Page 18 - Clinical Pearls in Cardiology

6 Clinical Pearls in Cardiology

localize the visceral cardiac pain sensation to these
dermatomal areas, instead of the heart. This referred pain
phenomenon is the reason for radiation of cardiac pain.
10. What is the reason for cardiac cachexia?
Cardiac cachexia (i.e. emaciation) is a condition
developing with severe long-standing heart failure.
Cachexia results from a combination of fatigue and
depression that interfere with food intake. The congestion
of the liver and gastrointestinal structures impair the
digestion and absorption of food, resulting in cachexia.
It has been shown that cardiac cachexia is also
linked to raise plasma levels of tumor necrosis factor
alpha (TNFa) and other inflammatory cytokines and
increased concentration of epinephrine, norepinephrine
and cortisol. Furthermore, these patients also have high
plasma renin activity and increased plasma aldosterone
level.
11. What are the important pulmonary symptoms of heart
disease?
The important pulmonary symptoms seen in patients
with acute or chronic heart disease of any etiology
include the following:
• Wheezing: The elevation of pulmonary or bronchial
vascular pressure results in reflex broncho
constriction. Other potential causes of airway
narrowing include a geometric decrease in airway
size due to reduced lung volume, obstruction from
intraluminal edema fluid in pulmonary edema and
bronchial mucosal congestion.
• Dyspnea: Vascular engorgement due to pulmonary
venous congestion and cardiac enlargement may
cause an increase in blood volume, to be contained
within the thorax, resulting in mechanical impedance