Importance of the history in diagnosing cardiac patients.

The importance of a good clinical history has been emphasized by reviewing the most common diagnostic criteria in cardiac patients. Dyspnea of cardiac origin should be differentiated from respiratory disturbances, neuroses, unfitness, etc. Orthopnea, paroxysmal nocturnal dyspnea, cardiac asthma and acute pulmonary edema are manifestations of left ventricular failure. Peripheral edema is most frequently due to circulatory disturbances of the lower extremities. Edema of cardiac origin is bilateral, related to postural changes and associated with cardiomegaly. Hepatic and renal problems are also common causes of edema. Chest pain due to myocardial ischemia (angina pectoris) is characteristic in its location, radiation, onset and relief. It should be differentiated from the many other causes of chest pain (neurosis, pericarditis, myalgia, etc.) by a carefully taken history. Palpitations and syncope are common symptoms of severe cardiac disease. Patients with these complaints should be thoroughly investigated. Syncope of cardiac origin (Stokes-Adams attack) should be differentiated from epileptic seizures.