AHA CLINICAL CONSULT

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AHA CLINICAL CONSULT
by council on clinical crdiology of AHA

The history is the foundation of the clinical diagnosis. The ability and
desire to obtain accurate, unbiased information is a major distinguishing
characteristic of every fine diagnostician. Although standardized
questionnaires, computers, and interviews conducted by paramedical
personnel have become increasingly useful in obtaining information, the
physician must still assume the major responsibility for ensuring that the
information is as complete and accurate as possible.
Despite the obvious necessity of obtaining accurate historical information
and relating that data to the physical examination, the clinical history,
unfortunately, may be neglected or slighted in favor of a glittering physical
finding or a multitude of laboratory tests. A brilliant biochemical diagnosis
may be the simple conclusion of a skilled medical interview.
In addition to accumulating essential historical information, the clinical
interview is the beginning of the patient-physician relationship, an
interaction in which the patient evaluates the physician’s patience,
thoroughness, skill, and interest, and the physician seeks subtle clues
from the patient’s appearance, voice, expression, mannerisms, position in
bed, and breathing pattern. As James Herrick, an early 20th century
American cardiologist of great distinction, remarked, \"The doctor may also
learn more about the illness from the way the patient tells the story than
from the story itself.\"*
This publication provides a basic approach to obtaining clinical history
related to the cardiovascular system. Common symptoms of cardiovascular
disease are also analyzed. A detailed discussion of the interrelations
among symptoms, physical signs, and pathophysiology may be found
among the titles listed under \"Suggested Reading.\"