In The Name Of ALLAH,

The Most Beneficent,

The Most Gracious,
The Most Merciful !
CARDIOVASCULAR SYSTEM
PRESENTED BY:

Prof. Muhammad Zafar

M.B;B.S., M.PHIL., PH.D
SYMPTOMS OF CVS DISEASES
Following are the main symptoms of CVS diseases

1.Chest pain (discomfort)

2.Breathlessness (Difficulty in Breathing)
3.Palpitation
4.Syncopial attacks (Syncope)
5.Peripheral oedema
1. Chest pain / discomfort – this
occurs due to angina, myocardial
infarction, pericarditis and rarely
aortic dissecting aneurysm. Cardiac
pain is retrosternal, pressure like
i.e. squeezing and radiates to left
shoulder and arm (may be in jaws
or upper abdomen).
Continue…..

It is of shorter duration in case of

angina and prolonged (more than
half hour) in cases of myocardial
infarction. Pain is relieved by rest
(occurs with exertion) and taking
sublingual nitroglycerine tablet
shows anginal pain. Pericarditis
pain is central. It is increased with
inspiration and changes with
posture and disappears with
NSAID.
PAIN

1.Site
2.localized or diffuse?
3.Radiate
4.Character (Burning, stabbing, crushing,
gripping, pricking, dull, colicky)
5.Intensity (mild, moderate, severe)
6.Factors which aggravate?
7.Factors which relieve?
8.Is pain associated with some other
symptoms?
9.Relationship of posture with pain
10.Pain continuous or intermittent?
2. BREATHLESSNESS (Dyspnoea)

Following should be asked:

1.What are the circumstances under which
attack of dyspnoea occurs i.e. after
exercise and exertion or in lying on bed
(orthopnoea)? If dyspnoea occurs after
exertion, what is the grade of exertion i.e.
severe, moderate or mild.
2.Does dyspnoea appear suddenly
(pulmonary oedema, asthma) or gradually
(advance chest or heart disease)?
BREATHLESSNESS – continue…

3.What is the character of breathing? Is it

rapid, wheezing or labored?
4.What is the degree of distress? Does the
patient collapse while having the attack of
dyspnoea (dyspnoea syncope).
5.Is the patient free from symptoms in
between the attacks (Asthma)?
In paroxsmal nocturnal dyspnoea, patient is
comfortable lying down to sleep but is
woken later with acute, severe,
breathlessness which is relieved by sitting
up.
3. Palpitation – awareness of heartbeat is
labeled as palpitation. During emotional
upset or after exercise it is a common
physiological phenomenon. Palpitation may
occur due to abnormal cardiac rhythm i.e.
extra systole or tachycardias. Atrial
fibrillation,supraventricular tachycaedia
(SVT) are common causes. Few patients
may complain of dropped or missed beats.
 Palpitation: (continued)
Ask about:
1. The mode of onset and termination
2. Specific triggers of exercise, alcohol,
caffeine
3. Frequency
4. Duration of attacks
5. Rhythm
4. Syncope (dizziness or loss of
consciousness) – this occurs due to abrupt
cerebral hypo function as a result of
transient hypotension (postural
hypotension). Cardiac causes are
arrhythmia, bradycardia, and aortic stenosis.
Other non-cardiac causes include stroke,
epilepsy and vosovagal syncope.
5. Peripheral oedema – pitting oedema of
lower limbs is cardinal feature of CCF. This
can occur in cases of Hypoproteinemia,
and kidney disease.
 SIGNIFICANCE OF HISTORY TAKING
FROM A CVS PATIENT

THE HISTORY:
The history is as important as clinical
examination in the evaluation of the patient
with cardiac disease. Indeed the most
common cause of cardiac symptoms,
coronary heart disease, commonly occurs
without abnormal physical findings.
PRESENTING COMPLAINT

Establish the frequency, duration and

severity of symptoms and causative and
relieving factors.
FUNCTIONAL IMPAIRMENT

Assess the impact of symptoms of exertional

chest pain or breathlessness on the patient’s
functional capacity.
PAST HISTORY

Rheumatic fever
Heart murmurs during childhood
Specifically enquire about conditions associated
with cardiac disease, including:
Diabetes mellitus
Glomerulonephritis and hypertensive heart
disease
Thyrotoxicosis and atrial fibrillation
Amyloidosis and cardiomyopathy
In cases of suspected infective endocarditis
ask about recent dental work
DRUG HISTORY

Thyroxine may precipitate or aggravate angina.

Non-steroidal anti-inflammatory drugs
Herbal remedies
FAMILY HISTORY

Genetically determined cardiovascular disorders

Single-gene defects Polygenic inheritance
Hypertrophic Ischaemic heart disease
cardiomyopathy
Marfan’s syndrome Hypertension
Familial Type 2 diabetes mellitus
hypercholesterolaemia
Muscular dystrophies Hyperlipidaemia
Long Q-T syndrome
SOCIAL HISTORY

Smoking
Consumption of alcohol
Caffeine consumption
OCCUPATIONAL HISTORY
3.15 Occupational aspects of cardiovascular disease
Occupational exposure associated with cardiovascular disease
Organic solvents Arrhythmias
cardiomyopathy
Vibrating machine tools Raynaud’s phenomenon
Publicans Alcoholic cardiomyopathy
Occupational exposure exacerbating pre-existing cardiac conditions
Cold exposure Angina
Raynaud’s diesase
Deep-sea diving Embolism through foramen ovale
Occupational requirements for high standards of cardiovascular fitness
Pilots
Public transport / heavy goods vehicle drivers
Armed forces
police
THANK YOU