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Pathological Cardiovascular Symptoms: Precordial Pain, Palpitation And Syncope
In the previous episode we discussed pathological Heart symptoms such as dyspnea, edema and orthopnea. Now we will discuss precordial pain, palpitation and syncope as common cardiovascular symptoms.
Among the several causes of precordial pain, cardiac cause is the most important. Pain sensitive structures in the heart are the pericardium which give rise to pain due to inflammation (Pericaditis) or stretching as in pericardial effusion, and the myocardium in which severe pain may occur as a result of ischemia.
Pain arising from the pericardium and myocardium are indsitinguishable in many cases, but sometimes they are identical. Ischemic pain is vague, felt over the precordium or retrosternal region and may be described as crushing, bursting, lancinating, burning or otherwise. Anginal pain comes on with exertion or emotional stress and is relieved with rest. The pain shows characteristic radiation.
The classical sites of radiation are:
- Along the inner aspect of the left arm to the little finger,
- left or both sides of neck and jaw
- left scapular region,
- right shoulder and arm,
- epigastrium and at times, to any other part of the body. Patients with cardiac neurosis and hypochondriasis may complain of chest pain. This pain is localized to the cardiac apex and may be described as catching or pricking. Such pain may not have an organic basis.
This is awareness of the Heart beat. Though normal individuals can experience the heart beat during exercise or emotional stress, under pathological states, this symptom may be troublesome. Palpitation may be due to tachycardia, extreme bradycardia, irregularity of rhythm or increase in stroke volume. In anxious individuals this is a common symptom.
Syncope a.k.a fainting
Loss of consciousness occurs when the cardiac output is not sufficient to maintain cerebral blood flow. The patient loses consciousness rapidly over seconds, unlike as in epilepsy in which the loss of consciousness is more abrupt. As the patient sinks into the flat position, consciousness is regained. If cerebral ischemia continues, the patient may develop convulsions (Stokes-Adam's Attacks). Syncope is common in fallot's tetralogy, aortic, pulmonary and mitrial stenosis, intermittent heart block and at the onset of acute myocardial infarction.
Other causes of syncope include pooling of blood in the lower limbs as seen in persons standing still for a long time (e.g parade or drill), sudden rise in intra-thoracic pressure resulting in diminution of venous return to the heart (e.g cough syncope), or hyper-reactivity of the carotid sinus in which sudden neck movements or pressure over the carotid sinus leads to severe bradycardia and syncope.
Apart from these specific symptoms, general symptoms such as extreme fatigue may be the result of low cardiac output states. Anemia and fever occur in infective endocarditis. Clubbing of fingers is a common symptoms of cyanotic congenital heart disease and infective endocarditis.
© 2013 Funom Theophilus Makama