1. Manifestations Of Cardiovasculardiseases

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

3. 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.
•Dyspnoea normally occurs after severe exercise and may occur in anxiety (psychogenic)

4. •Cardiac dyspnoea is due left side heart failureoccurs 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 go opening the window usually accompanied with cough. It lasts minutes •Acute pulmonary oedema is a severe breathlessness due to alveolar fluid transudation accompanied with cough productive of copious frothy pink stained sputum. It can be fatal & needs urgent treatment.

5. Palpitation
●This common symptom is defined asunpleasantawareness 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 . ●Palpitation can occur in a patient with normal heart rate ,increased heart rate & slow heart rate as in complete heart block .

6. 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 .

7. 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.
•Other cardiovascular causes for syncope may occur because of enhanced vagal response (vasovagal syncope) due to spcific stimuli e.g. at the sight of blood .A related cause sharing a similar mechanism is carotid sinus hypersensitivity syndrome .Gentle pressure on the carotid sinus may produce syncope by causing profound bradycardia.

8. Peripheral Oedema
•Oedema is accumulation of fluid in the intersticial tissues
•Oedema can be both a symptom (ankleswelling) & 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 ,it usually ascends to involve the legs,thighs,genitalia & abdominal wall. It may be generalized (anasarca) in severe heart failure ,but rarely involve the face markedly
•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).

9. Other symptoms
•Cyanosis though it is a physical sign sometime itis asymptom 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 .

10. •Intermittent claudication it is a pain in thelower limbs occurs on walking & disappearonstopping ,it is symptom of peripheral arterial disease .
•Reynaud'sphenomenon it is symptom of vasospasm of the digital vessels of the hand presented with pallor followed by cyanosis & redness .

11. Non-cardiac symptoms due to the cardiovascular diseases
•Tiredness & fatigue may occur in acute myocardial infarction & heart failure . •Nausea ,vomiting ,sweating & epigastricpain can occur in myocardial infarction. •Nocturiamay be early symptoms of heart failure •Anorexia ,right upper abdominal discomfort, weight loss & cachexiaare symptom of advanced heart failure •Cough and haemoptysis.