Semeiotics of the heart: history in the complete cardiac physical examination

By Cristiano Antonino On Jun 11, 2023

The objective examination of the heart includes auscultation, inspection and percussion, but to arrive at a diagnosis the doctor checks the history and may prescribe exams

Let us now discuss the history in the context of the cardiac objective examination

FAMILY HISTORY

There are numerous congenital cardiovascular diseases, among which we mention ischaemic cardiomyopathy, sudden death, dilated cardiomyopathy, arrhythmogenic right ventricular dysplasia and Brugada syndrome, so it is important in the family history to investigate whether our patient has had cardiovascular problems himself or in his family at a relatively young age, around 50-55 years.

PHYSIOLOGICAL ANAMNESIS

– in the past it was important to know whether a male had served in the military and whether a woman had completed a pregnancy, because these were the first visits a person made to the doctor, until recently, thus enabling us to rule out certain heart conditions.

Nowadays, even teenagers often go for doctor’s visits (when no heart problems are found on the objective test, we write down valid rhythmic tones and breath-free pauses on the medical history).

– atherosclerosis begins to manifest itself in the second month of intrauterine life, the clinical horizon of this pathology is present, however, around 40-50 years of age.

This pathology can create serious problems more or less precociously, depending on how much consideration is given to the risk factors for this disease, which can be congenital or acquired, so the lifestyle habits to be investigated in this physiological anamnesis are also important.

Atherosclerosis is also a disease that is much more sensitive to the cold, the vasculopath is in fact a patient who is worse off in the cold, see Raynaud’s syndrome, Buerger’s disease, exertional angina and arteriopathy in the lower limbs (in the latter case we can speak of window disease, in practice, these stenoses in the femoral arteries cause the subject to suffer severe pain, forcing him to stop every few hundred metres, so to give himself an attitude, he is said to stop often to look in shop windows, then when the pain disappears he resumes walking).

The coronary arteries are one of the districts most affected by these diseases, but there are several others; in any case, atherosclerosis tends to affect specific districts more frequently.

– it is important to recognise the presence of the metabolic syndrome, in which the summation of several risk factors (hypertension, hyperglycaemia, hypercholesterolaemia, obesity, tobacco habit and a sedentary lifestyle) leads the atherosclerotic plaque to have an earlier clinical horizon.

– Cocaine angina also needs to be investigated, since cocaine in the forms in which it is taken nowadays causes a violent coronary spasm, which can last for a long time and lead to a myocardial infarction, although in this case the coronary arteries may be completely healthy. One must therefore also find the courage to ask if the patient is using drugs, in order to be able to implement the correct therapy.

– The job is also important, as a sedentary job, a job that involves eating in restaurants or a job that leads to an alteration in the sleep-wake rhythm is important to find out from the anamnesis, we must in fact bear in mind that platelets have the highest aggregating power in the pre-dawn hours, in fact angina can easily occur during this time.

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