When our heart supplying the body with required oxygen and nutrients fails to perform its task for various reasons, it causes some disorders in its own structure, or other organs.
These are the complaints of patients as symptoms of the disease.
Symptoms of heart disease presented in patients generally include:
It is one of the most important and common symptoms of heart diseases. Myocardium that is unable to receive sufficient volume of oxygen due to coronary artery disease (namely stenosis or blockage of vessels supplying the heart) manifests this as pain.
However, not all of the chest pains are heart related. Pain of muscle, ribs, spine, and esophagus may be felt in the chest.
If the pain occurs when you get tired or excited and goes of when you rest, it is highly likely to be associated with coronary arteries.
Aortic stenosis, hypertrophic obstructive cardiomyopathy, severe hypertension, aortic regurgitation, severe anemia, and hypoxia can cause ischemic pains (i.e. reduced blood flow) in the chest.
Aortic dissection (rupture of major vessel), pericarditis, mitral valve prolapse cause non-ischemic pains.
Esophagus spasm, oesophageal reflux, rupture of esophagus, and peptic ulcus cause gastrointestinal pains in the chest.
There are chest pains associated with psychogenic causes, e.g. anxiety, depression, cardiac psychosis, personal interests.
Neurogenic causes related to musculoskeletal system such as thoracic outlet syndrome, degenerative joint disease of cervical-thoracic vertebra, costochondritis, herpes zoster, and pain and sensitivity of chest wall can produce chest pains.
Pulmonary embolism with or without pulmonary infarction, pneumothorax, and pneumonia involving pleura can produce chest pains. Pleurisy (inflammation, edema of pleura) manifests with rather flank pain.
Chest pain called angina pectoris caused by stenosis or blockage of coronary vessels often occurs following a heavy meal, or when feeling excited, nervous, and sad, and sometimes after a tiring job or walk.
Angina pectoris usually aggravates and radiates gradually. Stinging or stabbing type pains that occur suddenly at maximum severity are usually not related to the heart but to musculoskeletal or nerves.
Anginal pain is usually felt in retrosternal (posterior to breastbone), or slightly left to midline below the sternum. It is rarely down the left breast.
Myocardial ischemic pain tends to radiate to chest from both sides, and to arms (mostly left arm), neck and lower jaw. It can sometimes radiate to back and nape.
The pain that occurs in pericarditis, i.e. inflammation of pleura, is persistent. It increases with breathing and chest move. It aggravates when lying back and is relieved when bending frontward. It usually manifests with fever, shortness of breath, and heart-throb.
Similar type of pain is present in diseases of pleura (pleurisy).
There is a very severe pain in aortoclasia (aortic dissection). The patient can clearly feel the vascular rupture and the rupture-type pain. The patient experiences sweating, cyanosis, hypotension, feeling of faint, syncope, and cyanosis of arms and legs with the pain.
A severe pain occurs when major pulmonary vessel and its branches are blocked with clot. There is also cough, haemoptysis, heart-throb, and cyanosis.
Dyspnea means difficult and tiring breathing of a person, namely difficulty in breathing. There are many causes.
It can develop associated with chronic dyspnea, cardiac failure, chronic pulmonary disease, or lack of physical exercise (elderly, overweight persons or persons working mostly in sitting position).
Sudden increase in dyspnea suggests a heart disease rather than a pulmonary disease. On the other hand, it can be quite difficult to differentiate which of the two has caused the dyspnea in those with both pulmonary and heart diseases.
Dyspnea developing with lying position mostly occurs in patients with left heart failure or mitral valve disease. It is accompanied by cough.
Dyspnea developing in 2-3 hours after going to bed is usually relieved by getting up and sitting. The attacks can be mild, or accompanied by wheezing, cough, severe dyspnea, and panic. It sometimes may lead to pulmonary edema. It develops associated with increased central in patients with left heart failure when going to bed at night. With addition of blood accumulated in legs to central blood system at night, the heart becomes insufficient, which already functions at the limit.
Dry and persistent cough from effort or rest may be related to pulmonary edema associated with cardiac failure. Although dyspnea is usually present, cough may be prominent.
Pink bubbly phlegm associated with acut pulmonary edema is present in cough while phlegm of chronic bronchitis is often white and mucous.
Wheezing heard with dyspnea may be related to pulmonary or heart diseases.
Dyspnea may be present in many types of respiratory system diseases, anemia, and nervous system diseases as well as in heart diseases
It can develop associated with many causes. It mostly occurs related to anxiety and depression.
Anemia, hyperthyroidism, and other chronic diseases can cause tiredness and asthenia.
Diuretic drugs prescribed for patients with heart failure, and gradually increased heart failure lead to tiredness and asthenia.
Patients with generalized stenosis of coronary arteries experience serious tiredness with effort associated with extensive myocardial ischemia.
Heart-throb occurs when heartbeats are faster than normal, or felt disturbingly. Heart-throb is a benign symptom that usually develops with no severe heart diseases; however it can be sometimes life-threatening.
