Symptomatology In Cardiovascular Diseases: Dypsnea, Edema And Orthopnea
In our last Cardiology episode, we discussed three functional physiology of the heart which are: Heart sounds, cardiac output and arterial blood pressure, now we will discuss general symptoms in heart or heart-related clinical cases. When evaluating cardiovascular diseases, the first symptom that comes to mind is Dyspnea. We can also make this statement the other way round; if a person suffers from difficulty in breathing, alongside respiratory diseases, another possibility is to check for cardiovascular pathology.
Dypsea is the commonest symptom which brings the patient to the doctor in most instances. This is the uncomfortable awareness of breathing, or simply difficulty in breathing. Several factors may contribute to dyspnea. It has been quantified for assessing the severity of illness and for helping in follow up. It is very suggestive of Cardiac failure. The various grades are as follows:
- Grade I: (Slight): symptoms are provoked by more than ordinary activity like running, climbing uphill etc.
- Grade II: (moderate): Symptoms occur in ordinary activity like walking briskly, taking flights or climbing stairs etc.
- Grade III: (Considerable): Symptoms develop with less than ordinary activity like walking on level ground, light household work, etc.
- Grade IV (Gross): Total incapacity and dyspnea at rest and recumbency.
This is grade IV Dypsea and is common in left-sided heart failure. Paroxysmal nocturnal dypsnea is the occurrence of sudden onset of dypsea which abruptly wakes the patient up in the early hours of sleep. The patient jumps up for breath with cough and frothy sputum. Assuming the erect attitude relieves the distress in many cases.
Paroxysmal nocturnal dyspnea (also known as cardiac Asthma) is an early symptom of left-sdied heart failure. Pulmonary congestion and edema account for this phenomenon. Cheyne-Stokes respiration is the periodic alteration in the rate and depth of breathing. The respiratory rate waxes and wanes alternatively with apneic pause in several conditions, left-sided heart failure being a common cause.
Symptoms And Diseases
Subcutaneous edema is demonstrated by the phenomenon of pitting on pressure. Considerable amount of fluid (more than 2 liters) should accumulate in the body before manifesting as generalized edema. Abnormal increase in weight (0.5- 1Kg/day) associated with oliguria occurs early. When Edema is manifest, the skin is stretched and shiny and pitting can be demonstrated. The factors which help in retaining sodium and fluid are, reduction in the cardiac output, increases venous pressure, transudation of fluid into the interstitium and over-activity of aldosterone and antidiuretic hormones. These hormones act in minimizing the renal output of sodium and water.
The edema is "dependent" i.e it is more prominent in the most dependent parts of the body. In those who are ambulant, the edema is maximal on the feet, and that too in the evening. In bedridden patients, the edema is localized to the back and sacral region.
© 2013 Funom Theophilus Makama