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  • image Many cardiovascular disorders develop over years to decades. Evaluation of the patient with or at risk for cardiovascular disease (CVD) must therefore include a comprehensive patient (or caregiver) interview to identify traditional risk factors and risk-enhancing factors for CVD. Along with other key information (eg, vital signs, laboratory values), these data can be used to determine a patient’s risk for future cardiovascular events.

  • image Changes in the frequency, duration, and severity of cardiac-related symptoms (eg, ischemic chest pain, dyspnea) are essential to the assessment of CVD and often guide the urgency of intervention as well as the specific pharmacologic strategies selected. A comprehensive patient interview can also be useful for discerning CVD from noncardiac disorders that share similar symptomology.

  • image Obtaining an accurate blood pressure measurement is paramount to the evaluation and treatment of several cardiovascular disorders. Guidelines for appropriate measurement techniques include recommendations on patient preparation and position, cuff size, and blood pressure documentation.

  • image Several cardiovascular disorders, such as heart failure (HF) and peripheral arterial disease, warrant physical examination of areas that are more distal from the heart, including the neck (eg, carotid arteries, jugular venous pressure, abdominojugular reflux) and lower extremities (eg, peripheral pulses, edema). Abnormal findings can prompt further evaluation or alterations in pharmacologic therapy.

  • image Auscultation of the chest provides key information on valvular structure and function. Abnormal heart sounds can be used to guide the need for further evaluation.

  • image Two key cardiac-specific laboratory tests are cardiac troponin and brain natriuretic peptide (BNP). Elevations in cardiac troponin may indicate the presence of myocardial infarction and can be used to guide both pharmacologic and nonpharmacologic interventions. A normal BNP concentration in a patient with dyspnea excludes the presence of HF, whereas elevations are correlated with disease severity as well as long-term morbidity and mortality.

  • image An electrocardiogram (ECG) records the pattern of electrical activity across the heart and each segment corresponds to an event in the cardiac cycle. The ECG provides an electrical map of the heart, which can be used to locate areas of ischemia or other pathology and identify arrhythmias. Alterations in the ECG such as QT-interval prolongation can be drug-related and may place patients at risk of potentially life-threatening arrhythmias.

  • image Stress testing remains the most common initial strategy for evaluating chest pain suspicious for myocardial ischemia. The two main modalities for testing are inducing stress via exercise or the administration of a pharmacologic agent such as dobutamine or adenosine. The information provided by a stress test is often combined with echocardiography and radionuclide myocardial perfusion imaging.

  • image Echocardiography uses sound waves to create an image of the heart, providing important information on the structure and function of heart valves and chambers. Although a transthoracic echocardiogram (TTE) is less invasive and provides the key information necessary for most clinical decisions, a transesophageal echocardiogram (TEE) may be required to visualize structures located in posterior areas of the heart (eg, mitral valve, left atrial appendage) and to guide surgical planning.


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