Despite the large range of investigations that are now available for the diagnosis of cardiovascular disease, a good clinical history remains the clinician's most valuable diagnostic tool. In many cases, the diagnosis may be made from the history alone, and examination and investigations are confirmatory. In other cases, a useful differential diagnosis list can be made and used to direct investigations towards the most likely diagnoses. A key objective of history-taking is to establish a clear description of the presenting symptom, and to detect any pattern to episodes of the symptom. This involves asking about precipitating and relieving factors (e.g. exercise, emotional stress, meals), and identifying any diurnal or other temporal pattern. When the history is unclear, it can be helpful to ask patients or their partner to keep a diary of their symptoms. Although this contribution focuses on cardiac symptoms, helpful supportive information is often found by paying attention to the previous medical history, medication and the social history.