Analysis of Cardiac Disease Symptoms-Cardiac Disease Symptoms and their Causes-Detailed analysis

Cardiovascular System

Personal history :

Special habits:-
Smoking increases the risk of;
*Cor pulmonale (disorders predispose to cor pulmonale read here)
*Coronary H. D.
*Atherosclerosis
* Arrhythmia

I. V drug Addiction increases the risk of getting Endocarditis (fungal,Staph)

A- Analysis of complaint

B- Ask Leading questions about Cardiovascular symptoms:
1-Symptoms of pulmonary venous Congestion (explained below)
2-Symptoms of systemic venous Congestion.
3- Symptoms of low Cardiac output.
4-Chest pain.
5-Cyanosis & jaundice .
6-Palpitation .
7-Symptoms of Peripheral vascular disease .
8-Toxic symptoms

Pulmonary Venous Congestion:

Causes :-

L V F (left ventricular failure)
M. S (Mitral Stenosis)
Manifestations :
- Dyspnoea
-Orthopnea
- P.N. Dyspnoea
-Cardiac asthma
-Cough
-Haemoptysis

Cardiac Dyspnoea:

Dyspnoea = Breathlessness =uncomfortable awareness of breathing.
It is mainly due t reduced elastic properties of the lung (reduced pulmonary compliance).
Dyspnea on effort is usually the 1st symptom of pulmonary congestion.

Grades of dyspnoea:

Grade 1 : no breathlessness
Grade 2 : Breathlessness on severe exertion.
Grade 3 : Breathlessness on mild exertion.
Grade 4 : Breathlessness at rest .
(The New York Heart Association )

Orthopnea:

Breathlessness that occurs when the patient lies flat.

Pathogenesis :

1- ­ Venous return,which in case of LVF, increase pulmonary congestion.
2-Recumbence cause abdominal contents to press up against diaphragm.

Paroxysmal Nocturnal Dyspnoea:

The patient wake up from sleep with severe breathlessness and cough with expectoration,the attack usually lasts for 5 to 10 minutes by setting or getting up and inhalation of fresh air.
Wheezing, due to bronchial endothelial edema is common (Cardiac asthma )

Pulmonary edema:

Dyspnoea become very marked,with prominent central cyanosis ,cough and expectoration of big amount of frothy sputum tinged with blood.

Cough

Dry ,or productive of frothy sputum ,occurs on exertion or lying flat , accompanied or preceded by dyspnoea.

Hemoptysis :

-Blood tinged sputum : Pulmonary edema.
-Frank hemoptysis :(blood without sputum)
Causes:
*MS (Mitral Stenosis)
*Pulmonary embolism and infarction

Systemic Venous Congestion:

Causes : Right ventricular failure
Pericardial diseases.
Manifestations :
-Oedema of Lower limb: (bilateral pitting ,start in dependent parts,always precedes ascites)
-Pain in Right Hypochondrium & epigastrium ( hepatic congestion.)
-Anorexia & nausea ( G.I. T congestion. )

Chest Pain

Where ? Site & Radiation
What ? Character, Increase , Decrease , Associated symptoms.
When ? Onset ,Duration .
Causes :-
Cardiac :
Coronary Heart disease
Pericarditis.
Dissecting aortic aneurysm
-Pulmonary:
Pulmonary embolism .
Pleurisy (infusion of pleura)

-Cardiac neurosis .

an anxiety reaction characterized by quick fatigue, shortness of breath, rapid heartbeat, dizziness, and other cardiac symptoms, but not caused by disease of the heart.

Palpitations:

Causes :
-Dysrhythmias
- Hyperdynamic circulation.
-Volume overload (AR, MR,VSD )
-Anxiety .

Ask about :
-Is it regular or irregular ?
-Is it spontaneous.?
-Onset , Offset , and duration.
-Associated symptoms .
Example :Spontaneous regular palpitation with sudden onset and offset ® PSVT

Symptoms suggestive of Peripheral Vascular disease

-Coldness of extremities
-Claudication.(narrowing of arteries spec in legs and foot)
-Ulcers of the leg .

Toxic symptoms :

Fever,sweating, loss of weight ,loss of appetite.
Fever in cardiac patients :
- Rheumatic fever
-infective endocarditis
- MI
-pulmonary embolism
- pericarditis
-collagen diseases

Low Cardiac Output:

Causes:
-Stenotic valve lesions: (Mitral stenosis, Aortic Stenosis)
-Pulmonary hypertension.
-Heart failure.

Manifestations :
-Easy fatigue,blurring of vision,
- syncopal attacks.
-Coldness of extremities .

Cyanosis:

Bluish ting of skin

Cardiac causes

Central Cyanosis causes
-Congenital cyanotic Heart disease
-Chronic heart failure:

Peripheral Cyanosis causes:

- Low Cardiac output.
-Peripheral vascular Disease.
-Chronic heart failure.
Ask about:
-Onset, is it since birth ?
-Is it permanent .?
-Site  and Associated symptoms.

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