On completion of the chapter, the reader will be able to:
Identify the elements of a cardiovascular history.
Describe the symptoms associated with angina and congestive heart failure.
Apply the New York Heart Association grading system.
Classify heart murmurs.
Differentiate biomarkers of myonecrosis, inflammation, and hemodynamic stress.
Identify the P wave, QRS complex, and QT interval on the electrocardiogram, and describe their origin.
Determine which test(s) is(are) most appropriate for the person with a dsyrhythmia.
Describe the influence of pretest probability on stress test results.
Choose the most appropriate test to evaluate valvular function.
Differentiate exercise stress testing from pharmacologic stress testing.
Differentiate vasodilator stress testing from dobutamine stress testing.
Discuss the role of coronary calcium scoring.
Describe the indications for cardiac catheterization.
List the complications of cardiac catheterization.
Identify the methods to measure cardiac output.
Compare coronary angiography and intravascular ultrasound.
In the United States, cardiovascular disease (CVD) afflicts an estimated 83 million people (i.e., approximately one in three adults) and accounts for 33% of all deaths. One of every six hospital stays results from CVD. In 2008, the estimated direct and indirect cost of CVD—which includes hypertension, coronary heart disease, heart failure, and stroke—was $297.7 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 of systems.
The chief complaint is a brief statement describing the reason the patient is seeking medical attention. The ...