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Third stage
Medicine
Lec-1
د. مزاحم الجيتجي
1/1/2014
Manifestations of Cardiovascular diseases
The cardinal symptoms of heart disease are:
Chest pain
Breathlessness
Palpitation
Syncope
Peripheral Oedema
Breathlessness (Dyspnoea)
It is defined as an abnormally uncomfortable awareness of breathing
It is one of principal symptoms of cardiac and pulmonary disease and ranges from an
uncomfortable awareness of breathing to intense respiratory distress or a frightening
sensation of fighting for breath.
Dyspnoea normally occurs after severe exercise and may occur in anxiety
(psychogenic)
Cardiac dyspnoea is due left side heart failureoccurs initially on exertion and progress
to orthopnoea ,paroxysmal nocturnal dyspnoea , and dyspnoea at rest .
Orthopnoea is dyspnoea on lying flat due to increased pulmonary venous congestion
Paroxysmal nocturnal dyspnoea occurs during sleep the patient awakes one to two
hours after sleeping with dyspnoea causing him to sit up and may go opening the
window usually accompanied with cough. It lasts 15-30 minutes
Acute pulmonary oedema is a severe breathlessness due to alveolar fluid transudation
accompanied with cough productive of copious frothy pink stained sputum. It can be
fatal & needs urgent treatment.
Palpitation
This common symptom is defined asunpleasantawareness of the forceful or rapid
beating of the heart . It is described as pounding, jumping, racing, fluttering & skipping
a beat.
Most causes due to awareness of heart beating in normal sinus rhythm in a healthy
person e.g. after exercise, excessive tea &coffee & smoking .
Other common benign cause is premature ectopic beats (extrasystole) which cause
irregularity at rest & subside on physical activity .
Palpitation may be due to more serious conditions such as cardiac arrhythmia e.g.
atrial fibrillation, atrial flutter, supra ventricular & ventricular tachycardia .
Palpitation can occur in a patient with normal heart rate ,increased heart rate & slow
heart rate as in complete heart block .
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In a patient with palpitation ask about:
The mode of onset & termination.
Specific triggers e.g. exercise, alcohol, caffeine & drugs.
Frequency.
Duration of attacks.
Rhythm (ask patient to tap out).
Any associated symptoms.
History of organic heart diseases .
Syncope & presyncope
Syncope is a sudden brief loss of consciousness.
Presyncope is lightheadedness & near collapse
Cardiac syncope is usually sudden with no aura with extreme death –like pallor &
rapid recovery (< 1 minute) .usually due to serious cardiac arrhythmia such as
ventricular tachycardia & complete heart block (stokes-Adam) .
Severe aortic stenosis , hypertrophic cardiomyopathy & severe coronary artery
disease can cause lightheadedness or syncope on exertion.
Posturnal hypotension is a significant (>20 mmHg) fall in systolic BP on standing .due
to anti hypertensive drugs or autonomic neuropathy may be a cause.
Other cardiovascular causes for syncope may occur because of enhanced vagal
response (vasovagal syncope) due to spcific stimuli e.g. at the sight of blood .A related
cause sharing a similar mechanism is carotid sinus hypersensitivity syndrome .Gentle
pressure on the carotid sinus may produce syncope by causing profound bradycardia.
Peripheral Oedema
Oedema is accumulation of fluid in the intersticial tissues
Oedema can be both a symptom (ankleswelling) & a sign (pitting oedema). It is usually
found in the lower limbs,especially the ankles,or over the sacrum in patients confined
to bed .It is symptom & sign of right side or congestive heart failure mainly due to
increased systemic venous pressure. cardiac oedema is generally symmetrical as it
progresses ,it usually ascends to involve the legs,thighs,genitalia & abdominal wall. It
may be generalized (anasarca) in severe heart failure ,but rarely involve the face
markedly
Other causes for generalized oedema are liver cirrhosis & renal diseases as nephrotic
syndrome. In liver cirrhosis the oedema starts in the abdomem (ascites)& descend to
the lower limb. In renal diseases the oedema though generalized the patient notices
the oedema first around the eyes ( periorbital) & the face ( puffiness).
Other symptoms
Cyanosis though it is a physical sign sometime itis asymptom especially in children
.Cyanosis is bluish discoloration of the skin & mucous membrane resulting from an
increased quantity of reduced hemoglobin or of abnormal hemoglobin pigments in
the blood. There are two principal forms of cyanosis:(1) central cyanosis characterized
by decreased arterial oxygen saturation due to cardiac & pulmonary diseases. &(2)
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peripheral cyanosis ,most commonly secondary to cutaneous vasoconstriction due to
low cardiac output or exposure to cold. Central cyanosis usually appear when reduced
hemoglobin level in the blood exceed 40 gm/L .& usually involve the tongue, lips&
mucous membrane of the mouth .
Intermittent claudication it is a pain in thelower limbs occurs on walking & disappear
on stopping ,it is symptom of peripheral arterial disease .
Reynaud's phenomenon it is symptom of vasospasm of the digital vessels of the hand
presented with pallor followed by cyanosis & redness .
Non-cardiac symptoms due to the cardiovascular diseases
Tiredness & fatigue may occur in acute myocardial infarction & heart failure .
Nausea ,vomiting ,sweating & epigastricpain can occur in myocardial infarction.
Nocturiamay be early symptoms of heart failure
Anorexia ,right upper abdominal discomfort, weight loss & cachexiaare symptom of
advanced heart failure
Cough and haemoptysis.