Clinical Presentation

Dyspnoea is an awareness of breathlessness and a symptom of congestive cardiac failure, the endstage of many cardiac conditions. Orthopnoea and paroxysmal nocturnal dyspnoea are shortness of breath, which arise when the patient has been recumbent due to collection of fluid in the pulmonary circulation (pulmonary oedema).

a Anterior view


aortic trunk


superior vena cava


right atrium


left atrium


right ventricle


left ventricle


pulmonary artery


inferior vena cava


left coronary artery


right coronary artery


tricuspid valve


mitral valve


interventricular septum y

b Coronal section (rotated on its right axis)

Coronary artery


Coronary artery


Papillary muscles

Posterior c Sub-annular transverse section of the ventricles


Mital valve leaflets

LV Left


Figure 41.1. Anatomy of the heart.

Mital valve leaflets



Figure 41.1. Anatomy of the heart.

LV Left

Wheezing (cardiac asthma) is due to swelling of the bronchial lining and ankle swelling is secondary to congestive cardiac failure with systemic venous congestion.

Angina commonly presents as central gripping chest pain radiating to the jaws, neck or arms, provoked by exercise and relieved by rest. It is due to cardiac hypoxia.

Myocardial infarction is similar but is not relieved by rest.

Pericarditis presents with severe, sharp, central chest pain, aggravated by movement, posture, respiration and coughing, and myocarditis with mild pleuritic chest pain and lethargy.

Sudden unexplained death may be the presentation of acute cardiac failure due to ischaemic heart disease, and syncope (fainting episodes) may occur in aortic stenosis, both of which can also be caused by cardiac dysrhythmia.

Infective endocarditis presents with fever, weight loss, malaise, splenomegaly and splinter haemorrhages of the fingernails due to embolic infarcts of the skin. Abdominal pain may be secondary to renal or splenic infarcts. Chest pain due to pulmonary infarcts can occur in tricuspid valve endocarditis.

In hypertrophic obstructive cardiomyopathy the patient may present with atrial fibrillation, ventricular arrthymias or sudden death.

Cardiac myxoma can present with symptoms of mitral stenosis and embolisation of fragments of the tumour or of overlying thrombus. Fever, cachexia and malaise also occur.

Cardiac rhabdomyomas may cause stillbirth or death within the first few days of life.

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