Sometimes simple extrasystoles (early beats) can produce “fuzziness” or “blow-out” feeling in the chest.
Heart-throb can sometimes occur in attacks. Attacks can spontaneously disappear but sometimes last very long and require treatment. If the person, experiencing a heart-throb or their relative can take the pulse and pay attention whether it is regular at that time, they can provide great help in diagnosis.
We can easily palpate the pulse at the wrist in the direction of the thumb.
Sometimes, feeling faint associated with a heart-throb can lead to syncope. And sometimes a severe ventricular tachycardia developed in the presence of a serious underlying heart disease may not alter the general condition.
Swelling of legs and abdomen (edema and acid)
Swelling of legs (edema) is most common symptom of the left and right heart failure.
Edema of cardiac origin rarely involves the face and arms. Edema is present above the sacrococcyeal articulation in inpatients.
After a by-pass surgery, edema can develop in the leg where vein was obtained.
Leg and tarsus edema can occur in patients using specific drugs (calcium antagonist).
Swelling of legs and edema can also occur in diseases such as varicosis, adiposity, tight corset, renal failure, and hypoproteinemic cirrhosis.
Enlargement of abdominal circumference and abdominal swelling is associated with development of fluid called acid.
Acid develops in patients with severe edema associated with congestive heart failure.
Acid is very common in constrictive pericarditis (where pericardium becomes stiffened and exercises pressure on the heart).
Acid may develop associated with cirrhosis, renal diseases, and tumor.
Cough present in heart diseases is intermittent and associated with tiredness. Wheezing, heart-throb, and dyspnea can accompany it. Cough can be dry or with phlegm. If the phlegm is pink and bubbly, it suggests acute pulmonary edema.
Cough waking up at night and relieved by getting up and sitting is the symptom of heart failure.
There is dry cough caused by some drugs (ACE inhibitors).
Almost all pulmonary diseases have a cough. The phlegm is white, yellow, green and mucous. Chest pain, cough, haemoptysis accompany when clot gets to the lungs.
Cardiac syncope develops with sudden drop in cardiac output (volume of heart rate) and is defied as temporary blackout associated with insufficient blood flow to the brain. Presyncope is a state that although the patient feels lightheadedness and weakness and their posture appears to collapse, they do not lose consciousness.
Injury during the attack indicates a more serious state that occurs with sudden faint. Transient spasm may be present in syncope developed with cardiac arrhythmia.
Urinary incontinence may be seen in cardiogenic shock; conscious is recovered when rhythm is restored. State of drowsiness remains in neurologic one.
The most common type of syncope (vasovagal syncope) is due to drop in pulse and blood pressure caused by excessive vagal stimulant. There are mostly stimulant factors, e.g. a heavy meal in a hot room. Prodromes are present, e.g. nausea, sweating, yawning, sometimes blurred vision, and impaired hearing. The patient may be pale, sweaty and has a low heart rate after the attack. Syncope developed with any gastrointestinal symptom is often vasovagal.
Hypersensitiveness of carotid sinus in the neck may slow the pulse, resulting in syncope. It can develop during shaving, or when a tight tie is worn, or when the head is excessively turned. It is quite rare.
Bouts of coughing associated with underlying pulmonary disease may lead to syncope.
Too fast or slow arrhythmias can cause change in conscious from light dizziness to faint. Transient total heart blockage, cardiac arrest, and ventricular tachycardia may lead to syncope. Sudden blackout occurs without prodrome and the person is back to normal state when the rhythm is restored.
Blackout associated with effort may occur in those with aortic stenosis or hypertrophic cardiomyopathy.
Temporary obstruction of cardiac valve by tumor or clot in the cardiac cavity is a rare state that may lead to syncope depending on the position of the patient. Many normal patients may experience a transient dizziness associated with rapid change in position. Postural hypotension is common cause of syncope or dizziness that occurs when patient gets up suddenly while they are lying down or usually in lying or sitting position. The cause is often peripheral neuropathy, autonomic function disorder, loss of liquid, or drug side effect.
Indigestion, hiccup and swallowing difficulty
Many patients with angina pectoris related to coronary failure confuse their complaint with indigestion and burn. On the contrary, the complaints may be considered angina pectoris in patients with oesophageal reflux or spasm.
Hiccup rarely develops in patients with infarction and is common after a cardiac surgery.
Swallowing difficulty may occur in patients with systemic sclerosis, aortic arcus abnormality, or too large left atrium.
Head and nape pains are quite common when artery pressure is too high or too low. Headache is accompanied by nausea when it is too high.
Cyanosis occurs when the blood has poor oxygenation, or venous blood gets mixed with oxygenated blood at the level of major vessels. Heart-related cyanosis causes central type cyanosis, i.e. mucosa also (e.g. in-mouth) becomes purple.
It occurs in congenital heart diseases and heart failure.
Mucus membranes (e.g. in-mouth) do not become purple in peripheral type cyanosis. Circulatory failure and shock are seen in peripheral vasospasm.