1. MANIFESTATIONS OF CARDIOVASCULAR DISEASES

3. The cardinal symptoms of heart disease are: Chest pain Breathlessness Palpitation Syncope Peripheral Oedema

4. Symptoms of angina Chronic angina is chest pain, discomfort, or pressure that may happen because of 1,2 : Exercise Extreme temperatures Mental or emotional stress Walking in cold weather, uphill, or after eating

5. HISTORY MATTERS! Location: Central, left, or right Associated symptoms: SOB, sweating, nausea Timing: Gradual or sudden onset Provocation: What makes worse or better? Quality: Visceral vs somatic Radiation: Back, neck, arm Severity: Scale of 1-10

6. Some describe a feeling of uncomfortable pressure, squeezing, heaviness, or burning in the chest Some feel pain in the shoulder, arm, back, neck, or jaw Others may feel out of breath, faint, tired, or as if they have heartburn In women, angina can be different 4 : The pain may be sharp, throbbing, or burning They may experience pain in the neck or throat area more often Shortness of breath is also common

8. DIFFERENTIAL DIAGNOSIS Angina pectoris Acute Coronary Syndromes.Acute MI. Pulmonary Embolism Aortic Dissection Esophageal Rupture Pneumothorax Pneumonia

9. 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.

10. Cardiac dyspnoea is due left side heart failure occurs initially on exertion and progress to orthopnoea,paroxysmal nocturnal dyspnoea, and dyspnoea 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 with dyspnoea causing him to sit up and may Acute pulmonary oedema is a severe breathlessness due to alveolar fluid transudation accompanied with cough productive of copious frothy pink stained sputum.

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 & PRESYNCOPE Syncope is a sudden brief loss of consciousness. Presyncope is lightheadedness & near collapse 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. 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.