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  • Image not available. A careful patient history and physical examination are extremely important in diagnosing cardiovascular disease and should be done prior to any test.
  • Image not available. Heart sounds and heart murmurs are important in identifying heart valve abnormalities and other structural cardiac defects.
  • Image not available. Elevated jugular venous pressure is an important sign of heart failure and may be used to assess severity and response to therapy.
  • Image not available. Electrocardiography is useful for determining rhythm disturbances (tachy- or bradyarrhythmias).
  • Image not available. Exercise stress testing provides important information concerning the likelihood and severity of coronary artery disease; changes in the electrocardiogram, blood pressure, and heart rate are used to assess the response to exercise.
  • Image not available. Cardiac catheterization and angiography are used to assess coronary anatomy and ventricular performance.
  • Image not available. Echocardiography is used to assess valve structure and function as well as ventricular wall motion; transesophogeal echocardiography is more sensitive for detecting thrombus and vegetations than transthoracic echocardiography.
  • Image not available. Radionuclides such as technetium-99m and thallium-201 are used to assess ischemia and myocardial viability with suspected coronary artery disease and heart failure.
  • Image not available. Pharmacologic stress testing is used when patients cannot perform physical exercise to assess the likelihood of coronary artery disease.

Upon completion of the chapter, the reader will be able to:

  • 1. List the cardinal symptoms of coronary artery disease and congestive heart failure.
  • 2. Relate the type of murmur (systolic or diastolic) with specific valvular abnormalities, such as stenosis and regurgitation.
  • 3. Describe the various serum biomarkers and their utility in providing diagnostic and prognostic information related to myocardial injury.
  • 4. Describe the various waveforms of the electrocardiogram and the changes that are seen in it with myocardial ischemia and infarction.
  • 5. List the drugs that may cause lethal arrhythmias by prolonging the QT interval.
  • 6. Differentiate between exercise and pharmacologic stress testing and the methods used to detect myocardial ischemia (i.e., electrocardiography, myocardial perfusion study, and evaluation of cardiac function).
  • 7. Outline the role of cardiac catheterization and angiography in the diagnosis and management of subjects with coronary artery disease.
  • 8. List three echocardiographic methods and describe their role in assessing cardiac structure and function.
  • 9. Describe the use of dobutamine, dipyridamole, and adenosine in so-called pharmacologic stress testing.

In the United States, cardiovascular disease (CVD) afflicts an estimated 80 million people (i.e., approximately 1 in 3 adults) and accounts for 35% of all deaths. In 2009, the estimated direct and indirect cost of CVD—which includes hypertension, coronary heart disease, heart failure, and stroke—was $475.3 billion.1

Atherosclerosis, the cause of most CVD events, is typically present for decades before symptoms appear. With a thorough history, comprehensive physical examination, and appropriate testing, the individual with subclinical CVD usually can be identified, and the subject with symptomatic CVD can be assessed for the risk of an adverse event and can be managed appropriately.

The elements of a comprehensive history include the chief complaint, current symptoms, past medical history, family history, social history, and review ...

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