Physical Examination

What should you bring to your doctor's visit?
Patients often ask what they should bring to their doctor visit. This is a very important question because bringing the right things helps your physician have as much information as possible when making a diagnosis and creating a treatment plan.
Please bring the following with you to the appointment:

1. Current medication and allergy list (include vitamins and herbal supplements)
2. List of symptoms – what they are, when they occur, how long they last and what relieves them
3. Results from prior tests and lab work (include films and reports):
• Actual heart catheterization film and report (if applicable)
• Actual echocardiograph (echo) tape and report (if applicable)
• Electrocardiogram (EKG) report, if performed within the last year
• Reports and films (if applicable) from all other tests, such as Stress Test, MRI, CAT Scans and Carotid and Vascular Ultrasounds, if performed within the last year
• If you have had surgery related to your cardiovascular condition, please bring:
• Surgeon's operative report
• Hospital discharge summary
• If you have had a device, such as pacemaker or defibrillator, implanted, please bring a copy of the front and back of the device card.
4. Any measurements your doctor has asked you to keep track of, such as blood pressure, blood sugar or daily weight readings
5. Medical and surgical history (a record of your past diagnoses, treatments and procedures)
6. Report from a physical exam done within the last year
7. Questions you would like answered
8. A list of your current doctors, including their names, addresses, phone numbers and fax numbers. Please let us know if you would like reports sent to those physicians.

The exam is the first step in evaluating your heart.
During the visit: Tell me what’s bothering you
The physical exam always begins with you telling the doctor, in your words, how you are feeling, what is bothering you and what symptoms you are having. Symptoms vary from person to person. Start by telling the doctor why you made the appointment. What kinds of symptoms are you having? It’s important that you describe your symptoms and when they occur.
Some things the doctor needs to know are:

• Do you feel any unusual discomfort?
• Where is the discomfort/pain located?
• What does the pain feel like? Is it dull, achy, pressure or sharp?
• How long does the pain last? Does it come and go? Does it stay for a long time?
• Do you notice that anything causes the discomfort? Do you feel it after eating, after exercise or at night?
• What relieves the discomfort? Rest, medications, position?

Pain from  coronary artery disease is usually felt in the chest, but may also be felt in the arms, shoulders, back or jaw. It may range from a slight discomfort or feeling of pressure to a feeling of heaviness or unbearable pain. Sweating, nausea, vomiting, lightheadedness, anxiety and shortness of breath occur along with the discomfort.
Angina, a symptom of coronary artery disease, occurs when the heart muscle is not getting enough oxygen-rich blood to meet its needs. Angina lasts for a short period of time and is often happens after eating, exertion (activity), emotional stress or exposure to cold weather. These are known as the four Es. Angina is relieved by rest and, in some cases, medication.
Other symptoms of heart disease include:

• Palpitations (a fluttering or flip-flop feeling in the chest)
• Shortness of breath
• Edema (swelling in the ankles, feet or stomach)
• Weakness or feeling overtired
• Dizziness or faintness
• Varying degrees of chest pain or tightness

Learn more about symptoms of:

• Peripheral arterial disease
• Carotid artery disease

The physical exam ….trained eyes, ears and touch
The doctor will look at your skin for good color, which shows that your body is getting a good supply of oxygen-rich blood. Your doctor will also feel your skin for warmth and feel your pulse to check your heart's rate, rhythm and regularity. Each pulse matches up with a heartbeat that pumps blood into the arteries. The force of the pulse also helps evaluate the amount (strength) of blood flow to different areas of your body and problems with circulation. Your doctor will check for swelling, which is a sign that your heart is not pumping efficiently.
Your doctor will use a stethoscope to listen closely to the sounds the heart makes with each heartbeat. The doctor can evaluate your heart and valve function and hear your heart’s rate and rhythm by listening to your heart sounds.
Abnormal sounds include:

• Murmur: An abnormal whooshing sound made by blood flowing abnormally through the heart. This may indicate a leaky heart valve.
• Click: An abnormal sound made by a valve that is stiff or stenotic (narrowed).

Blood Pressure
The doctor will measure your blood pressure (sometimes referred to as BP). High blood pressure (hypertension) is a common problem that often leads to heart disease.
Blood pressure is the force (pressure) exerted in the arteries by the blood as it is pumped around the body by the heart.
Blood pressure is a measurement of two types of pressure that are recorded as mm Hg (millimeters of mercury):

• Systolic pressure: This is the amount of pressure in the arteries when the heart contracts. This is the higher of the two numbers.
• Diastolic pressure: This is the amount of pressure in the arteries when the heart is relaxed between heartbeats. This is the lower of the two numbers.

The normal blood pressure for an adult who is relaxed at rest is less than 140/90 mm Hg.
Blood pressure may go up or down, depending on your age, heart condition, emotions, activity and the medications you take.
One high blood pressure reading does not mean you have high blood pressure. You may have to have your blood pressure measured at different times to find out what your typical reading is.