![]() ![]() Manifestations of pulmonary congestion 3. Manifestations of the cause as chest pain in IHD 2. Great vessels pain: Aneurysm of the aorta Dissecting aneurysm in the aorta Pulmonary embolismġ5 B-NON CARDIAC CAUSES: Pain from chest wall Pain from lungs, pleura or mediastinum Pain from abdominal causesġ. 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 inspirationġ4 3. 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 deathġ3 2. RELIEVING FACTORS: Relieved by rest-after 1-3 min and by sublingual nitroglycerinĮxertion Emotion Heavy meals Exposure to cold Sexual intercourse ASSOCIATED MANIFESTATIONS: Sweating Tachycardia Anxiety Rise in blood pressure ![]() 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. The coronaries are only partly occluded UNSTABLE ANGINA: Prolonged severe myocardial ischemia with or without patches of necrosis MYOCARDIAL INFARCTION: Complete arterial occlusion with myocardial tissue necrosisġ0 ANGINA PECTORIS CHARACTER: SITE: RELIEVING FACTORS:ĭull aching, squeezing, compressing or burning. ISCHEMIC CHEST PAIN Atherosclerosis of coronaries is the most common cause Ischemic chest pain may be due to: ANGINA PECTORIS: transient myocardial ischemia during exercise. Cardiac causes: Ischaemia Pericardial painĩ 1. Increased force of cardiac contraction - Change in the heart rate - Change in the rhythmĨ Chest pain A. Mitral valve disease (due to pulmonary congestion) Acute left ventricular failure ( pulmonary oedema) Pulmonary infarction ( pulmonary embolism)ħ Palpitation “Awareness of heart beats” Mechanism: “ Attacks of severe dyspnea occurring at night and waking the patient up from sleep” Mechanism: Same mechanism + Sliding down from semi-sitting position after falling asleep Blunting of respiratory and cough center response during sleep allows pulmonary congestion to accumulate Bad dreams increase the heart rate and blood pressureĦ Haemoptysis “ coughing of blood” Cardiovascular causes: Venous return and cardiac output are increased by 25% on lying down Reabsorption of edema fluid from lower limb into the circulation Viscera push the diaphragm up and encroach on the lung Left ventricular failure Mitral valve disease Cadiomyopathy Constrictive pericarditis and pericardial effusionĤ ORTHOPNEA “Respiratory distress on lying down” Mechanism: Physiological Cardiac Respiratory Abdominal Metabolic Anaemia Psychogenic 1 SYMPTOMS of CVS Dyspnea Orthopnea Paroxysmal nocturnal dyspnea (PND)Ĭough Haemoptysis Syncope Fatigue Palpitations Chest painĢ DYSPNEA “Awareness of respiratory effort” Causes of dyspnea: ![]()
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