The physical exam always begins with you, telling the doctor in your words, how you are feeling, what is bothering you, what symptoms you are feeling. Symptoms vary from person to person.

It is important for you to describe:

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 pressure to a 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 associated with times of increased demand, such as eating, exertion (activity), emotional stress or exposure to cold weather. These are known as the four E’s. Angina is relieved by rest and, in some cases, medications.

Other symptoms related to heart disease include:

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 in order 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. 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:

Your doctor will also measure your blood pressure to screen for high blood pressure. High blood pressure is a common problem that often leads to heart disease.

Blood pressure is the force or pressure exerted in the arteries by the blood as it is pumped around the body by the heart. It is recorded as two measurements:

Systolic pressure: pressure in the arteries during the period of the heart's contraction (the higher number).

Diastolic pressure: pressure in the arteries when the heart is relaxed between heartbeats (the lower number).

Normal blood pressure (BP) for an adult, relaxed at rest, is less than 140/90.

• BP may increase or decrease, depending on your age, heart condition, emotions, activity and the medications you take.
• One high BP does not mean you have high blood pressure. It may be necessary to measure your BP at different times to find out your typical value.

The exam is the first step in evaluating your heart.