MainsymptomsandsignsofheartdiseaseMD.PhDIntroductionHeartdiseaseisthemostcommonplaceofourdailylife.Therearebasicallysevenclassicsymptomsofheartdisease.Recognizedbysimpleobservationandcombinedwithmedicalhistorytaking,canleadtoanaccurateandearlydiagnosis.Theclassicsymptomsofheartdisease1.DyspneaMedicaltermforshortnessofbreath,SubjectivesymptomThreecommoncausesCardiac,poorpumpingqualityPulmonary,narrowingorstiffeningoftheairways.Functional(psychological)ThedegreeofdyspneaExertionaldyspneaDyspneaonrestOrthopnea(dyspneawhensupine)ParoxysmalnocturnaldyspneaThecommoncausesofdyspneaHeartfailureAsthma,Emphysema,PneumothoraxPleuraleffussionPulmonaryembolismAcidosis2.ChestpainPaininthechestmayoriginatefromavarietyofstructures.Peoplewhoexperienceitshouldalwayslettheirphysiciandecidewhetheritisrelatedtoheartdisease.PossiblecausesofchestpainChestpainhistorytakingQuality,severity,durationofthechestpain.TheprecipitatingandtherelievingfactorsWhere,whenandhowithappens?Thesubsequent

storyshouldn'tbeneglected.AnginapectorisOccursbecausetheheartmuscleisnotreceivingenoughoxygentofunctionproperly.Thequalityofanginadescribedasapressureinthechestorasiftheheartwerebeingsqueezed.Theonsetofanginadependsonthedegreeofthenarrowingofcoronaryartery.Exertionalpain,restpain,silentpain.CaseshowChiefCompliant

Thepatientisa50yearoldwhitemalewithhypertensionwhocomplainsofchestpainfor4hours.Durationofchestpain.Location,radiation(toarm,jaw,back),character(squeezing,sharp,dull),intensity,rateofonset(gradualorsudden);relationshipofpaintoactivity(atrest,duringsleep,duringexercise);reliefbynitroglycerine;increaseinfrequencyorseverityofbaselineanginalpattern.Improvementorworseningofpain.Pastepisodesofchestpain.HistoryofthePresentIllnessAssociatedSymptoms:Diaphoresis,nausea,vomiting,dyspnea,orthopnea,edema,palpitations,syncope,dysphagia,cough,sputum,paresthesias

AggravatingandRelievingFactors:Effectofinspirationonpain;effectofeating,NSAIDS,alcohol,stress.

CardiacRiskfactors:Hypertension,hyperlipidemia,diabetes,smoking,andastrongfamilyhistory(coronaryarterydiseaseinearlyormid-adulthoodinafirst-degreerelative).SocialHistory:Smoking,alcohol,cocaineusage,illicitdrugs.Medications:Aspirin,beta-blockers,estrogenAcutePericarditis.Characterizedbypleuritic-typechestpainanddiffuseSTsegmentelevationAorticDissection.“Tearing”chestpainwithuncontrolledhypertension,widenedmediastinumandincreasedaorticprominenceonchestX-ray.EsophagealRupture.Occursaftervomiting;Xraymayrevealairinmediastinumoraleftsidehydrothorax.AcuteCholecystitis.Characterizedbyrightsubcostalabdominalpainwithanorexia,nausea,vomiting,andfever.AcutePepticUlcerDisease.Epigastricpainwithmelenaorhematemesis,andanemiaDifferentialDiagnosisofChestPain3.PalpitationsPalpitationistheawarenessofone’sheartbeatandisoftenquitedisturbingwhenitoccurs.Thesensationdescribedasafluttering,thumping,flip-flopping,pounding.ThecausesofpalpitationArrhythmias

prematureventricularoratrialbeats.

Supraventricular

tachycardia

paroxysmalatrialtachycardia

Holtermonitorexaminationoftenneeded.Anxiety

or

tensionPanic

attack.4.SyncopeSyncopesimplymeansfaintingorthesuddenlossofconsciousness.Syncopeusuallyresultsafterthebrainhasbeendeprivedofoxygenandbloodforabouttenseconds.consideredapotentiallyserioussymptom.ThecausesofsyncopeCardiovascularReflex(heartstructurallynormal)Orthostatichypotension

Neurologic Psychiatric Metabolic Drug-induced UnknownreasonsOtherorganicdiseasesCardiovascularsyncopeBradyarrhythmias

Sicksinussyndrome(SSS)

Pacemakerfailure VentriculartachyarrhythmiasOtherstructuralheartdisease.Thedetailedhistorytakingisquiteimportant!ChiefCompliant

Thepatientisa50yearoldwhitemalewithhypertensionwhopresentswithlossofconsciousnessfor1minute,1hourbeforeadmission.HistoryofthePresentIllness:

Timeofoccurrenceanddescriptionoftheepisode.

Durationofunconsciousness,

rateofonset;

activitybeforeandafterevent.

Bodyposition,

mentalstatusbeforeandafterevent.

