Heart examination

Diseases of the cardiovascular system are currently the most common. Manifestations of these should be sought first of all in the examination of the heart and blood vessels. However, a number of symptoms are found with a general systematic examination of the patient. Violation of blood circulation caused by heart disease leads to the appearance of a variety of symptoms, which can be associated with both ischemia and stagnation of blood, as well as a systemic disease that led to the defeat of the heart.

Success in the study of the heart was achieved through the use of electrocardiography. The accuracy of the diagnosis of heart disease has increased in connection with the use of X-ray contrast angiocardiography and measurement of pressure in the heart cavities by an invasive method. Advances in non-invasive cardiac research are associated with the use of an ultrasound method- echocardiography.

However, despite the possibility of using highly informative instrumental methods, the most common methods for diagnosing heart diseases are the usual physical methods of research, especially auscultation.

The patient's questioning is very important in the recognition of heart disease. This applies primarily to complaints of pain in the heart or behind the breastbone, which even in the absence of objective manifestations can often diagnose ischemic disease.

Anamnesis of the disease in heart diseases

It is necessary to clarify the time of appearance of the main symptoms in the patient, their evolution under the influence of treatment, the effectiveness of therapy.

It is important to ascertain how often and when the periods of disability occurred, whether a disability was prescribed and whether there were hospitalization cases, especially in connection with hypertension and angina pectoris.

It is advisable to know the results of the clinical examination and the data of electrocardiography, echocardiography, and also their evaluation by the treating physicians. However, prior diagnoses, such as a heart attack, should be treated with caution. This also applies to the diagnosis of " heart disease " (this term is sometimes used by patients themselves in the sense of having a heart attack).

It is important to clarify the reason for hospitalization and the assessment of the patient's circumstances of hospitalization, as this determines in many respects the range of issues in differential diagnosis.

All the questions related to the anamnesis (history) of life, including the conditions of work, life, are clarified, life style, bad habits are clarified, in women - violations of menstrual function, contraceptive use, past illnesses, heredity.

As already mentioned, when examining and detecting certain symptoms, the doctor is especially forced to return to the anamnesis in connection with emerging questions and considerations. So, having identified angina and transferred heart attack, the doctor details the nature of nutrition, fixes attention to the undesirability of excess nutrition and indicates the need to replace animal fats with plant. If there is a doubt about the presence of ischemic disease and for resolving prognosis, attention is drawn to the so-called risk factors, which include the intensity of smoking and especially heredity (what did the parents and close relatives suffer and at what age? It is very important, for example, to pay attention to the fact that one of the parents died from an infarction before the age of 50 or the development of a heart pathology in a woman during menopause and early menopause. Particular attention should be paid to the so-called alcoholic anamnesis. In this case, doubts may arise especially in the persistence of withdrawal (alcohol withdrawal) in the case of progression of heart failure in a patient with congestive cardiomyopathy.

In many patients, details of treatment are important: dosage (eg, diuretic furosemide), duration of administration, complications and symptoms of intolerance.

The state of the nervous system is important to clarify, not only from the point of view of the significance of the nervous factor in the development of the disease, but also its influence on the quality of life of the patient. Treatment of arrhythmia, for example, extrasystole, largely depends on how the patient tolerates it, that is, including the sensitivity of its nervous system.

The patient's questioning is an extremely important element of his examination. It allows you to find key manifestations of the disease more often than using other physical methods, contributing to the diagnosis and especially to the rational management (the nature of additional examination and treatment) of the patient.

[1], [2], [3], [4], [5], [6]

Complaints of heart disease

Pain in the heart or behind the breastbone  is a frequent complaint of patients. It is important to distinguish coronary, or ischemic, pain due to coronary artery insufficiency (angina pectoris, myocardial infarction), and cardialgia associated with lesions of the heart muscle, pericardium, and other causes.

Features of pain in angina pectoris caused by acute myocardial ischemia are:

1. localization behind the sternum;
2. occurrence in the form of attacks with physical exertion, cold action;
3. compressive or pressing character;
4. rapid decrease and disappearance when taking nitroglycerin (under the tongue).

Features of the inquiry in the detection of ischemic heart pain

1. Do you notice unpleasant sensations in the chest (behind the sternum), arms, neck?
2. What kind of character are they (squeezing, pressing, stitching, aching pains)?
3. When did you first feel it?
4. What do  you  do when you  feel them?
5. What leads to their appearance (give examples)?
6. How long have they been going on?
7. What else worries about them at the same time?
8. Do they arise in peace: sitting or sleeping?
9. How often do they occur (several times a day, a week)?
10. Have the pains intensified and intensified in recent days?
11. Do you take nitroglycerin every time you attack, how fast does it help?
12. How many tablets of nitroglycerin a day (per week) do you take?

