COMMON PRESENTING SYMPTOMS OF HEART DISEASE

The common symptoms of heart disease are chest pain, breathlessness, palpitations, syncope, fatigue and peripheral oedema, but none are specific for cardiovascular disease. The severity of anginal pain, dyspnoea, palpita-tions or fatigue may be classified according to the New York Heart Association grading of ‘cardiac status' (Table 10.1).

Chest pain

Chest pain or discomfort is a common presenting symptom of cardiovascular disease and must be differentiated from non-cardiac causes. The site of pain, its character, radiation and associated symptoms will often point to the cause (Table 10.2)

Dyspnoea

Causes are discussed on page 407. Left heart failure is the most common cardiac cause of exertional dyspnoea and may also cause orthopnoea and paroxysmal nocturnal dyspnoea (p. 407).

Palpitations

Palpitations are an awareness of the heartbeat. The normal heartbeat is sensed when the patient is anxious, excited, exercising or lying on the left side. In other circumstances it usually indicates a cardiac arrhythmia, com-monly ectopic beats or a paroxysmal tachycardia (p. 420).

Syncope

This is a temporary impairment of consciousness due to inadequate cerebral blood flow. There are many causes and the most common is a simple faint

Table 10.1 The New York Heart Association grading of ‘cardiac status' (modified)

Grade 1

Uncompromised (no breathlessness)

Grade 2

Slightly compromised (on severe exertion)

Grade 3

Moderately compromised (on mild exertion)

Grade 4

Severely compromised (breathless at rest)

Table 10.2 Common causes of chest pain

Central

Angina pectoris

Crushing pain on exercise, relieved by rest. May radiate to jaw or arms

ACS

Similar in character to angina but more severe, occurs at rest, lasts longer

Pericarditis

Sharp pain aggravated by movement, respiration and changes in posture

Aortic dissection

Severe tearing chest pain radiating through to the back

Massive PE

With dyspnoea, tachycardia and hypotension

Musculoskeletal

Tender to palpate over affected area

GORD

May be exacerbated by bending or lying down (at night). Pain may radiate into the neck

Lateral/peripheral

Pulmonary infarct

Pneumonia

Pneumothorax

Pleuritic pain, i.e. sharp, well-localized, aggravated by inspiration, coughing and movement

Musculoskeletal

Sharp, well-localized pain with a tender area on palpation

Lung carcinoma

Constant dull pain

Herpes zoster

Burning unilateral pain corresponding to a dermatome that appears 2 to 3 days before the typical rash

ACS, acute coronaiy syndrome; PE, puỉmonaiy emboỉus; GORD, gastro-oesophageaỉ reflux disease.

or vasovagal attack (p. 717). The cardiac causes of syncope are the result of either very fast (e.g. ventricular tachycardia) or very slow heart rates (e.g. complete heart block) which are unable to maintain an adequate cardiac output. Attacks occur suddenly and without warning. They last only 1 or 2 minutes, with complete recovery in seconds (compare with epilepsy, where

complete recovery may be delayed for some hours). Obstruction to ventricular outflow also causes syncope (e.g. aortic stenosis, hypertrophic cardiomyo-pathy), which typically occurs on exercise when the requirements for increased cardiac output cannot be met.

Other symptoms

Tiredness and lethargy occur with heart failure and result from poor perfusion of brain and skeletal muscle, poor sleep, side-effects of medication particu-larly β-blockers, and electrolyte imbalance due to diuretic therapy. Heart failure also causes salt and water retention leading to oedema, which in ambulant patients is most prominent over the ankles. In severe cases it may involve the genitalia and thighs.

Ebook Essentials of Kumar and Clark's Clinical Medicine, 5e

1. Ethics and communication

Ethics and communication

2. Infectious diseases

Infectious diseases

3. Gastroenterology and nutrition

Gastroenterology and nutrition

4. Liver, biliary tract and pancreatic disease

Liver, biliary tract and pancreatic disease
LIVER BIOCHEMISTRY AND LIVER FUNCTION TESTS
SYMPTOMS AND SIGNS OF LIVER DISEASE
JAUNDICE
HEPATITIS
NON - ALCOHOLIC FATTY LIVER DISEASE (NAFLD)
CIRRHOSIS
COMPLICATIONS AND EFFECTS OF CIRRHOSIS
LIVER TRANSPLANTATION
TYPES OF CHRONIC LIVER DISEASE AND CIRRHOSIS
PRIMARY SCLEROSING CHOLANGITIS
BUDD - CHIARI SYNDROME
LIVER ABSCESS
LIVER DISEASE IN PREGNANCY
LIVER TUMOURS
GALLSTONES
THE PANCREAS
CARCINOMA OF THE PANCREAS
NEUROENDOCRINE TUMOURS OF THE PANCREAS

5. Haematological disease

Haematological disease
ANAEMIA
Assessment and treatment of suspected neutropenic sepsis
HAEMOLYTIC ANAEMIA
INHERITED HAEMOLYTIC ANAEMIAS
ACQUIRED HAEMOLYTIC ANAEMIA
MYELOPROLIFERATIVE DISORDERS
THE SPLEEN
BLOOD TRANSFUSION
THE WHITE CELL
HAEMOSTASIS AND THROMBOSIS
THROMBOSIS
THERAPEUTICS

