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You can help your doctor choose the best diagnostic tests by providing an accurate medical history. The medical history is a report the doctor of your “medical biography,” or a history of all the significant medical events in your life. The questions asked about your medical history will be more extensive during your first visit with a doctor than on subsequent visits. Also, during a general examination the history that is obtained is broader than during an examination for a specific problem. When you are seeing the doctor for a specific problem, the history can be limited to features pertinent to that problem.
The medical interview is often conducted by the doctor, but it may be conducted by a nurse or physician’s assistant. Sometimes the information is collected with a questionnaire. Regardless of the format, it is helpful if you have thought about and organized this information/before coming to the doctor.
The medical history that you provide will help your doctor decide where and how to focus the subsequent evaluation. The more you can help your doctor pinpoint the problem, the better the doctor will be able to avoid unnecessary testing and focus on finding the problem. If you feel that something is worth mentioning, say it. Your doctor is more likely to make an efficient and correct diagnosis if you focus on the symptoms that are relevant to the problem at hand.
The medical history should consist of the following parts: chief complaint, medical history, family medical history, social history, and review of organ systems.
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Rick is a 35-year old teacher who has noticed the general development of breathlessness and chest heaviness during exertion. At first these symptoms were very vague, so he is not sure when they started, although he thinks they may have developed perhaps 2 years ago. Yesterday, he ran upstairs from his basement to answer the doorbell; when he reached the top of the stairs and opened the door, he almost passed out and had to lie down.
Hypertrophic cardiomyopathy is an overgrowth of heart muscle that can impair blood flow both into and out of the heart. This type of cardiomyopathy is less common than dilated cardiomyopathy, but it is not rare and has been the focus of much medical interest.
Hypertrophic cardiomyopathy results from abnormal thickening of the heart wall. The thickening can occur in several places throughout the ventricles. Most commonly it occurs in the septum between the two ventricles just beneath the aortic valve. The septum may be 1 1/2 or more times as thick as the outer wall of the heart. With a thicker muscle wall, the cavity of the ventricle may be smaller. Thus, the volume of blood in the ventricle may be normal or decreased.
This thicker wall is unable to stretch as well during the diastolic (filling) phase of the heartbeat, although contraction during systole is normal or even exaggerated.
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