SYMPTOMS of CVS

 Dyspnea
 Orthopnea
 Paroxysmal nocturnal dyspnea (PND)
 Cough
 Haemoptysis
 Syncope
 Fatigue
 Palpitations
 Chest pain
 DYSPNEA
“Awareness of respiratory effort”

Causes of dyspnea:

 Physiological
 Cardiac
 Respiratory
 Abdominal
 Metabolic
 Anaemia
 Psychogenic
 Cardiac causes of dyspnea:

• Left ventricular failure

• Mitral valve disease
• Cadiomyopathy
• Constrictive pericarditis and pericardial
effusion
 ORTHOPNEA
“Respiratory distress on lying down”

Mechanism:
1. Venous return and cardiac output are
increased by 25% on lying down
2 Reabsorption of edema fluid from lower
limb into the circulation
3 Viscera push the diaphragm up and
encroach on the lung
 Paroxysmal Nocturnal
dyspnea
“ Attacks of severe dyspnea occurring at
night and waking the patient up from sleep”

Mechanism: Same mechanism +

1. Sliding down from semi-sitting position after
falling asleep
2. Blunting of respiratory and cough center
response during sleep allows pulmonary
congestion to accumulate
3. Bad dreams increase the heart rate and blood
pressure
 Haemoptysis
“ coughing of blood”

Cardiovascular causes:
 Mitral valve disease (due to pulmonary

congestion)
 Acute left ventricular failure ( pulmonary oedema)

 Pulmonary infarction ( pulmonary embolism)

 Palpitation

”Awareness of heart beats “

:Mechanism

Increased force of cardiac contraction-

Change in the heart rate-
Change in the rhythm-
 Chest pain
A. Cardiac causes:

1. Ischaemia

2. Pericardial pain

3. Great vessel pain

1. ISCHEMIC CHEST PAIN

Atherosclerosis of coronaries is the most common

cause
Ischemic chest pain may be due to:

1. ANGINA PECTORIS: transient myocardial ischemia

during exercise. The coronaries are only partly
occluded

2. UNSTABLE ANGINA: Prolonged severe myocardial

ischemia with or without patches of necrosis

3. MYOCARDIAL INFARCTION: Complete arterial

occlusion with myocardial tissue necrosis
 ANGINA PECTORIS
 CHARACTER:
 Dull aching, squeezing, compressing or burning. Never
stitching or throbbing

 SITE:
 Mostly retrosternal, usually radiates to left arm
 Sometimes may spread to root of neck, both shoulders and
arms, back, epigastrium or jaw.
 Not under left breast.

 RELIEVING FACTORS:
 Relieved by rest-after 1-3 min and by sublingual nitroglycerin
 PRECIPITATING FACTORS:
 Exertion
 Emotion
 Heavy meals
 Exposure to cold
 Sexual intercourse

 ASSOCIATED MANIFESTATIONS:
 Sweating
 Tachycardia
 Anxiety
 Rise in blood pressure
 MYOCARDIAL INFARCTION

 Pain is identical with that of angina in

character, site and radiation but is much
more severe and prolonged and is not
relieved by rest or sublingual nitroglycerin

 May be accompanied by vomiting and

sense of impending death
2. Pericardial pain:

 Site: to the left of the sternum overlying

the heart, may radiate to shoulder or
neck
 Character: sharp and cutting
 Constant or made worse by sudden
movement
 Worse on lying back, eased by leaning
forward
 Increased by coughing, swallowing or
inspiration
3. Great vessels pain:

 Aneurysm of the aorta

 Dissecting aneurysm in the aorta

 Pulmonary embolism
 B-NON CARDIAC CAUSES:

1. Pain from chest wall

2. Pain from lungs, pleura or
mediastinum
3. Pain from abdominal causes
 How these symptoms occur:

1. Manifestations of the cause as chest pain in IHD

2. Manifestations of pulmonary congestion

3. Manifestations of low cardiac output

Manifestations of pulmonary
congestion

 Causes of pulmonary congestion

* Left heart failure due to :

- Valvular disease (AS – AR – MR)
- Hypertension
- IHD
- Cardiomyopathy

* Mitral stenosis
Effects of left ventricular failure leading to
congestive heart failure
1. There is increased LVEDP  increased LAP 
increased pulmonary venous and capillary pressure 
interstitial edema

2. The lungs are overfilled, stiff, difficult to distend

leading to dyspnea, orthopnea and PND

3. Dyspnea also results from reflexes initiated from the

stiff lungs and distended left atrium
4. Transudation of small amount of serum
in the alveoli makes the alveolar wall
sticky and their inflation with inspiration
produces fine crepitations

5. With severe congestion the alveoli

become filled with transudate resulting in
pulmonary edema
 In pulmonary edema there is severe dyspnea,
cyanosis, cough with expectoration of large
amount of frothy sputum tinged with blood

 The flow of air in the fluid produces bubbling

crepitations heard all over the chest

 Some distended pulmonary and bronchial veins

and capillaries may rupture and release blood in
the alveoli and bronchi causing haemoptysis
 Congestion of bronchial mucosa increases
the secretion of mucus which is
expectorated as white or colorless sputum

 Congestion of the visceral pleura may

result in pleural effusion
 Pulmonary vessels react to congestion by
arteriolar vasoconstriction

 Blood flow from pulmonary arteries to

pulmonary veins will be limited by the
resistance of the arterioles leading to:

 Decrease in severity of pulmonary

congestion and relief of its symptoms
 Increase in the pressure in the pulmonary
arteries  Pulmonary Hypertension
 Right ventricular hypertrophy and failure
may result
 Low cardiac output
 Causes:
 Resistance to cardiac emptying:
1. Severe valvular stenosis
2. Severe pulmonary hypertension

 Incomplete cardiac filling:

1. External compression limiting diastolic filling:
massive pericardial effusion
2. Limitation of diastolic filling by severe tachycardia
3. Reduction of venous return by dehydration
Clinical features of low COP
 Symptoms
 Easy fatigability
 Dizziness, blurring of vision, syncope
 Angina
 Signs
 Small volume of pulse
 Sinus tachycardia
 Peripheral cyanosis
 Cold extremities
 Pallor
 Oliguria