This document discusses the symptoms and signs of heart disease, including chest pain, breathlessness, palpitations, syncope, fatigue, and peripheral edema. It describes the differential diagnosis of chest pain and details specific cardiac and non-cardiac causes. Specific types of chest pain are associated with conditions like ischemic heart disease, aortic dissection, and pericarditis. Breathlessness can indicate issues like left ventricular failure or heart failure. Palpitations most commonly result from arrhythmias like premature beats or tachycardias. Syncope can be caused by vascular, obstructive, or arrhythmia issues. Fatigue and peripheral edema are often symptoms of heart failure.

1. Symptoms and Signs
of Heart Diseases
M. Jude Nilshan Fernando
JMJ 1

2. Symptoms of heart diseases
• Chest pain
• Breathlessness
• Palpitation
• Syncope
• Fatigue
• Peripheral oedema
JMJ 2

3. Differential diagnosis of Chest
Pain
JMJ 3
Central
Lateral
/Peripheral
Cardiac
Non-
Cardiac
Pulmonary
Non-
Pulmonary
1) IHD (Infarction
or angina)
2) Coronary artery
spasm
3) Pericarditis/
myocarditis
4) Mitral valve
prolapse
5) Aortic
aneurysm/
dissection
1) Pulmonary
embolism
2) Oesophageal
disease
3) Mediastinitis
4) Costochondritis
(Tietze disease)
5) Trauma (Soft
tissue, injury)
1) Infarction
2) Pneumonia
3) Pneumothorax
4) Lung cancer
5) Mesothelioma
1) Bornholm disease
(epidemic myalgia)
2) Herpes zoster
3) Trauma (Ribs,
muscular

4. Central Chest Pain
• Pain of angina pectoralis & myocardial
infarction :myocardial hypoxia
• Angina
– Retrosternal heavy or gripping sensation
– With radiation to the left arm or neck
– Provoked by exertion &
– eased with rest or nitrates
• Acute coronary syndrome
– Similar pain at rest
JMJ 4

5. Central Chest Pain
• Aortic dissection
– Severe tearing chest pain
– Radiating through to the back
• Pericarditis pain
– Sharp central chest pain
– Worse with movement or respiration
– Relieved with sitting forwards
• Da Costa’s syndrome
– Sharp stabbing left submammary pain
– Associated with anxiety
JMJ 5

6. Dyspnoea
• Left ventricular failure
• Orthopnoea
– Breathlessness on lying fat
• Paroxysmal nocturnal dyspnoea (PND)
– When a patient is woken from sleep fighting for
breath
• Hyperventilation with altering episodes of
apnoea (Cheyne- Stroke respiration)
– Severe heart failure
JMJ 6

7. Dyspnoea
• Central sleep apnoea syndrome (CSAS)
– If hypoapnoea occurs rather than apnoea
– Periodic breathing
– Due to malfunction of respiratory centre in
the brain
JMJ 7

8. Palpitation
• Increased awareness of the normal
heart beat or
• The sensation of slow, rapid or irregular
heart rhythms
• Most common arrhythmias felt as
palpitations
– Pre-mature ectopic beats
– Paroxysmal tachycardias
JMJ 8

9. Palpitation
• Premature beats (ectopics)
– Felt as a pause followed by a forceful beat
– This is because premature beats are usually
followed by a pause before the next normal
beat, as the heart resets itself
• Paroxysmal tachycardias
– Felt as a sudden racing heart beat
• Bradycarditis
– Slow, regular, heavy or forceful beats
JMJ 9

10. Syncope
• Transient loss of consciousness due to inadequate cerebral
blood flow
JMJ 10
Cardiovascular Causes of syncope
Vascular Obstructive Arrhythmias
1) Neurocardiogenic
(Vasovagal)
2) Postural
hypotension
3) Postprandial
hypotension
4) Micturition
syncope
5) Carotid sinus
syncope
1) Aortic stenosis
2) Hypertrophic
cardiomyopathy
3) Pulmonary stenosis
4) Tetralogy of Fallot
5) Pulmonary hypertension /
embolism
6) Atrial myxoma /thrombus
7) Defective prosthetic
valve
1) Rapid tachycardias
2) Profound
bradycardias
(Stroke – Adams)
3) Significant pauses
(in rhythm)
4) Artificial
pacemaker failure

11. Fatigue
• Symptom of inadequate systemic
perfusion in heart failure
• Due to poor sleep, direct side effect of
medication, particularly beta- blockers,
electrolyte imbalance due to diuretic
therapy
JMJ 11

12. Peripheral oedema
• Heart failure
• Results in salt and water retention due
to renal under perfusion and consequent
activation of the renin- angiotensin-
aldosterone system
JMJ 12