Coronary Artery Disease | Symptoms of various Types

Symptoms of coronary artery disease

Following symptoms are present with various types of CAD

Stable angina: It is characterize by central chest pain that is precipitated by exertion and promptly relived by rest. Pain may radiate to neck, jaw and in the arms particularly in left arm & hand. Occasionally the pain is in the epigastric or interscapular region. Breathlessness is sometimes the prominent feature.
Unstable angina: This is also called pre-infarction angina as 20% of these patient develop myocardial infarction within four months. Patient presents with severe worsening chest pain rest or prolong.
Nocturnal angina: angina appears in the middle of the night due to left ventricular failure which may be precipitated by dreams causing release of catecholamine a full urinary bladder or transient hypoglycemia.

Pain is the cardinal symptom of acute myocardial infarction. There is severe central chest pain may radiate to neck, jaw and arms which last longer and described as tightness, heaviness and constriction in the chest..
Breathlessness: Breathlessness is actually presents with the pain rarely it may be the only presenting symptom.
Vomiting: It is the common feature only in severe cases and is often associated with cardiogenic shock.
Collapse or Syncope: it is usually due to an arrhythmia or profound hypotension. The patient may be pale or cyanosed with intense perspiration. The patient may be restless, excited and rarely unconscious.
Sometimes infarct occurs in the absence of any physical signs. Some pass unrecognized; these silent infarcts are particularly common in elderly and diabetics patient.

A low cardiac output causes fatigue, restlessness and poor effort tolerance, the peripheries are cold and the blood pressure is low. Poor renal perfusion may lead to oliguria and uremia.
Pulmonary edema with left heart failure may present with breathlessness even at rest, orthopnoea i.e.; breathlessness even in propped up position. There is paroxysmal nocturnal dyspnoea and cough commonly occurs. The attacks of breathlessness and cough precipitate at night and may be characterized by sudden awakening with extreme suffocation, cyanosis, perspiration, and air hunger.
In contrast right heart failure produces a high jugular venous pressure, hepatic congestion which causes anorexia, nausea, and vomiting, abdominal fullness after meals and pain in right hypochondriac area. Peripheral edema is also present; massive accumulation of fluid may causes ascites or plural effusion.
Chronic heart failure sometimes associated with marked weight loss caused by a combination of anorexia and impaired absorption due to gastrointestinal congestion, poor tissue perfusion due to low cardiac output and skeletal muscle atrophy due to immobility.

These actually cause no symptoms but can give the sensation of a missed beat or an abnormally strong beat. The patient may complain of palpitation or breathlessness. This can be diagnosed only on ECG.

It is due to an arrhythmia related to an acute myocardial infarction, ischemia, and cardiac failure also in patient with other cardiac abnormalities.

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