Paroxysmal dyspnoea

In mitral stenosis, paroxysmal dyspnoea may be precipitated by tachycardia secondary to emotion or exertion and is particulary liable to occur during pregnancy. The distinction between bronchial and cardiac asthma may occasionally be difficult. A long history of similar attacks, a personal or family history of allergic disorders, extreme expiratory difficulty, the tendency to occur in younger people and the absence of signs of heart disease are features of the former. Cough may result from pulmonary congestion or oedema, from superimposed infection or occasionally from pulmonary infarction. It is frequently troublesome at night and may be responsible for insomnia. Pulmonary congestion from cardiac failure may mimic chronic bronchitis in elderly persons.

Left ventricular

The principal manifestations of left ventricular failure are dyspnoea, cough crepitating at the bases of the lungs, enlargement of the heart due to hypertophy and dilation of the left ventricle, triple rhythm and pulses alternant. Dyspnea is usually the earliest manifestation of heart failure. It may occur on exertion or at rest. Dyspnoea at rest may be paroxysmal and is often nocturnal. Cheyne-Stokes respiration refers to a special from of periodic respiration which may or may not be accompanied by the sensation of dyspnoea. Dyspnoea at rest is always pathological. Dyspnoea on exertion occurs in normal people and hence must be assessed in relation to age, obesity and physical fitness. Progression or regression of dyspnoea on exertion is a valuable guide to the course of the underlying heart disease. Later dyspnoea will be present at rest and finally the patient cannot lie flat without distress (orthopnoea). In the recumbend posture the venous return to the heart is increased. Pulmonary congestion is aggravated and this together will the elevation of the diaphragm which results from lying down reduces still further the vital capacity of the lungs.

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Pregnancy information

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