Symptoms in cardiovascular diseases

Heart complaints
Chest pain
Angina pectoris
Heart attack pain
Cardialgia (non-coronary pain)
Palpitations and interruptions in the work of the heart
Fainting (loss of consciousness, syncope)
Dyspnea (shortness of breath)
Cough
Weakness and fatigue
Edema

Causes of chest pain
Heart disease
Ischemic heart disease
Pericarditis
Vascular disease
Aortic dissecting aneurysm
PE
Diseases of the lungs
Pleurisy
Pneumothorax
Diseases of the gastrointestinal tract
Esophagitis
Peptic ulcer
Cholecystitis
Pancreatitis
Diseases of the musculoskeletal system
Psychogenic pain
Fibromyalgia

Angina pectoris
Coronary artery narrowing
Coronary
artery plaque

Pathogenesis of angina pectoris
The lumen of the artery is narrowed by plaque by 60-70%
↓
Inability to increase coronary blood flow with an increase in myocardial demand for O2 (increased heart rate, blood pressure, contractility)
↓
Supply of the O2 does not meet the O2 demand
↓
Myocardial Ischemia
↓
Angina pectoris

Clinical features of angina pectoris
Discomfort or pain of a pressing, squeezing character, a feeling of heaviness
Typical localization - behind the breastbone
Irradiation - to the neck, jaw, epigastrium, or arms
Duration of an angina attack - minutes

Provoked by physical or psycho-emotional stress
The pain goes away at rest, s/l nitrates relieve the pain in 30 seconds or a few minutes
Associated symptoms: fear, sweating, palpitations, arrhythmias, shortness of breath

Heart attack pain

Pathogenesis
Plaque rupture with thrombus formation at the rupture site
↓
CA occlusion
↓
No flow and O2 delivery
↓
Severe and prolonged myocardial ischemia
↓
Heart attack pain

Feature
The pain is similar in character to angina pectoris
Stronger and longer lasting (> 30 min)
Does not go away at rest and after taking nitroglycerin
Can be stopped with narcotic analgetics
Often accompanying symptoms: cold sweat, palpitations, shortness of breath, fear of death

NonСoronary pain
NCP - nonspecific chest pains of various nature
Are established by excluding all other causes of chest pain, primarily angina pectoris

Palpitation
The sensation of P occurs with an increase in heart rate and / or an increase in the work of the heart
Constant heartbeats (sinus tachycardia with HF or with thyroid hyperfunction)
Sudden heartbeats
- Rhythmic (paroxysmal tachycardia) or irregular heartbeat (atrial fibrillation)
Ask patient: how attacks are provoked and stopped?
Duration and frequency of attacks?
Concomitant symptoms (severe heart rhythm disturbances cause: a decrease in cardiac output - presyncope and syncope, ALVF - dyspnea, ischemia - angina pectoris)

Interruptions of heart beats
Feeling of extra beats or pause
Causes: extrasystoles, atrial fibrillation
Ask patient:
About provocation and relief
How often there are happened ?

Syncope (fainting)
The main reason of cardiogenic fainting – sudden decrease of the cardiac output and brain arterial flow deficiency.
Causes:
Cardiac arrhythmias – bradycardia HR < 35-40, tachycardia HR > 150
Acute myocardial infarction
Pulmonary embolism

Shortness of breath
Shortness of breath - a painful sensation difficulty breathing
The degree of shortness of breath is determined by the level of physical activity
Cardiac dyspnea is a manifestation of LV HF

Pathogenesis of dyspnea
LV disease
↓
Decreased contractility and / or impaired LV relaxation
↓
Congestion of the blood in the pulmonary circulation ↓
Violation of gas exchange
↓
Excessive activation of the breathing drive center (brain)
↓
Overload of breath muscles
Dyspnea

In severe LV HF, dyspnea appears when lying down - ortopnea
Pathogenesis : in the supine position
↑ P hydrostatic in the lungs due to the redistribution of fluid from the veins of the LE to the vessels of the chest → increased pulmonary congestion

