Medical History and Physical Exam for Coronary Artery Disease

Exam Overview

A medical history and physical exam are always a part of evaluating a person who has symptoms of chest pain or pressure or risk factors for coronary artery disease.

During the medical history, the doctor will focus on areas such as:

• Chest pain or pressure, or other symptoms of heart disease. Your doctor will ask you to describe your symptoms. Also, he or she will want to know where any pain or pressure starts and if it spreads to other parts of your body. Your doctor will also ask when it happens. Tell your doctor about other symptoms, such as nausea, vomiting, shortness of breath, dizziness, fainting, rapid heartbeat, irregular heartbeat, or "skipped" heartbeat, along with your chest symptoms.
• Other symptoms of coronary artery disease, such as fatigue, irregular or rapid heartbeats, swelling, shortness of breath, coughing, or difficulty breathing when lying down.
• Personal health history. Your doctor will ask questions about your health and lifestyle. He or she will ask about your cholesterol levels, blood pressure, exercise habits, stress level, and other areas of your life. Tell your doctor if you smoke or if you have diabetes or any other health problems.
• Family medical history. Your doctor will want to know if one or more of your close relatives have or had early coronary artery disease. Tell your doctor if you have a family history of heart attack, heart failure, abnormal heart rhythms, sudden death, diabetes, high cholesterol, and high blood pressure.

A complete physical exam will also be done. This may include:

• A blood pressure check.
• An examination for fatty deposits (xanthomas) under the skin.
• A general assessment of blood circulation. Circulation can be evaluated by checking skin color, fingernails and toenails, and pulses in several locations, including the neck, wrist, and feet.
• A funduscopic exam of the back of the eye (retina). Changes in the blood vessels in the retina give clues to the presence and severity of high blood pressure or diabetes.
• An examination of the blood vessels of the neck by looking at them and by listening to blood flow using a stethoscope.
  • Bulging or swollen neck veins may be a sign of heart failure.
  • Changes in how the blood sounds as it flows through a narrowed artery can be heard when listening to the arteries in the neck (carotid arteries).
• Listening to the heart with a stethoscope for heart murmurs and extra heart sounds.
• Listening to the lungs for abnormal breath sounds. Soft crackling sounds (crepitations or rales) may be a sign that heart failure has caused fluid to build up in the lungs.
• An examination of the abdomen. Using a stethoscope, the doctor will listen to blood flow in the abdomen. Changes in the sounds of blood flow (bruits) may indicate a narrowed blood vessel in the abdomen. This is a sign of hardening of the arteries (atherosclerosis) in the large blood vessels that run through the abdomen.
• A check for swelling in the feet and legs (a sign of heart failure). Fluid buildup in the legs causes swelling (edema) and may be a sign of heart failure. To assess swelling in the legs, the doctor will press down on the skin over the lower leg bone. Edema is present if the pressure leaves a dent in the skin.