Heart: Symptoms and signs

COMMON SYMPTOMS

The most common symptoms of Heart disease are dyspnea, Chest pain , palpitations, syncope or presyncope, and fatigue. None are specific, and interpretation depends on the entire clinical picture and, in many cases, diagnostic testing.

Dyspnea

Dyspnea due to Heart disease is precipitated or exacerbated by exertion and results from elevated left atrial and pulmonary venous pressures or from hypoxia. The former are most commonly caused by left ventricular systolic dysfunction, left ventricular diastolic dysfunction (due to hypertrophy, fibrosis, or pericardial disease), or valvular obstruction. The acute onset or worsening of left atrial hypertension may result in pulmonary edema. Hypoxia may be due to pulmonary edema or intracardiac shunting.

Dyspnea should be quantified by the amount of activity that precipitates it. Dyspnea is also a common symptom of pulmonary disease, and the etiologic distinction may be difficult. Shortness of breath is also found in sedentary or obese individuals, anxiety states, anemia, and many other illnesses.

Orthopnea is dyspnea that occurs in recumbency and results from an increase in central blood volume. Orthopnea may also result from pulmonary disease and obesity. Paroxysmal nocturnal dyspnea is shortness of breath that occurs abruptly 30 minutes to 2 hours after going to bed and is relieved by sitting up or standing up; this symptom is more specific for cardiac disease. Both are more specific for cardiac diseases than exertional dyspnea, but neither is diagnostic of heart failure.

Chest Pain or Discomfort

Chest pain and other forms of discomfort are common symptoms that can occur as a result of pulmonary, pleural, or musculoskeletal disease, esophageal or other gastrointestinal disorders, cervicothoracic nerve root irritation, or anxiety states, as well as many cardiovascular diseases. Myocardial ischemia is the most frequent cause of cardiac Chest pain , but it is often experienced more as a sensation of discomfort than actual pain, thereby increasing the potential for neglect on the part of the patient and misdiagnosis by the physician. This is usually described as dull, aching, or as a sensation of "pressure," "tightness," "squeezing," or "gas," rather than as sharp or spasmodic. Ischemic symptoms usually subside within 5-20 minutes but may last longer. Protracted episodes often represent myocardial infarction. The pain is commonly accompanied by a sense of anxiety or uneasiness. The location is usually retrosternal or left precordial. Though the pain may radiate to or be localized in the throat, lower jaw, shoulders, inner arms, upper abdomen, or back, it nearly always also involves the sternal region. Ischemic pain is often precipitated by exertion, cold temperature, meals, stress, or combinations of these factors and is usually relieved by rest, but many episodes do not conform to these patterns. It is not related to position or respiration and is usually not elicited by chest palpation. In myocardial infarction, a precipitating factor is frequently not apparent.