| Popis: |
The symptomatic repertoire of cardiac disease is relatively narrow and most conditions will present with one or more of chest pain, dyspnoea, palpitation, syncope, or presyncope. On the other hand, the differential diagnosis of each of these symptoms is broad and includes both cardiac and non-cardiac disorders. Certain features of acute chest pain alter the likelihood of acute coronary syndrome but, in isolation, the history is usually insufficient to rule in or rule out the diagnosis. Intermittent chest pain can be categorized as typical angina, atypical angina, or non-anginal based on three symptom characteristics; this classification has substantial diagnostic value and helps to determine the need for and the most appropriate mode of further investigation. Orthopnoea and paroxysmal nocturnal dyspnoea are more specific for heart failure than other forms of dyspnoea. However, it is not possible to diagnose either acute or chronic heart failure by the history alone. For both angina and chronic heart failure, the European Society of Cardiology recommends objective assessment of symptom severity using the Canadian Cardiovascular Society and New York Heart Association classifications respectively. Definitive diagnosis of palpitation usually requires documentation of the cardiac rhythm during symptoms but a clear description of the symptom may suggest the likely diagnosis and guide the optimal approach to rhythm monitoring. The history is invaluable in differentiating syncope and presyncope from other causes of transient loss of consciousness and dizziness. Beyond this, clinical features such as prodromal symptoms or precipitation of episodes by exposure to pain can help to distinguish cardiac from reflex syncope. |
