There are many assocaited symptonls with cardiovascular diseases and they are discussed in this section.
1)Cough
A dry non-productive cough, at rest or on exertion, suggests pulmonary venous congestion as in congestive cardiac failure or rnitral stenosis. The sputum may be blood tinged. Chroilic bronchitis on the other hand causes a white and ~nucoid expectoration. A dry irritating cough is a not uncommon side effect of ACE inhibitor therapy. Structures like an aneurysm of the aorta pressing on the trachea can also produce a distinct type of cough.
2) Oliguria
A history of passing "less urine than before" is a syinpto111 of congestive cardiac
failure.
3)Fatigue
Heart failure, anemia, thyrotoxicosis a ~ i d anxietyldeprcssion may be associated wit11 fatigue. Following an acute MI the patient may experience great wealcness. Chronic severe fatigue should be intel-preted as an angina equivalent. Statins are known to cause muscle pain and fatigue.
4)Palpitation
The patient may col~lplain of the heart poultding, skipping a beat or jumping in the chest. It may be a benign synlptom but it needs evaluation. Occasionally, the patient inay have a slight pounding sensation in the neck (cannon 'a' waves). A sudden or instantaneous origin of palpitation with an equally abrupt cessation indicates paroxysinal supraventricular tachycardia. One of the varieties is the Wolff-Parkinson-White syndrome. Syncope can occur during such tachycardias without any awareness of the rhythm disturbance.
5)Syncope
Transient loss of consciousness can occur (Cardiac Syncope) in patients with heart disease. It may be postural with a drop in blood pressure, or due to low cardiac output, hypovolemia, or due to a rhythm disturbance (either tachy or bradyarrhythmia).
1)Cough
A dry non-productive cough, at rest or on exertion, suggests pulmonary venous congestion as in congestive cardiac failure or rnitral stenosis. The sputum may be blood tinged. Chroilic bronchitis on the other hand causes a white and ~nucoid expectoration. A dry irritating cough is a not uncommon side effect of ACE inhibitor therapy. Structures like an aneurysm of the aorta pressing on the trachea can also produce a distinct type of cough.
2) Oliguria
A history of passing "less urine than before" is a syinpto111 of congestive cardiac
failure.
3)Fatigue
Heart failure, anemia, thyrotoxicosis a ~ i d anxietyldeprcssion may be associated wit11 fatigue. Following an acute MI the patient may experience great wealcness. Chronic severe fatigue should be intel-preted as an angina equivalent. Statins are known to cause muscle pain and fatigue.
4)Palpitation
The patient may col~lplain of the heart poultding, skipping a beat or jumping in the chest. It may be a benign synlptom but it needs evaluation. Occasionally, the patient inay have a slight pounding sensation in the neck (cannon 'a' waves). A sudden or instantaneous origin of palpitation with an equally abrupt cessation indicates paroxysinal supraventricular tachycardia. One of the varieties is the Wolff-Parkinson-White syndrome. Syncope can occur during such tachycardias without any awareness of the rhythm disturbance.
5)Syncope
Transient loss of consciousness can occur (Cardiac Syncope) in patients with heart disease. It may be postural with a drop in blood pressure, or due to low cardiac output, hypovolemia, or due to a rhythm disturbance (either tachy or bradyarrhythmia).
Common fainting is vaso-vagal in origin. A needle prick, witnessing a surgical operation, sight of blood, standing on the feet for long hours etc. can precipitate such an attack in those who are predisposed to these episodes.
A hypersensitive carotid sinus may be present in some patients with syncope.
Lefi ventricular outflow obstruction due to aortic valve stenosis or hypertrophic subaortic stenosis inay cause syncope.
Syncope needs to be carefillly distinguished froin epileptic seizures or cerebral embolization.
Headache
Headache particularly in the occipital region can be due to hypertension. In patients with a central R-L shunt in the heart, with fever exclude a cerebral abscess. In patients with HIV induced myocarditis it may be due tn mycosis of the CNS.
7)Fever, Rigors and Sweats
In rheumatic heart disease there can be fever with associated tachycardia and joint pains. Chills and fever should make one suspect infective endocarditis. Fever with pleuritic pain suggests acute pericarditis. Sweating is often found with acute myocardial infarction.
8)Hoarseness of Voice
Patients with an enlarged left atrium as in mitral stenosis can develop a hoarse voice due to pressure on the left recurrent laryngeal nerve (Ortner's Syndrome). A hoarse voice may also suggest an aortic aneurysm.Patients with myxedema and heart disease can have a hoarse voice (old gramophone I-ecord at low speed).
Following cardiac surgery, hoarseness may be present due to vocal cord damage produced by the endotracheal tube.
