Main Symptoms
1. Chest Pain
- Important symptom for many cardiac diseases (especially ischemic heart disease).
- Character:
- Pressure-like, squeezing, burning, or stabbing sensation.
- Radiation:
- Can radiate to the left arm, jaw, neck, back, or epigastrium.
- Timing:
- Stable angina: Occurs during exertion, relieved by rest or nitroglycerin.
- Unstable angina / Myocardial infarction: Occurs at rest, more severe, lasts longer (>20 minutes).
- Associated symptoms:
- Sweating, nausea, palpitations, shortness of breath.
Always assess: nature of pain, duration, triggers, relieving factors.
2. Palpitations
- Awareness of abnormal heartbeat: either too fast, too slow, or irregular.
- Described by patients as:
- Fluttering
- Pounding
- Skipping beats
- Possible causes:
- Arrhythmias (e.g., atrial fibrillation, supraventricular tachycardia)
- Anxiety, hyperthyroidism, anemia.
- Important to ask:
- Onset (sudden or gradual), duration, associated symptoms (e.g., syncope, chest pain).
3. Dyspnea
- Shortness of breath, often cardiac in origin when no lung disease present.
- Types:
- Orthopnea:
- Difficulty breathing while lying flat.
- Seen in left-sided heart failure (pulmonary congestion).
- Patient often uses multiple pillows to sleep.
- Paroxysmal Nocturnal Dyspnea (PND):
- Sudden severe breathlessness at night.
- Patient wakes up gasping for air, needs to sit up.
- Caused by redistribution of fluids into lungs when lying down.
Dyspnea on exertion is an early symptom of heart failure.
4. Fatigue
- Common but nonspecific symptom.
- Seen in:
- Heart failure (reduced cardiac output → ↓ oxygen supply to muscles).
- Valvular heart diseases (e.g., aortic stenosis, mitral regurgitation).
- Worse with exertion, improves with rest.
5. Dizziness/Syncope
- Syncope = transient loss of consciousness due to decreased cerebral perfusion.
- Causes:
- Arrhythmias (e.g., bradycardia, tachyarrhythmias)
- Aortic stenosis (fixed cardiac output)
- Hypertrophic obstructive cardiomyopathy
- Severe hypotension
- Important points:
- Circumstances (at rest, exertion, emotional stress)
- Warning signs (palpitations, chest pain)
- Duration of unconsciousness
- Recovery (spontaneous, full recovery)
6. Edema
- Swelling most often seen in:
- Lower legs and ankles (dependent edema)
- Sacrum (especially in bedridden patients)
- Mechanism:
- Right-sided heart failure → increased venous pressure → fluid leakage into tissues.
- Features:
- Pitting on pressure.
- Worse in evening (gravity-related).
Edema can also occur in nephrotic syndrome, liver cirrhosis — important to differentiate.