The Patient History in Cardiovascular Disease

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]


The cardinal symptoms of cardiac disease are shown below. Click on the link in blue to read about a component of the patient history in detail.

Chest Pain:

Discomfort in the chest which can be squeezing, a heaviness, a tightness, a burning or an aching.

Claudication:

Recurring burning, aching, fatigue, or heaviness in the leg muscles with predictable level of walking, that resolves with a predictable duration of rest.

Cough:

  • Cough is defined as being a reflex explosive expiration that promotes the removal of secretions and foreign particles from the lungs, while preventing aspiration
  • Coughing can take on two forms:
    • Nonproductive
    • Productive
  • A cough can either be chronic or acute (coughing lasting less than three weeks)
  • The production of sputum is important when assessing a cough
  • The quality, quantity and circumstances of the sputum production surrounding the coughing episodes are also important

Dyspnea:

Dyspnea is an uncomfortable awareness of breathing, shortness of breath, or difficulty or distress in breathing. It is often associated with cardiac or pulmonary disease.

Orthopnea:

Orthopnea is dyspnea which occurs when lying flat, causing the person to have to sleep propped up in bed or sitting in a chair. Orthopnea is generally a symptom of heart failure. It can also occur in those with asthma and chronic bronchitis, as well as those with sleep apnea or panic disorder. The condition is often due to left ventricular failure and/or pulmonary edema. It is also associated with Polycystic Liver Disease. Patients with orthopnea often complain of waking up suddenly during the night 'unable to breathe' if they have slipped down from their pillows into the supine position. They may run to the window to 'get some air'. It is commonly measured according to the number of pillows needed to prop the patient up to enable breathing (Example: "3 pillow orthopnea"). See also: Paroxysmal Nocturnal Dyspnea which means that a patient wakes up short of breath.

Paroxysmal Nocturnal Dyspnea:

Paroxysmal nocturnal dyspnea (PND) is a medical symptom wherein people with congestive heart failure develop difficulties breathing after lying flat. PND commonly occurs several hours after a person with heart failure has fallen asleep. PND resolves quickly once a person awakens and sits upright.

PND is caused by increasing amounts of fluid entering the lung during sleep and filling the small, air-filled sacs (alveoli) in the lung responsible for absorbing oxygen from the atmosphere. This fluid typically rests in the legs during the day when the individual is walking around and redistributes throughout the body (including the lungs) when recumbent. PND is a sign of severe heart failure

Pedal Edema:

Syncope:



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