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(BQ) Part 2 book "Essentials of Kumar and Clark's clinical medicine" presents the following contents: Cardiovascular disease, respiratory disease, intensive care medicine, drug therapy, poisoning, and alcohol misuse, endocrine disease, diabetes mellitus and other disorders of metabolism, the special senses, neurology, dermatology. | Cardiovascular disease COMMON PRESENTING SYMPTOMS OF HEART DISEASE The common symptoms of heart disease are chest pain breathlessness palpitations syncope fatigue and peripheral oedema but none are specific for cardiovascular disease. The severity of anginal pain dyspnoea palpitations or fatigue may be classified according to the New York Heart Association grading of cardiac status Table 10.1 . Chest pain Chest pain or discomfort is a common presenting symptom of cardiovascular disease and must be differentiated from non-cardiac causes. The site of pain its character radiation and associated symptoms will often point to the cause Table 10.2 Dyspnoea Causes are discussed on page 407. Left heart failure is the most common cardiac cause of exertional dyspnoea and may also cause orthopnoea and paroxysmal nocturnal dyspnoea p. 407 . Palpitations Palpitations are an awareness of the heartbeat. The normal heartbeat is sensed when the patient is anxious excited exercising or lying on the left side. In other circumstances it usually indicates a cardiac arrhythmia commonly ectopic beats or a paroxysmal tachycardia p. 420 . Syncope This is a temporary impairment of consciousness due to inadequate cerebral blood flow. There are many causes and the most common is a simple faint 2011 Elsevier Ltd Inc BV 10 408 Cardiovascular disease Table 10.1 The New York Heart Association grading of cardiac status modified Grade 1 Uncompromised no breathlessness Grade 2 Slightly compromised on severe exertion Grade 3 Moderately compromised on mild exertion Grade 4 Severely compromised breathless at rest Table 10.2 Common causes of chest pain Central Angina pectoris Crushing pain on exercise relieved by rest. May radiate to jaw or arms ACS Similar in character to angina but more severe occurs at rest lasts longer Pericarditis Sharp pain aggravated by movement respiration and changes in posture Aortic dissection Severe tearing chest pain radiating through to the back Massive PE With dyspnoea .