Nocturnal attacks of cardiac asthma
Attacks of severe shortness of breath and coughing at night (in the 1st half), which cause the patient to awaken
Pathogenesis
↓ adrenergic myocardial stimulation
Increased blood volume ("resorption" of
edema) and venous return
↓
A sharp increase in pulmonary congestion

Cough
Cough is common in LV HF
Characterized by the appearance of a dry cough with exertion or lying down (often with shortness of breath)
Pathogenesis - edema of interstitial and bronchial tissue with pulmonary congestion

Fatigue and weakness
Frequent and earliest but nonspecific symptoms of LV HF
Pathogenesis
Inability of the heart to provide the necessary blood flow for muscle function

Life history
Age - an increase in the prevalence of arterial hypertension and the likelihood of CHD with age (men> 55 years, women> 65 years - CVD RF)
Gender - male gender is a risk factor for CVD
Childhood period:
- frequent sore throats – rheumatic fever
- frequent acute respiratory infections, pneumonias, stunting – CHD
Lifestyle and dietary habits
- sports loads
- hypodynamia - lack of exercise (RF CVD)
- food rich in animal fats and cholesterol
- occupation (stress, hypodynamia, night job)

Bad habits
- smoking (RF CVD)
alcohol abuse
Gynecological history - postmenopause (RF CVD)
Family history (hypertension, diabetes mellitus, ischemic heart disease, MI, SD, strokes; early onset of CVD in close relatives)

Smoking accelerates the aging of blood vessels and heart !!!

General examination
The severity of the condition is determined
- by the severity of heart failure,
- by presence of the coronary syndrome,
or high blood pressure
Consciousness can be impaired with a sharp increase in blood pressure or a fall in CO (cardiogenic shock)
Ortopnea position - with severe LV heart failure

Anthropometry
BMI (20-25 kg/m2 and waist (80/94 sm)
Obesity and overweight - RF CVD (hypertension, ischemic heart disease, diabetes mellitus)

Skin
Acrocyanosis (peripheral cyanosis)
↓ cardiac output → slowing blood flow → ↑ O2 extraction from blood → ↑ concentration of dezoxyhemoglobin
Central (diffuse) cyanosis (right-to-left shunt with CHD or lack of the oxygenation of blood in the lungs)
Joundice of the skin (cardiac fibrosis of the liver)
Cold, moist skin (vasoconstriction in severe LV HF)
Xanthomas and xanthelasms (deposition of cholesterol in the skin with dyslipidemia)

Other symptoms

Edema
Pathogenesis
RV HF
↓
↑ P in veins
↓
↑Р in capillars
↓
Fluid transudation to the interstitium
↓
Edema

Features of cardiac edema
Symmetrical, cold, cyanotic
Distributed by gravity
Strengthen in the evening, decrease in the morning
When pressed, a fossa remains
Visible swelling occurs when> 3 L of fluid has accumulated

Investigation of the lungs in cardiac patient
Percussion dull sound - sign of hydrothorax
Fine crackles (late inspiratory) in lower lobes bilateraly – pulmonary congestion

Examination and palpation of the heart area
Apex beat
Localization (left or left and downward displacement in LV hypertrophy and dilation)
Area (an increase of more than 2 cm – LV dilation)
Duration (long-term AB reflects LV pressure overload in hypertension or AS)

Pathological pulsations (beats)
- Precardiac beat - 3-4-5th i/s to the left of the sternum (dilation and hypertrophy of the RV)
- Epigastric pulsation (dilation and hypertrophy of the RV)
In the 2nd i/s on the left - pulsation of the PA (PAH, increased pulmonary blood flow)
In the 2nd i/s on the right - aortic pulsation (aneurysm of the ascending part of the aorta)

Heart murmur over the region of the heart - palpable low-frequency vibration of the chest wall, caused by a heart noise (appears with an intense noise)
Apex systolic murmur – mitral insufficiency
Systolic murmur at the base of the heart:
- on the right - AS (performed on the vessels of the neck)
- diastolic murmur at the base of the heart on the right – aortic insufficiency