We cannot always pick those up through the primary cardiac exam. There are some findings such as heart murmurs, abnormal pulses ... And we base a lot of trying to find those on the history that we get from the patient. Do they have any history of syncope or passing out during or after activity. Do they have any strong family history of cardiac disease. Do they have any family members who died suddenly of heart related issues or unknown death, particularly at a young age less than 40 or 50 years old. Do they have any history of heart murmurs that their pediatrician or family doctor has picked up in previous years. Do they have any history of abnormal heart rhythms or beats in them or in family members. So there's a lot of different parts to the physical exam and the history that can help point us to some of these different pathologies.
