1. Of Cardiovascular diseases
Manifestations
Of Cardiovascular diseases
Dr.Fakhir Yousif

2. The cardinal symptoms of heart disease are:
Chest pain
Breathlessness(dyspnea)
Palpitation
Syncope
Peripheral Edema

3. Risk factors : Age,sex,obesity.smoking,diabetes.
Angina pectoris
Sudden,severe,pressing chest pain starting substernal &radiate to left arm.
Due to imbalance between myocardium oxygen requirement and oxygen supply.
Risk factors : Age,sex,obesity.smoking,diabetes.

4. Classification of angina
Angina pectoris (Stable angina)
Exertional angina,Atherosclerotic,Classic,
Due to obstruction of coronaries by atheroma.
2- Unstable angina. (rest angina)
Due to spasm and more obstruction of coronaries.

5. Transient Myocardial ischemia
Clinical Manifestations
Myocardial Blood Flow
Myocardial O2 Demands
Differential Diagnosis of Chest Pain
Transient Myocardial ischemia
Fixed threshold angina
Variable threshold angina
Severe Chest pain

6. Character of chest pain
Dull Ache
Character of chest pain
Pressure

8. Breathlessness (Dyspnoea)
It is defined as an abnormally uncomfortable awareness of breathing It is one of principal symptoms of cardiac and pulmonary disease and ranges from an uncomfortable awareness of breathing to intense respiratory distress or a frightening sensation of fighting for breath.

9. Cardiac dyspnea is due left side heart failure occurs initially on exertion and progress to orthopnea ,paroxysmal nocturnal dyspnea , and dyspnea at rest . Orthopnoea is dyspnoea on lying flat due to increased pulmonary venous congestion Paroxysmal nocturnal dyspnoea occurs during sleep the patient awakes one to two hours after sleeping

11. Palpitation
● This common symptom is defined as unpleasant awareness of the forceful or rapid beating of the heart . It is described as pounding, jumping, racing, fluttering & skipping a beat.
●Most causes due to awareness of heart beating in normal sinus rhythm in a healthy person e.g. after exercise, excessive tea &coffee & smoking .
●Other common benign cause is premature ectopic beats (extrasystole) which cause irregularity at rest & subside on physical activity .
●Palpitation may be due to more serious conditions
such as cardiac arrhythmia e.g. atrial fibrillation,
atrial flutter, supra ventricular &
ventricular tachycardia . ●

12. In a patient with palpitation ask about:
● The mode of onset & termination. ● Specific triggers e.g. exercise, alcohol, caffeine & drugs. ● Frequency. ● Duration of attacks. ● Rhythm (ask patient to tap out). ● Any associated symptoms. ● History of organic heart diseases .

13. Syncope
Syncope is a sudden brief loss of consciousness. Cardiac syncope is usually sudden with no aura with extreme death –like pallor & rapid recovery (< 1 minute) .usually due to serious cardiac arrhythmia such as ventricular tachycardia & complete heart block (stokes- Adam) . Severe aortic stenosis , hypertrophic cardiomyopathy & severe coronary artery disease can cause lightheadedness or syncope on exertion. Posturnal hypotension is a significant (>20 mmHg) fall in systolic BP on standing .due to anti hypertensive drugs or autonomic neuropathy may be a cause.

14. Peripheral Oedema
Oedema is accumulation of fluid in the intersticial tissues Oedema can be both a symptom (ankle swelling) & a sign (pitting oedema). It is usually found in the lower limbs,especially the ankles,or over the sacrum in patients confined to bed .It is symptom & sign of right side or congestive heart failure mainly due to increased systemic venous pressure. cardiac oedema is generally symmetrical as it progresses Other causes for generalized oedema are liver cirrhosis & renal diseases as nephrotic syndrome. In liver cirrhosis the oedema starts in the abdomem (ascites)& descend to the lower limb. In renal diseases the oedema though generalized the patient notices the oedema first around the eyes ( periorbital) & the face ( puffiness).

15. Peripheral Oedema

16. Other symptoms
Cyanosis though it is a physical sign sometime it is a symptom especially in children .Cyanosis is bluish discoloration of the skin & mucous membrane resulting from an increased quantity of reduced hemoglobin or of abnormal hemoglobin pigments in the blood. There are two principal forms of cyanosis: (1) central cyanosis characterized by decreased arterial oxygen saturation due to cardiac & pulmonary diseases. &(2) peripheral cyanosis ,most commonly secondary to cutaneous vasoconstriction due to low cardiac output or exposure to cold. Central cyanosis usually appear when reduced hemoglobin level in the blood exceed 40 gm/L .& usually involve the tongue, lips& mucous membrane of the mouth .

17. Cyanosis