your doctor about other
symptoms, such as nausea, vomiting, shortness of breath, dizziness, fainting,
rapid heartbeat, irregular heartbeat, or "skipped" heartbeat, along with your
- Other symptoms of coronary artery disease, such as
fatigue, irregular or rapid heartbeats, swelling, shortness of breath,
coughing, or difficulty breathing when lying down.
- Personal health
history. Your doctor will ask questions about your health and lifestyle. He or
she will ask about your cholesterol levels, blood pressure, exercise habits,
stress level, and other areas of your life. Tell your doctor if you smoke or if you
have diabetes or any other health problems.
Family medical history. Your doctor will want to know if one or more of your close
relatives have or had early coronary artery disease. Tell your doctor if you
have a family history of heart attack, heart failure, abnormal heart rhythms,
sudden death, diabetes, high cholesterol, and high blood pressure.
A complete physical exam will also be done. This may
blood pressure check.
- An examination for
fatty deposits (xanthomas) under the skin.
- A general assessment of
blood circulation. Circulation can be evaluated by checking skin color,
fingernails and toenails, and pulses in several locations, including the neck,
wrist, and feet.
- A funduscopic exam of the back of the eye
(retina). Changes in the blood vessels in the retina give clues to the presence
and severity of
high blood pressure or
- An examination of the blood
vessels of the neck by looking at them and by listening to blood flow using a
- Bulging or swollen neck veins may be a sign
- Changes in how the blood
sounds as it flows through a narrowed artery can be heard when listening to the
arteries in the neck (carotid arteries).
- Listening to the heart with a stethoscope for
heart murmurs and extra heart sounds.
- Listening to the lungs for
abnormal breath sounds. Soft crackling sounds (crepitations or rales) may be a
sign that heart failure has caused fluid to build up in the
- An examination of the abdomen. Using a stethoscope, the
doctor will listen to blood flow in the abdomen. Changes in the sounds of blood
flow (bruits) may indicate a narrowed blood vessel in the abdomen. This is a
sign of hardening of the arteries (atherosclerosis) in the large blood vessels that run
through the abdomen.
- A check for swelling in the feet and legs (a
sign of heart failure). Fluid buildup in the legs causes swelling (edema) and
may be a sign of heart failure. To assess swelling in the legs, the doctor will
press down on the skin over the lower leg bone. Edema is present if the
pressure leaves a dent in the skin.
Why It Is Done
The combination of medical history,
physical exam, and electrocardiography (ECG or EKG) is used to evaluate most
people who have chest pain that does not have a clear cause. This combination
of tests also is used to evaluate people who have chest pain that appears to be
angina or those who are at risk for heart
A medical history and physical exam may
provide the following results.
A normal medical history and physical exam do not always
mean that no further tests are needed.
The following are
- No risk factors for heart disease based on
- Normal heartbeat: strong heartbeat, regular rhythm, less
than 100 beats per minute but more than 50 beats per minute
blood pressure. Systolic blood pressure is less than 140 mm Hg; diastolic blood
pressure is less than 90 mm Hg.
- No signs of hardening of the
arteries. All pulses are strong and equal; no abnormal sounds (bruits) are
heard when listening to blood flow through blood vessels.
- No signs
of an enlarged heart
- No new heart murmurs are heard.
signs of heart failure (swelling in the legs or feet, lung congestion)
An abnormal medical history
reveals risk factors for heart disease. An abnormal medical history, physical
exam, or EKG may lead to further testing, depending on how likely it is that
you have heart disease. The following are abnormal
- History of chest pain that occurs predictably
with activity and is relieved by rest
- Abnormal heart rate or
- Abnormally high or low blood pressure
- Signs of
atherosclerosis (diminished or unequal pulses in the arms or legs, abnormal
sounds heard when listening to blood flow through blood
- New or changed heart murmur
- Signs of heart failure (bulging neck veins, extra heart
sounds, fluid in the lungs, fluid buildup in the abdomen, enlarged liver, or
swelling in the legs and feet)
- Medical history reveals two or more
risk factors for heart disease.
The decision to do further testing based on the medical
history and physical exam will depend on:
- The severity of the signs of heart
- How likely it is that the findings are related to heart
- How likely it is that the course of heart disease can be
changed based on the person's age and other factors.
An EKG usually is done whenever a heart-related problem is
suspected. If the medical history and physical exam indicate that coronary
artery disease is present, other tests, such as the stress echocardiography or
stress thallium test, may be used.
If the medical history and
physical exam suggest that the cause of chest pain is not related to the heart
(such as a stomach ulcer or gastroesophageal reflux disease), other testing may
be done to evaluate for other conditions. For information on the symptoms of
these conditions, see the topics Peptic Ulcer Disease and Gastroesophageal
Reflux Disease (GERD).
What To Think About
After the medical history and
physical exam, the doctor may have a better idea about whether the symptoms are
caused by coronary artery disease and how severe it may be. Risk factors are an
important part of deciding what further testing is needed. The history and
physical exam help to guide further decisions about testing and treatment.
Extensive testing is not always necessary to diagnose coronary artery disease.
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Primary Medical Reviewer
||Rakesh K. Pai, MD, FACC - Cardiology, Electrophysiology
Specialist Medical Reviewer
||Robert A. Kloner, MD, PhD - Cardiology
Current as of
||March 12, 2014