Symptoms & Signs

By Barry M. Massie, MD, & Thomas M. Amidon, MD

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.