General Signs and Symptoms of CVS

Hey people, these are some of the things I prepared before the previous PCL. Below is the informations I summarised and gathered from Kumar and Clark's Clinical Medicine (: Unfortunately, there isn't much corellation with the pathogenesis but I hope it still helps (:

SYMPTOMS OF HEART DISEASE:

· Chest pain:

o Causes: Angina pectoris and myocardial infarction due to myocardial hypoxia.

o Pain usually described as crushing, gripping, heavy pain behind sternum in the middle of the chest and may radiate. Parasthesia, pain or heaviness or upper limb/s may also be associated with.

o Angina pectoris – Usually provoked on strenuous activity. Relieved by short acting nitrates.

o Pain radiating to the back – Enlarging thoracic aortic aneurysm

· Dyspnoea:

o Abnormal awareness or breathlessness

o Causes:

§ Pain in chest or abdomen may lead to dyspnoea

§ Main causes – cardiac and pulmonary pathologies – notably left ventricular failure (LVF)

o Pathophysiology

§ Oedema of the pulmonary interstitium and alveoli à Lungs being stiff and less compliant à more respiratory effort required to ventilate the lungs

· Palpitations:

o Increased awareness of the normal heartbeat or sensation of slow rapid or irregular heart rhythms.

o Normal heartbeat may be sensed due to anxiety, excitement or recumbency of the left side. Therefore, careful history must be taken to rule out.

o Most common arrhythmias felt as palpitations are:

§ Premature ectopic beats:

· Pause followed by forceful beat

· Pause present because heart resets itself before the next normal beat. Forceful beat present due to longer diastolic period and therefore heart is filled with more blood.

§ Paroxysmal tachycardia:

· Start abruputly and felt as racing heartbeat. May terminate suddenly but also tend to slow down first leading to sensation og palpitations fading away.

· Paroxysmal atrial fibrillation- irregular rhythm but other supraventricular or ventricular tachycardia - regular

· Symptoms: Syncope, presyncope, dyspnoea or chest pain. Polyuria after palpitations owing the release of atrial natiuretic peptide (ANP) which leads to sodium and water lost from kidneys.

o Different arrhythmias have different characteristics. One way to determine is to ask patient to tap out the rate and rhythm or their palpitations.

o Postural Orthostatic Tachycardia Syndrome: tachycardia on standing – mild drop in BP with dizziness and near syncope

o Maybe also caused by bradycardia but usually not common.

· Syncope

o Transient loss of consciousness due to inadequate cerebral blood flow

o Cardiovascular causes

§ Vascular – usually due to bradycardia and vasodilation

· Neurocardiogenic (Vasovagal attack)

· Postural hypotension – Pooling of blood

· Postbrandial hypotension – After a meal, BP drops

· Micturition syncope – Parasympathetic overactivity after bladder evacuated

· Carotid sinus syncope

§ Obstructive

· Aortic stenosis

· Pulmonary stenosis... etc

§ Arrhythmias

· Rapid tacchycardias

· Profound Bradycardia ( Stokes-Adams)

· Significant pauses in rhythm

· Artificial pacemaker failure

· Fatigue:

o Inadequate systemic perfusion in heart failure

o Other factors can be

§ poor sleep due to paroxysmal nocturnal dyspnoea, orthopnoea, decubitus angina, nocturia (due to diuretic therapy) or nightmares (due to amiodarone therapy)

§ direct side-effect of medication, particularly beta-blockers

§ electrolyte imbalance due to diuretic therapy

§ as a systemic manifestation of infection such as endocarditis.

· Peripheral oedema: