History-taking in cardiology

History taking is central to making a diagnosis in patients with heart disease. Chest pain should be evaluated with particular attention to its reproducible precipitation by exertion and prompt relief by rest. Only four common arrhythmias cause palpitation. Ectopic beats present as a sensation of missed beats and thumps; paroxysmal supraventricular tachycardia with very clearly defined attacks usually lasting minutes only; paroxysmal atrial fibrillation with longer but still clearly defined attacks. In sinus tachycardia there is an almost constant feeling of palpitation, often with other symptoms of anxiety. Cardiac breathlessness may be associated with orthopnoea, paroxysmal nocturnal dyspnoea and peripheral oedema, though can be very difficult to distinguish from other causes. Syncope is most commonly vasovagal with recognisable precipitants; when due to arrhythmia is very sudden in onset and recovery. Epilepsy is distinguished by an aura and abnormal movements at the onset; maintained (rather than floppy) body tone during the attack and a post-ictal phase. Time spent taking a careful history will yield more towards a diagnosis than any number of sophisticated and expensive tests.