6
Table 3. History and Physical Examination in HF
History Comments
Potential clues suggesting etiolog y
of HF
A careful family history may identify an
underlying familial cardiomyopathy in patients
with idiopathic DCM. Other etiologies should be
considered as well.
Duration of illness A patient with recent-onset systolic HF may
recover over time.
Severity and triggers of dyspnea
and fatigue, presence of chest pain,
exercise capacity, physical activity,
sexual activity
To determine NYHA class, identify potential
symptoms of coronary ischemia.
Anorexia and early satiety, weight
loss
Gastrointestinal symptoms are common in
patients with HF. Cardiac cachexia is associated
with adverse prognosis.
Weight gain Rapid weight gain suggests volume overload.
Palpitations, (pre)syncope, ICD
shocks
Palpitations may be indications of paroxysmal
AF or ventricular tachycardia. ICD shocks are
associated with adverse prognosis.
Symptoms suggesting transient
ischemic attack or thromboembolism
Affects consideration of the need for
anticoagulation.
Development of peripheral edema
or ascites
Suggests volume overload.
Disordered breathing at night, sleep
problems
Treatment for sleep apnea may improve cardiac
function and decrease pulmonary hypertension.
Recent or frequent prior
hospitalizations for HF
Associated with adverse prognosis.
History of discontinuation of
medications for HF
Determine whether lack of GDMT in patients
with HFrEF reflects intolerance, an adverse
event, or perceived contraindication to use.
Withdrawal of these medications has been
associated with adverse prognosis.
Medications that may exacerbate HF Removal of such medications may represent a
therapeutic opportunity.
Diet Awareness and restriction of sodium and fluid
intake should be assessed.
Adherence to medical regimen Access to medications; family support; access to
follow-up; cultural sensitivity.
Diagnosis
