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Extra info for Bedside Cardiology
Pathophysiology is similar to that for orthopnea. The failing left ventricle is suddenly unable to match the output of a more normally functioning right ventricle; this results in pulmonary congestion. Other mechanisms include decreased responsiveness of the respiratory center in the brain, decreased adrenergic activity in the myocardium during sleep and nocturnal arrhythmia. Commonest diseases are mitral stenosis, other valvular heart diseases, ischemic heart disease and dilated cardiomyopathy.
However, one should not over diagnose anxiety and should do a total evaluation, as arrhythmia can coexist with anxiety. Anxiety causes catecholamine surge and may induce ventricular tachycardia. Nonarrhythmic Cardiac Cause Rugurgitant lesions, like aortic and mitral regurgitation and lesions, which cause volume-overload, like ASD and VSD are important causes of palpitation. Extracardiac Cause Fever, anemia, hypoglycemia, pheochromocytoma and hyperthyroidism are some common noncardiac causes of palpitation.
2006;27:1207. 4. Wood P. An appreciation of mitral stenosis. Brit Med J. 1954;1:1051. 27 5 A Triad: Cardinal Symptoms in Congenital Left-to-Right Shunt Tachypnea and dyspnea, feeding difficulty and failure to thrive, the triad is the hallmark of congestive heart failure (CHF), which is obvious in some specific congenital heart diseases. Important issue is, how does it occur in large L-R shunt. As discussed, pulmonary structural changes rather than pulmonary congestion is responsible for the respiratory distress in L-R shunt in infancy.