2. Common signs and symptoms in cardiovascular emergencies

The cardiovascular emergencies can present with typical or atypical signs and symptoms. Some patients have so minor complaints that they can be missed if physicians do not have a high index of suspicion. While examining a patient, it is important to have a wide range of differentials in mind. Emergency physicians should examine a patient to pick up signs or symptoms related to cardiovascular emergencies—complications directly or indirectly related to cardiovascular emergencies or signs and symptoms related to underlying diseases which manifest as acute cardiovascular problems at the time of presentation in the emergency department. Physicians with depth of medical knowledge, good skills of history taking and examination will less likely miss serious cardiovascular emergencies.

Following are the signs and symptoms which may indicate cardiovascular problems and need to be evaluated with a high index of suspicion in the emergency department.

	- 1. Chest symptoms (chest pain, chest tightness or pressure-like symptoms, discomfort)
	- 2. Breathlessness (orthopnea, paroxysmal nocturnal dyspnea, exertional breathlessness)
	- 3. Palpitation
	- 4. Sweating
	- 5. Pedal edema or generalized edema

Diagnosis becomes challenging when patients present with atypical symptoms [1]:

	- 1. Hypotension

a cardiovascular problem may present. I will also discuss the approach to deal with these

The cardiovascular emergencies can present with typical or atypical signs and symptoms. Some patients have so minor complaints that they can be missed if physicians do not have a high index of suspicion. While examining a patient, it is important to have a wide range of differentials in mind. Emergency physicians should examine a patient to pick up signs or symptoms related to cardiovascular emergencies—complications directly or indirectly related to cardiovascular emergencies or signs and symptoms related to underlying diseases which manifest as acute cardiovascular problems at the time of presentation in the emergency department. Physicians with depth of medical knowledge, good skills of history taking and

Following are the signs and symptoms which may indicate cardiovascular problems and need

1. Chest symptoms (chest pain, chest tightness or pressure-like symptoms, discomfort) 2. Breathlessness (orthopnea, paroxysmal nocturnal dyspnea, exertional breathlessness)

Diagnosis becomes challenging when patients present with atypical symptoms [1]:

3. Pain or numbness in the leg or cold extremities (related to poor circulation associated

2. Pain in abdomen (related to heart failure/liver congestion or ischemia)

2. Common signs and symptoms in cardiovascular emergencies

symptoms and how to manage them and finally dispose them.

194 Essentials of Accident and Emergency Medicine

examination will less likely miss serious cardiovascular emergencies.

A. Typical cardiovascular symptomatology

5. Pedal edema or generalized edema

5. Light headedness or dizziness

7. Fainting (Syncope) or near fainting

6. Pain at the back (ischemia)

8. Fatigability and tiredness 9. Cardiac asthma (cough)

1. Pain in the neck, jaw, throat or arm (ischemic pain)

with vascular problems or poor cardiac output)

3. Palpitation 4. Sweating

4. Dyspepsia

B. Atypical symptomatology:

to be evaluated with a high index of suspicion in the emergency department.

	- a. Aortic regurgitation signs:
		- 1. Corrigan's pulse
		- 2. De Musset's sign
		- 3. Quincke's sign
		- 4. Traube's sign
		- 5. Duroziez's sign
		- 6. Landolfi's sign
		- 7. Becker's sign
		- 8. Müller's sign
	- b. Mitral stenosis:
		- 1. Heart failure symptoms, such as dyspnea on exertion, orthopnea and paroxysmal nocturnal dyspnea (PND)
		- 2. Thromboembolism in later stages when the left atrial volume is increased
		- 3. Palpitations
		- 4. Hemoptysis
		- 5. Chest pain
	- 1. Dyspnea
	- 2. Fatigue
	- 3. Orthopnea
	- 4. Pulmonary edema

3.1.1. Differential diagnosis of atraumatic chest pain

3.1.2. History taking

2. Acute Coronary Ischemia 3. Aortic Dissection 4. Cardiac Tamponade

1. Tension Pneumothorax 2. Pulmonary Embolism Gastrointestinal:

Non-emergent diagnosis

1. Mitral Valve Prolapse 2. Valvular Heart Diseases 3. Aortic stenosis

4. Pneumomediastinum Gastrointestinal: 1. Esophageal spasm 2. Esophageal Reflux 3. Peptic ulcer disease 4. Biliary Colic /Musculoskeletal: 1. Muscle strain 2. Rib Fracture 3. Arthritis 4. Costochondritis 5. Tumor

6. Non-Specific pain

1. Spinal Root Compression 2. Thoracic outlet 3. Herpes Zoster 4. Post herpetic neuralgia

Table 1. Differential diagnosis of atraumatic chest pain.

Neurologic:

1. Boerhaave (Esophageal Rupture)

4. Hypertrophic cardiomyopathy

CVS: 1. Acute MI

Pulmonary:

Cardiac:

Pulmonary: 1. Pneumonia 2. Pleurisy 3. Tumor

Chest pain is a symptom which could be due to a very serious underlying condition that may be life threatening, or it may be due to very benign condition [2, 3]. Here is the list of conditions

The most important key to diagnose serious medical conditions in the emergency department is the accurate history and examination. While taking history, all the important question

CVS:

Respiratory: 1. Mediastinitis 2. Pneumothorax Gastrointestinal: 1. Mallory Weiss 2. Cholecystitis 3. Pancreatitis

1. Unstable Angina 2. Coronary Spasm 3. Prinzemetal Angina

Systematic Approach to Acute Cardiovascular Emergencies

http://dx.doi.org/10.5772/intechopen.74682

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4. Cocaine induced Pericarditis/Myocarditis

which needs to be considered in patients presenting with chest pain [2] Table 1.

Critical diagnosis Emergent diagnosis

