Cardiovascular disease

Cardiovascular disease COMMON PRESENTING SYMPTOMS OF HEART DISEASE Chest pain Chest pain or discomfort is a common presenting symptom of cardiovascular disease and must be differentiated from non-cardiac causes. The site of pain, its character, radiation and associated symptoms will often point to the cause Dyspnoea Left heart failure is the most common cardiac cause of exertional dyspnoea and may also cause orthopnoea and paroxysmal nocturnal dyspnoea. Palpitations Palpitations are an awareness of the heartbeat. The normal heart beat is sensed when the patient is anxious, excited, exercising or lying on the left side. In other circumstances it usually indicates a cardiac arrhythmia, commonly ectopic beats or a paroxysmal tachycardia. Syncope This is a temporary impairment of consciousness due to inadequate cerebral blood flow. There are many causes and the most common is a simple faint or vasovagal attack. The cardiac causes of syncope are the result of either very fast (icular tachycardia) or very slow heart rates (e.g. complete heart block) which are unable to maintain an adequate cardiac output. Other symptoms Tiredness and lethargy occur with heart failure and result from poor perfusion of brain and skeletal muscle, poor sleep, side effects of medication, particularly β-blockers, and electrolyte imbalance due to diuretic therapy. Heart failure also causes salt and water retention, leading to oedema, which in ambulant patients is most prominent over the ankles. In severe cases it may 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, and calcification of the pericardium or heart valves. A cardiothoracic ratio of greater than 50% on a PA film is abnormal and normally indicates cardiac dilatation or pericardial effusion. Examination of the lung fields may show signs of left ventricular failure, valvular heart disease (e.g. markedly enlarged left atrium in mitral valve disease) or pulmonary oligaemia (reduction of vascular markings) associated with pulmonary embolic disease