The examination of the heart: the importance of initial screening.
The screening examination of the heart and blood vessels require the use of the history, physical examination, electrocardiogram, and chest x-ray film. The relevant anatomy, pathology, and physiology responsible for the abnormalities found by using these methods of examination must be understood. The abnormalities that can be detected by the use of these methods of examination are discussed in this monograph. The techniques themselves are referred to as being low technology. The skill required in the use of these methods must be developed to its fullest. The data collected by using the history, physical examination, electrocardiogram, and chest x-ray film must be carefully analyzed in order for the examiner to diagnose the patient's cardiac problem. When possible, a complete cardiac diagnosis should be made according to guidelines formulated by the New York Heart Association. The four elements of a complete diagnosis are: Etiology, anatomy, physiology, and cardiac status and prognosis. In many cases, no additional data are needed and no additional data should be collected. When it is not possible to create a complete cardiac diagnosis from this information, the examiner must determine if it is wise and proper, given the patient's other health problems, to collect additional data that would permit a complete cardiac diagnosis. This effort hones the judgmental skill of the physician. When the cardiac diagnosis remains incomplete, or when a complete cardiac diagnosis is made but additional information is needed for follow-up purposes, carefully selected high technology should be used. With the unanswered questions in mind, the procedure used should be the one that answers the question with a predictive value that permits a defensible clinical decision. A complete medical problem list should be created for every patient. The cardiovascular problem must always be viewed in the context of other medical problems; there is no other way to make a sound judgment regarding the care of the patient with heart disease. When low technology, consisting of the history, physical examination, electrocardiogram, and chest x-ray film, is used poorly it is very likely that high technology will be used poorly. It is not possible to take a second step (high technology) without taking a well placed first step (low technology).
Emory University School of Medicine, Atlanta, Georgia.
J W
JW
Hurst
D004562:Electrocardiography; D006331:Heart Diseases / Q000175:diagnosis*; D006801:Humans; D008487:Medical History Taking / Q000379:methods; D010808:Physical Examination / Q000379:methods; D013902:Radiography, Thoracic