Cardialgias (noncoronogenic pains) usually localize in the region of the left nipple (or the apex of the heart), have the character of stitching, aching, cutting, lasting from a few seconds to many hours and even days, usually do not decrease when taking nitroglycerin, arise due to various factors (rarely - with a long load).

Both these and other pains can irradiate into the left shoulder, arm, scapula. This is due to the spread of pain impulses along the nerve pathways and their projection in the brain.

It is important to distinguish a group of diseases in which paroxysmal, intense, prolonged pains behind the sternum or in the left half of the chest are accompanied by other serious symptoms, especially a decrease in blood pressure. This refers to the pain of myocardial infarction, thromboembolism of the large pulmonary artery, exfoliating aortic aneurysm.

However, between the intensity of pain and severity, the danger of the disease for life is most often not direct dependence, ie, strong (according to the patient) and prolonged pain can be in a person without a serious pathology, and vice versa, minor cardialgia may be a symptom of a dangerous disease.

Pain in the heart (sometimes very intense) is often "caused by non-cardiac causes. These include lung and pleural diseases (pneumonia with secondary pleurisy, pneumothorax ), peripheral nervous system ( intercostal neuralgia ), digestive system ( reflux-esophagitis ), inflammatory changes in chondrosteral connections. Neurosis with signs of depression (in the absence of organic damage to the heart and other organs) is one of the frequent causes of cardialgia. At present, there are dozens of diseases in which there are pains in the heart.

Diseases accompanied by paroxysmal pain in the region of the heart

Cause	Characteristics of pain
Angina pectoris.	The feeling of compression and pressure behind the breastbone 2-3 minutes, is associated with physical activity, food, is eliminated at rest and after taking nitroglycerin.
Pleurisy.	Strengthens with deep breathing, cough, often combined with signs of pleurisy.
Psychoneurosis.	It is connected with emotions, localized in the region of the apex of the heart, has a varied character and duration (from 1-2 s to several hours).
Disease of the esophagus.	Burning behind the sternum, more often at night in bed, is eliminated after a meal, as well as nitroglycerin.
Cervical osteochondrosis.	It is provoked during movement and palpation of the vertebrae and persists for a long time after the end of the movements.
Diseases of the chest (muscular, osteoarticular).	They are provoked during movement and palpation of the chest (especially the costal cartilage), have a long-lasting character.

Shortness of breath  - a frequent manifestation of heart disease, is associated with a worsening of its contractile function, i.e. heart failure. Dyspnea with heart disease primarily occurs with physical stress (walking, other muscle tension).

Shortness of breath is a subjective feeling of lack of air or quick breathing. The appearance of this sensation depends not only on changes in the function of the heart and lungs, but also on the sensitivity of the central nervous system, which perceives these changes through the interoceptors. The emergence of this feeling depends on the overall fitness. In healthy, trained individuals who are forced to follow a sedentary lifestyle for a long time, dyspnea occurs with less exercise.

Attacks of sudden dyspnoea or asthma can develop in patients with heart disease at rest, for example during a night's sleep or after intense stress. These attacks are associated with acute left ventricular heart failure, with stagnation of blood in the lungs. In this case the patient occupies a sitting position.

Coughing and hemoptysis  may be associated with heart disease as a result of blood stagnation in the lungs due to left ventricular failure. Cough, usually dry, may precede the appearance of dyspnea. It can appear with an aneurysm of the aorta, leading to compression of the trachea or bronchi.

Palpitations and interruptions  in the work of the heart arise in connection with an increase in the number of cardiac contractions or their irregularity, i.e., arrhythmia. The palpitations, like other complaints, are subjective and may occur with a very small increase in the rhythm due to increased heartbeat.

Syncope, or fainting,  (seizures with impaired consciousness or dizziness) may be associated with disorders of cerebral circulation as a result of cardiac arrhythmias (its significant deceleration) or the occasional reduction in cardiac output into the aorta against the background of the existing restriction of its mouth.

Rapid  fatigue  - a characteristic symptom of serious heart disease, usually appears on the background of heart failure. But it can also be a consequence of general intoxication during the inflammatory process.

Pain and heaviness in the right upper quadrant  can be combined with edema of the  shins and are the consequence of heart failure  and stagnation of blood in a large circle of blood circulation. To these manifestations, especially with the rapid development of insufficiency, nausea and vomiting may be added. These symptoms are possible due to an overdose of a number of cardiovascular drugs, in particular cardiac glycosides (digoxin, etc.). In general, most of the complaints are related to cardiac dysfunction, such as heart failure and arrhythmias. A special place among the complaints is occupied by periodically recurring pains, the coronary character of which is specified in detailed questioning.

[7], [8]