Precipitants(fear,pain,cough,urination,defecation,exertion,tightshirtcollar).Tellordescribeacompletestory!5.EdemaEdemaisaswellingorpuffinessoftissuearoundtheankles,legs,eyes,chestwall,orabdominalwall.Technically,edemaisclassifiedasasign.Thecauseofedemaheartdisease,esptherightsideoftheheartisweakened,occurintheabdomenorlegs.theresultofgravityinpeoplewhoaresedentary.kidneydiseaseliverdiseaseallergicreactiontosubstancesInterferencewiththelymphaticsystem.Theclinicalpresentation

ofsomecommoncirculatorydiseases1.MitralstenosisRheumaticheartdiseaseisusuallytheetiologyofmitralstenosis.Theaveragelatencyperiodbetweenrheumaticfeverandtheonsetofsymptomsofmitralstenosiswas19years.MVA,mitralvalveareaPathophysiologyLeftatrialpressurerises,whileleftventricularpressureremainslowornormal.Transmittedtothepulmonarycirculation,resultinginincreasedpulmonarycapillarywedgepressure.Rightventricularfailure,secondarytricuspidregurgitation,andpassivehepaticcongestion.pathophysiology

inmitralstenosisSymptomsDyspneaEdemaPalpitationCyanosisCoughHemoptysisInspectionMitralfacies(pinkish-purplepatchesonthecheeks)Jugularveindistension

PalpationDiastolicthrill,attheapexwiththepatientintheleftlateralrecumbentposition.RightventricularliftispalpablePercussionPear-shapedoutlineoftheheart.Theleftventriclemaynotbereallyenlarged.AuscultationTheauscultatorycharacteristicareLoudfirstheartsound(

awideclosingexcursionofthemitralleaflets)OpeningsnapDiastolicrumble

Auscultation

conThesecondheartsoundisnormallysplit.Thepulmoniccomponentisaccentuatedifpulmonaryhypertensionispresent.

Ahigh-pitcheddecrescendodiastolicmurmursecondarytopulmonaryregurgitation(GrahamSteellmurmur)maybeaudibleattheuppersternalborder.

2.MitralRegurgitation(MR)

Mitralregurgitation(MR)isdefinedasanabnormalreversalofbloodflowfromtheleftventricle(LV)totheleftatrium(LA).Itiscausedbydisruptioninanypartofthemitralvalve(MV)apparatus.EtiologiesofMRMVprolapse(MVP)RheumaticheartdiseaseInfectiveendocarditis

AnnularcalcificationCardiomyopathyIschemicheartdiseasePathophysiology

inChronicMRPathophysiologyinacuteMRSymptomsSignificantacuteMR

(byacutemyocardialinfarction

),severe!

Dyspnea,Fatigue,Orthopnea,Pulmonaryedema.ChronicMR

Asymptomaticforyears

chestpalpitations

congestiveheartfailure

SignsInspection

ApexbeatdisplacestoleftanddownwardsPalpation:

hyperdynamiccardiacimpulsePercussion:enlargedAuscultation:pansystolicmurmur

Usuallybestheardovertheapex;usuallyradiatestotheleftaxillaorsubscapularregion.high-pitched.3.Aorticstenosis(AS)

Aorticstenosisistheobstructionofbloodflowacrosstheaorticvalve.

EtiologyPathophysiologyTheclassictriadofsymptomsDyspneaChestpainSyncopeSignsInspection

ApexbeatdisplacestoleftPalpation

heavingapeximpulse;systolicthrill(secondleftintercostalspaceonrightsideofthesternum)

Percussion:enlargedAuscultation

harshandraspingsystolicmurmur(aorticareatransmittingtotheneck)

4.Aorticregurgitation(AR)Aorticregurgitation(AR)isthediastolicflowofbloodfromtheaortaintotheleftventricle(LV).EtiologyBicuspidaorticvalveRheumaticfeverInfectiveendocarditisCollagenvasculardiseasesDegenerativeaorticvalvediseaseTraumaticPostsurgical(includingpost-transcatheteraorticvalvereplacement)Pathophysiology

ChronicAorticRegurgitationPathophysiology

acuteaorticregurgitationSymptomsAorticregurgitationmaybeachronicdiseaseprocessoritmayoccuracutely,presentingasheartfailure.SignsInspection

Apexbeatisratherdiffuseanddisplacestoleftanddownwards.Palpation

enlargedheartoutlinePercussion

shapeofaboot

SignsconAuscultation

diastolicdecrescendomurmur

(thesecondaorticarea);sighing.

Austin-Flintmurmur

Theregurgitantjetfromtheaortamaypreventfullopeningoftheanteriormitralleafletwhenitissevere,causingastateoffunctionalmitralstenosis.Thismaycauseturbulenceinthemitralinflow,inturngivingrisetoamid-diastoliclow-frequencymurmurattheapex.PeripherialvascularsignsCapillarypulsationasdetectedinthenailbedWater-HammerpulsePistol-shotsoundsDuroziez’ssigndeMusset’ssignVisiblelarge-amplitudecarotidpulsationRelatedtotheLargestrokevolume,increasedejectionvelocity,decreasedperipheralresistance,widenedpulsepressurewithlowdiastolicpressure.5.PericardialeffusionPericardialeffusionisthepresenceofanabnormalamountoffluidinthepericardialspace.

Tuberculosisandtumorarethemostcommonplace.PathophysiologyClinicalmanifestationsofpericardialeffusionarehighlydependentontherateofaccumulationoffluidinthepericardialsac.Rapidaccumulationaslittleas80mLoffluidmaycauseelevatedintrapericardialpressures,whileslowlyprogressingeffusionscangrowto2Lwithoutsymptoms.SymptomsClassicBecktriadofpericardialtamponade

Hypotension

Muffledheartsounds

JugularvenousdistentionDyspnea,fatigue,palpitation,abdominaldistensionoredemaetc.SignsInspection

Distentionofthejugularvein

Diminutioninstrengthoftheapexbeat.Palpation

Paradoxicalpulse,Hepatojugularreflux

Percussion:Enlargementofcardiacdullnessbilaterally.Heartborderchangesaccordingtobody’sposition.SignsconEwartsign-Dullnesstopercussionbeneaththeangleofleftscapulafromcompressionoftheleft