6. Malignant disease

Malignant disease
MYELOABLATIVE THERAPY AND HAEMOPOIETIC STEM CELL TRANSPLANTATION
THE LYMPHOMAS
THE PARAPROTEINAEMIAS
PALLIATIVE MEDICINE AND SYMPTOM CONTROL

7. Rheumatology

Rheumatology
COMMON INVESTIGATIONS IN MUSCULOSKELETAL DISEASE
COMMON REGIONAL MUSCULOSKELETAL PROBLEMS
BACK PAIN
OSTEOARTHRITIS
INFLAMMATORY ARTHRITIS
THE SERONEGATIVE SPONDYLOARTHROPATHIES
Clinical features, Investigations
INFECTION OF JOINTS AND BONES
AUTOIMMUNE RHEUMATIC DISEASES
SYSTEMIC INFLAMMATORY VASCULITIS
DISEASES OF BONE
THERAPEUTICS

8. Water, electrolytes and acid–base balance

WATER AND ELECTROLYTE REQUIREMENTS
BODY FLUID COMPARTMENTS
REGULATION OF BODY FLUID HOMEOSTASIS
PLASMA OSMOLALITY AND DISORDERS OF SODIUM REGULATION
DISORDERS OF POTASSIUM REGULATION
DISORDERS OF MAGNESIUM REGULATION
DISORDERS OF ACID - BASE BALANCE
THERAPEUTICS

9. Renal disease

Renal disease
INVESTIGATION OF RENAL DISEASE
GLOMERULAR DISEASES
NEPHROTIC SYNDROME
URINARY TRACT INFECTION
TUBULOINTERSTITIAL NEPHRITIS
HYPERTENSION AND THE KIDNEY
RENAL CALCULI AND NEPHROCALCINOSIS
URINARY TRACT OBSTRUCTION
ACUTE RENAL FAILURE/ACUTE KIDNEY INJURY
CHRONIC KIDNEY DISEASE
RENAL REPLACEMENT THERAPY
CYSTIC RENAL DISEASE
TUMOURS OF THE KIDNEY AND GENITOURINARY TRACT
DISEASES OF THE PROSTATE GLAND
TESTICULAR TUMOUR
URINARY INCONTINENCE

10. Cardiovascular disease

COMMON PRESENTING SYMPTOMS OF HEART DISEASE
INVESTIGATIONS IN CARDIAC DISEASE
CARDIAC ARRHYTHMIAS
HEART FAILURE
ISCHAEMIC HEART DISEASE
RHEUMATIC FEVER
VALVULAR HEART DISEASE
PULMONARY HEART DISEASE
MYOCARDIAL DISEASE
CARDIOMYOPATHY
PERICARDIAL DISEASE
SYSTEMIC HYPERTENSION
ARTERIAL AND VENOUS DISEASE
ELECTRICAL CARDIOVERSION
DRUGS FOR ARRHYTHMIAS
DRUGS FOR HEART FAILURE
DRUGS AFFECTING THE RENIN - ANGIOTENSIN SYSTEM
NITRATES, CALCIUM - CHANNEL BLOCKERS AND POTASSIUM - CHANNEL ACTIVATORS

11. Respiratory disease


Respiratory disease
TUBERCULOSISnd
DIFFUSE DISEASES OF THE LUNG PARENCHYMA
OCCUPATIONAL LUNG DISEASE
CARCINOMA OF THE LUNG
DISEASES OF THE CHEST WALL AND PLEURA
DISORDERS OF THE DIAPHRAGM

12. Intensive care medicine

Intensive care medicine

13. Drug therapy, poisoning, and alcohol misuse

Drug therapy, poisoning, and alcohol misuse

14. Endocrine disease

Endocrine disease
PITUITARY HYPERSECRETION SYNDROMES
THE THYROID AXIS
MALE REPRODUCTION AND SEX
FEMALE REPRODUCTION AND SEX
THE GLUCOCORTICOID AXIS
THE THIRST AXIS
DISORDERS OF CALCIUM METABOLISM
DISORDERS OF PHOSPHATE CONCENTRATION
ENDOCRINOLOGY OF BLOOD PRESSURE CONTROL
DISORDERS OF TEMPERATURE REGULATION
THERAPEUTICS

15. Diabetes mellitus and other disorders of metabolism

DIABETES MELLITUS
DIABETIC METABOLIC EMERGENCIES
COMPLICATIONS OF DIABETES
SPECIAL SITUATIONS
HYPOGLYCAEMIA IN THE NON - DIABETIC
DISORDERS OF LIPID METABOLISM
THE PORPHYRIAS

16. The special senses

THE EAR
THE NOSE AND NASAL CAVITY
THE THROAT
THE EYE

17. Neurology

COMMON NEUROLOGICAL SYMPTOMS
COORDINATION OF MOVEMENT
THE CRANIAL NERVES
COMMON INVESTIGATIONS IN NEUROLOGICAL DISEASE
UNCONSCIOUSNESS AND COMA
STROKE AND CEREBROVASCULAR DISEASE
EPILEPSY AND LOSS OF CONSCIOUSNESS
NERVOUS SYSTEM INFECTION AND INFLAMMATION
HYDROCEPHALUS
HEADACHE, MIGRAINE AND FACIAL PAIN
SPINAL CORD DISEASE
DEGENERATIVE NEURONAL DISEASES
DISEASES OF THE PERIPHERAL NERVES
MUSCLE DISEASES
MYOTONIAS
DELIRIUM
THERAPEUTICS

18. Dermatology

Dermatology

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