Diseases of The Heart and Blood Vessels

The amount of work accomplished by the heart is rarely appreciated, for its output amounts to something like ten tons of blood each day.

The Symptoms of Heart Disease

The patient with heart disease may complain of many different symptoms. It should be emphasised, however, that each of the symptoms which is commonly found in heart disease may also be due to disease in other organs such as the lungs, the stomach, the kidneys, and the brain, the heart itself being normal. On the other hand, there may be no symptoms at all, and an abnormal heart may be found only on examination, for example, for life insurance. A complaint of one or more of the following symptoms should, however, direct attention to the heart.

Shortness of Breath, or Dyspnoea.

This is the most common, and perhaps the most important symptom of heart disease. It points to failure of the heart, early or late, although alone it is not evidence of heart failure unless other causes (such as lung diseases and anaemias) have been excluded. The commonest type of breathlessness occurs on exertion, and it may occur long before the appearance of any other symptoms.

If the patient becomes more breathless year by year, or month by month, by climbing the same hill, a gradual exhaustion of the heart's reserve may be presumed, in the absence of other causes.

Paroxysmal Breathlessness occurring at rest or during sleep, and causing the patient to awaken, is found in certain forms of heart disease. The patient wakes with a sense of oppression or suffocation, and sits by an open window seeking relief. The breathing is laboured and wheezing, and distress may be very great. It is often accompanied by a cough with frothy and blood-tinged sputum. The attack may continue for a few hours, though it is often reckoned in minutes. It is commonly known as 'cardiac asthma.'

Palpitation.

The patient is conscious of his heart beats, which he may describe as bumping, throbbing or fluttering in the chest, or he may be conscious of the heart missing a beat, or ‘turning over.' The symptom is more common in excitable states of the nervous system than in true heart disease.

Pain in The Region of The Heart.

Pain occurs frequently without much evidence of heart disease, and a diagnosis may have to rest on this symptom alone.

Angina Pectoris.

This may be a pain of extraordinary severity. It arises beneath the breast-bone, usually in its upper part, and is described as crushing or gripping in character, or as a sense of weight or tightness in the chest. Not uncommonly the patient refers to it as indigestion.

It may pass towards the tip of the heart, and often to the neck, and down the inner aspect of the left arm as far as the elbow or the finger tips. The pain is usually so severe that the patient stops whatever he is doing, and stands motionless until it passes away in two or three minutes. The symptom is generally brought on by effort.

Other Forms of Heart Pain.

Pain in the region of the heart may be brought on by many other causes besides actual heart disease, and they should be carefully distinguished from the anginal type of pain just described.

Transient pain occurring over the tip of the heart is most usual in certain neurotic states, especially after fatigue.

Aching and sharp pain occurs also in muscular rheumatism and neuralgia affecting the muscles and nerves of the chest. This is usually worse on movement of the affected part, and there may be some local tenderness.

The pain of pleurisy is generally severe and cutting in character, and is made worse by deep breathing.

Digestive Symptoms.

Loss of appetite, nausea, and distension of the abdomen may be met with in heart failure. Pain may be felt in the right upper abdomen, and the liver may be tender.

Urinary Symptoms.

A decrease in the quantity of urine passed, or oliguria, may be noticed in heart failure. The urine passed is highly coloured, owing to its concentration. There may be complete suppression of urine, none at all being passed in very severe cases.

Nervous Symptoms.

Fainting occurs when insufficient blood reaches the brain. It is generally seen in persons of nervous temperament, from emotional causes such as shock, fright, or unpleasant sights and smells. It is usually a harmless symptom and is not a characteristic feature of heart disease. In exceptional cases, however, it may be due to actual disease of the heart.

Dropsy or Oedema.

The patient may complain of swelling of the lowest parts of the body - that is, of the ankles and feet -towards the end of the day if he is up and about, and of the lower part of the back and the backs of the thighs if he is confined to bed.

It is due to a collection of fluid in the tissues beneath the skin and its distribution is controlled by gravity. It is recognised by ‘pitting' on pressure with the finger tips.

Cyanosis.(Blueness of The Fingers, Toes, Lips, And Cheeks).

This is seen particularly in disease of the mitral valve and in congenital diseases of the heart. It is also a feature of some chronic lung diseases. Blueness is increased by cold and exertion.

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