Etiology: unknown or ignored?

It is important to determine whether a patient's medical problem is a physiological complication that has resulted from a disease process (such as heart failure that is a complication of calcific aortic valve stenosis) or a structural complication that has resulted from a disease process (such as a stroke due to an embolus from a left atrial thrombus caused by atrial fibrillation in a patient with mitral stenosis). Whereas treatment is available for heart failure and stroke regardless of the cause, the progress of medicine is nullified when treatment is not directed at the etiology of heart failure and stroke. Finally, and most importantly, the identification and treatment of cardiovascular diseases that may cause heart failure and stroke may provide the physician with an opportunity to prevent these serious complications. The New York Heart Association four-part diagnosis (a complete diagnosis) requires the physician to consider all the important aspects of a patient's disease.