Coronary Artery Disease (CAD) is one of the top five causes of death worldwide (Doğan et al. 2017). The evaluation of history and performance of physical assessment on patients suspected to have CAD forms the basis of its diagnosis (Maleki et al., 2017). Although it is not the sole basis of diagnosis, it provides a basis for further tests and diagnosis or directly leads to the diagnosis. The evaluation of history targets identification of evidence of chest pain, other symptoms of CAD, personal health history, and family health history. The physical examination, on the other hand, targets non-invasive tests. They include a funduscopic exam, checking the blood pressure, a general assessment of the blood circulation, and analysis of the blood vessels.
A patients’ history of chest pain is a pointer to CAD. Dolly et al., 2019 notes that CAD patients exhibit predictable chest pains that occur during physical activities. However, they are relieved of the pain when they rest. Most of the patients experience a vertical or horizontal pain in front of the chest. The pain usually is tight and crushing. A horizontal movement of chest pain towards the middle of the chests points to possible angina pain. A vertical movement of chest pain to the upper xiphisternum edge, on the other hand, indicates a possible oesophageal spasm.
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A personal health history also provides a fundamental pointer to the identification and diagnosis of CAD. CAD patients have a health history that can be observed in the urinary system, abdominal cavity, head, and limps. For instance, the urinary system presents a history of oliguria. The abdominal cavity, on the other hand, shows swelling that can be characterized by an enlarged liver and general abdominal distension. Patients may also report frequent headaches (Dolly et al., 2019). The CAD patients’ limps, on the other hand, are prone to ischemia.
Other symptoms of CAD for evaluation of history include breathlessness, palpitation, fatigue, rapid heartbeats, and swellings . Breathlessness presents itself in various forms. One of the most common in patients with CAD is the shortness of breath during rest. Other historical presentation of CAD includes orthopnea that causes the patient to require a pillow when lying to avoid the flat position. Patients of CAD also report a history of frequent fatigue. Their heartbeats are also rapid and sometimes irregular. Thus they either have a skipped bit or abnormally large bit. Finally, they have a history of swelling (Maleki et al., 2017) . The swelling is attributed to the accumulation of fluids, especially in the abdominal and lower limps.
The physical exam for CAD includes a funduscopic exam that establishes changes in blood vessels in the retina due to hypertension. The changes include the silver wiring effect, microaneurysms, and fluffy deposits, and a swollen disc. Doğan et al. (2017) found that 87% of patients diagnosed with CAD who underwent a funduscopic examination had blood vessel changes.
The physical examination of the blood pressure and analysis is also crucial for the identification and diagnosis of CAD. Heart pressure should be analyzed for systolic and diastolic pressures with healthy individuals exhibiting measurements less than 140mm hg and 90mm hg, respectively. It is also advisable to measure the brachial artery of both arms because asymmetry and differences in the measurement in both arms indicate a possible aortic dissection (Maleki et al., 2017). Deviation from the normal heart rate range of 50-100 bits per minute, such as high pressure, especially in young people and low blood pressure in older individuals, is an indication of a possible case of CAD.
The general assessment of the blood circulation involves listening to the heart at various places of the body. The circulation check should reveal the equality of pulses in arms and legs. Thus unequal pulses and abnormally large or diminished pulses are a possible indicator of CAD. The heart murmurs should also be consistent. As noted by Heshmati (2018), abnormality in the blood circulation indicates a possible CAD case, especially when combined with a history of smoking and chest pains.
In conclusion, the evaluation of history targets the identification of evidence of chest pain, other symptoms of CAD, personal health history, and family health history. The physical examination, on the other hand, targets non-invasive examinations such as a funduscopic exam, checking the blood pressure, a general assessment of the blood circulation, and examination of the blood vessels. Abnormal findings that point to the detection and diagnosis of CAD include a history of predictable chest pains, and abnormal heart rhythm, and rate. The evidence of failed heart such as swollen liver and accumulation of fluids in the abdomen and lower limps and a medical history that reveal more than two CAD risk factors are also possible identifiers of CAD. The patient can, however, be recommended for further testing and examination, depending on the severity of the symptoms and whether the cause of CAD can be changed.
References
Doğan, T., Serdar, O., Topal, N., & Yalçınbayır, Ö. (2017). Investigation of Retinal Microvascular Findings in patients with Coronary Artery Disease. Journal Of Cardiology And Cardiovascular Medicine , 2 (1), 1-8. https:// doi.org/10.29328/journal.jccm.1001012
Dolly, S., Moteea, S., Preston, C., Watson, V., & Bulugahapitiya, S. (2019). Cardiac Chest Pain Evaluation In Patients With Diabetes And An Intermediate Probability Of Cad (Coronary Artery Disease). Atherosclerosis , 287 , e192-e193. https://doi.org/10.1016/j.atherosclerosis.2019.06.584
Heshmati, R. (2018). Investigating the Predictive Role of Health Beliefs and Cardiac Self-Efficacy in History of Tobacco Smoking in Patients with Coronary Artery Disease (CAD). Journal Of Health , 9 (3), 267-276. https://doi.org/10.29252/j.health.9.3.267
Maleki, M., Alizadehasl, A., & Haghjoo, M. (2017). Practical cardiology (pp. 7-15). Elsevier Health Sciences.