9)Hiccups
Hiccups may be rare initial presentation of myocardial infarction. Amoebic abscess can irritate the diaphragm and even invade the pericardium with hiccups and chest pain as its presentation.
10) Dysphagia
Heartburn, oesophageal reflux, oesophageal spasm can co-exist with angina in many elderly patients with heart disease.
11) Anorexia, Nausea, Vomiting Right heart failure with an enlarged liver can present with these symptoms. Digitalis toxicity is another important cause.
12) Skin Colour
Pallor is often present in myocardial infarction. The patient may point out that his nails are blue (cyanosis). If the cyanosis is central the patient may note that his mucous membranes are bluish.Jaundice may be due to liepatic congestion in chronic right heart failure, pulmonary infarction or red cell hemolysis by a prosthetic valve. Sudden flushing of the skin occurs during meiiopause or more uncommonly if carcinoid heart disease is present.With amiodarone toxicity the skin takes on a patchy slate-like discoloration.
13) Insomnia, Anxiety and Depression chronic ischaemic heart disease.These symptoms are often due to ~~nderlying Depression is not ulicommon especially after heart surgery.
14) Impotence
Often the patient returds to the consulting room alone to talk about his embarrassing problem of impoteuce. It may be indication of severe coronary artery disease or the side effect of one or more of the anti-hypertensive drugs and other medications.
15) Nocturnal Cramps, Intermittent Claudication These signify peripheral vascular disease in the legs or a side effect of beta-blocker therapy. Cramps, by itself, may be due to isolated potassium deficiency caused by enthusiastic diuretic therapy.
16) Embolism
An embolism may be the first indication of heart disease. This typically occurs in the context of atrial fibrillation, dilated cardiomyopathy, left ventricular ancurysm and infective endocarditis.A well-taken history. in a congenial atmospllere is the beginning ofthe healing process. A wise clinician always pays a great deal of attention to the patient's history.
Headache
Headache particularly in the occipital region can be due to hypertension. In patients with a central R-L shunt in the heart, with fever exclude a cerebral abscess. In patients with HIV induced myocarditis it may be due tn mycosis of the CNS.
7)Fever, Rigors and Sweats
In rheumatic heart disease there can be fever with associated tachycardia and joint pains. Chills and fever should make one suspect infective endocarditis. Fever with pleuritic pain suggests acute pericarditis. Sweating is often found with acute myocardial infarction.
8)Hoarseness of Voice
Patients with an enlarged left atrium as in mitral stenosis can develop a hoarse voice due to pressure on the left recurrent laryngeal nerve (Ortner's Syndrome). A hoarse voice may also suggest an aortic aneurysm.Patients with myxedema and heart disease can have a hoarse voice (old gramophone I-ecord at low speed).
Following cardiac surgery, hoarseness may be present due to vocal cord damage produced by the endotracheal tube.
9)Hiccups
Hiccups may be rare initial presentation of myocardial infarction. Amoebic abscess can irritate the diaphragm and even invade the pericardium with hiccups and chest pain as its presentation.
10) Dysphagia
Heartburn, oesophageal reflux, oesophageal spasm can co-exist with angina in many elderly patients with heart disease.
11) Anorexia, Nausea, Vomiting Right heart failure with an enlarged liver can present with these symptoms. Digitalis toxicity is another important cause.
12) Skin Colour
Pallor is often present in myocardial infarction. The patient may point out that his nails are blue (cyanosis). If the cyanosis is central the patient may note that his mucous membranes are bluish.Jaundice may be due to liepatic congestion in chronic right heart failure, pulmonary infarction or red cell hemolysis by a prosthetic valve. Sudden flushing of the skin occurs during meiiopause or more uncommonly if carcinoid heart disease is present.With amiodarone toxicity the skin takes on a patchy slate-like discoloration.
13) Insomnia, Anxiety and Depression chronic ischaemic heart disease.These symptoms are often due to ~~nderlying Depression is not ulicommon especially after heart surgery.
14) Impotence
Often the patient returds to the consulting room alone to talk about his embarrassing problem of impoteuce. It may be indication of severe coronary artery disease or the side effect of one or more of the anti-hypertensive drugs and other medications.
15) Nocturnal Cramps, Intermittent Claudication These signify peripheral vascular disease in the legs or a side effect of beta-blocker therapy. Cramps, by itself, may be due to isolated potassium deficiency caused by enthusiastic diuretic therapy.
16) Embolism
An embolism may be the first indication of heart disease. This typically occurs in the context of atrial fibrillation, dilated cardiomyopathy, left ventricular ancurysm and infective endocarditis.A well-taken history. in a congenial atmospllere is the beginning ofthe healing process. A wise clinician always pays a great deal of attention to the patient's history.
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