Cardiovascular disease
, COMMON PRESENTING SYMPTOMS OF HEART DISEASE
Chest pain
Chest pain or discomfort is a common presenting symptom of cardiovas
disease and must be differentiated from non-cardiac causes. The site of
its character, radiation and associated symptoms will often point to the
Dyspnoea
Left heart failure is the most common cardiac cause of exertional dyspno
and may also cause orthopnoea and paroxysmal nocturnal dyspnoea.
Palpitations
Palpitations are an awareness of the heartbeat. The normal heart beat i
sensed when the patient is anxious, excited, exercising or lying on the le
In other circumstances it usually indicates a cardiac arrhythmia, commo
ectopic beats or a paroxysmal tachycardia.
,Syncope
This is a temporary impairment of consciousness due to inadequate cereb
blood flow. There are many causes and the most common is a simple fain
vasovagal attack. The cardiac causes of syncope are the result of either ve
(e.g.ventricular tachycardia) or very slow heart rates (e.g. complete heart
which are unable to maintain an adequate cardiac output.
Other symptoms Tiredness and lethargy occur with heart failure and resu
poor perfusion of brain and skeletal muscle, poor sleep, side effects of
medication, particularly β-blockers, and electrolyte imbalance due to diur
therapy.
Heart failure also causes salt and water retention, leading to oedema, wh
ambulant patients is most prominent over the ankles. In severe cases it m
involve the genitalia and thighs.
, INVESTIGATIONS IN CARDIAC DISEASE
The chest X-ray
A chest X-ray is usually taken in the postero-anterior (PA) direction at
maximum inspiration. A PA chest film can aid the identification of
cardiomegaly, pericardial effusions, dissection or dilatation of the aorta,
calcification of the pericardium or heart valves. A cardiothoracic ratio of
greater than 50% on a PA film is abnormal and normally indicates cardia
dilatation or pericardial effusion. Examination of the lung fields may sho
signs of left ventricular failure, valvular heart disease (e.g. markedly enla
left atrium in mitral valve disease) or pulmonary oligaemia (reduction of
vascular markings) associated with pulmonary embolic disease.
, COMMON PRESENTING SYMPTOMS OF HEART DISEASE
Chest pain
Chest pain or discomfort is a common presenting symptom of cardiovas
disease and must be differentiated from non-cardiac causes. The site of
its character, radiation and associated symptoms will often point to the
Dyspnoea
Left heart failure is the most common cardiac cause of exertional dyspno
and may also cause orthopnoea and paroxysmal nocturnal dyspnoea.
Palpitations
Palpitations are an awareness of the heartbeat. The normal heart beat i
sensed when the patient is anxious, excited, exercising or lying on the le
In other circumstances it usually indicates a cardiac arrhythmia, commo
ectopic beats or a paroxysmal tachycardia.
,Syncope
This is a temporary impairment of consciousness due to inadequate cereb
blood flow. There are many causes and the most common is a simple fain
vasovagal attack. The cardiac causes of syncope are the result of either ve
(e.g.ventricular tachycardia) or very slow heart rates (e.g. complete heart
which are unable to maintain an adequate cardiac output.
Other symptoms Tiredness and lethargy occur with heart failure and resu
poor perfusion of brain and skeletal muscle, poor sleep, side effects of
medication, particularly β-blockers, and electrolyte imbalance due to diur
therapy.
Heart failure also causes salt and water retention, leading to oedema, wh
ambulant patients is most prominent over the ankles. In severe cases it m
involve the genitalia and thighs.
, INVESTIGATIONS IN CARDIAC DISEASE
The chest X-ray
A chest X-ray is usually taken in the postero-anterior (PA) direction at
maximum inspiration. A PA chest film can aid the identification of
cardiomegaly, pericardial effusions, dissection or dilatation of the aorta,
calcification of the pericardium or heart valves. A cardiothoracic ratio of
greater than 50% on a PA film is abnormal and normally indicates cardia
dilatation or pericardial effusion. Examination of the lung fields may sho
signs of left ventricular failure, valvular heart disease (e.g. markedly enla
left atrium in mitral valve disease) or pulmonary oligaemia (reduction of
vascular markings) associated with pulmonary embolic disease.
