Cardiovascular disorders represent the most prevalent serious diseases in industrialized countries and a growing problem in most developing countries.
The signs and symptoms of cardiac disease are usually the result of
myocardial ischemia, of the disturbances of the contraction or relaxation of the myocardium, abnormal cardiac rhythm or by the obstruction to blood flow.
Ischemia, is determined by an imbalance between the heart's oxygen supply and demand. Ischemia usually manifests as chest discomfort and the reduction of the heart's pumping ability leads to fatigue and elevated intravascular pressure upstream the affected ventricle. The latter leads to an abnormal fluid accumulation, with
peripheral edema,
dyspnea and
pulmonary congestion. Obstruction to blood flow (like, for example, the one that occurs in valvular stenosis) may determine symptoms similar to those of myocardial failure.
Cardiac arrhythmias usually have a sudden onset and the signs and symptoms of this disturbances are: palpitations, syncope, dyspnea and hypotension, which may occur abruptly and may disappear as rapidly.
Even though chest discomfort, dyspnea, syncope and edema are the most common features of
cardiac disease, they may occur in other conditions as well, making the differential diagnosis quite difficult. For example dyspnea is also observed in other disorders such as pulmonary disease, marked obesity, and anxiety . Similarly, the chest discomfort may be the result of many other non cardiac and cardiac causes, not only of myocardial ischemia. Edema, an important feature in most untreated or inadequately treated cases of heart failure, may also occur with primary renal disease, parasitoses, chronic liver disease and in hepatic cirrhosis.
Syncope (brief loss of consciousness followed by rapid, spontaneous revival) occurs not only in the patients with serious cardiac arrhythmias but it's also an important symptom in many neurologic diseases.
The patient may complain of persistent
fatigue because of the reduced cardiac output. The low cardiac output will lead to an increased respiratory rate, especially in case of pulmonary venous congestion.
Central cyanosis is also determined by the insufficient oxigenation and when is associated with clubbing of the fingers and toes it indicates right -to- left cardiac shunting.
Cyanosis in the distal extremities accompanied by cool skin and sometimes increased sweating is usually the result of vasoconstriction in severe heart failure cases. Some disorder such as endocarditis or rheumatic fever may cause fever. Low grade fever is also common after a miocardic infarction.
The examination of the peripheral veins may also give important information. They should be observed for arteriovenous shunting, arteriovenous malformations and varicosities. The inflammation and the tenderness of these peripheral veins usually indicate thromboflebitis. Chest diformities may suggest congenital cardiac malformations or genetic disorders such as X monosomy (or Turner's syndrome) in which the chest has a bird-like, proeminent sternum (pectus carinatus). In some cases. an aortic aneurism determined by syphilis may be suggested by an upper chest bulge. Pectus excavatum ( a depressed aspect of the sternum) may indicate the myxomatous degeneration of the cardiac valves or chordae or a genetic disease which leads to cardiac malformations, Marfan syndrome.