Signs & Symptoms of Angina

Angina is chest pain or discomfort that occurs when your heart muscle does not get enough blood. Angina may feel like pressure or a squeezing pain in your chest. The pain may also occur in your shoulders, arms, neck, jaw, or back. It may also feel like indigestion.
Angina is a symptom of coronary artery disease (CAD), the most common type of heart disease. CAD occurs when plaque builds up in the coronary arteries. This buildup of plaque is called atherosclerosis. As plaque builds up, the coronary arteries become narrow and stiff. Blood flow to the heart is reduced. This decreases the oxygen supply to the heart muscle.

Signs & Symptoms of Arteriosclerosis

Arteriosclerosis {ahr-tir-ee-oh-skluh-roh'-sis} is a term used to describe several diseases that involve the cardiovascular system and the many arteries and vessels which make it up. Atherosclerosis invades both the superficial and deep layers of the vessel walls. Arteriosclerosis is often referred to as "hardening of the arteries."
Arteriosclerosis occurs over a period of many years during which the arteries of the cardiovascular system develop areas which become hard and brittle. Vessels become thickened. There is a loss of elasticity. It can involve the arteries of the cardiovascular system, the brain, kidneys, upper and lower extremities. This occurs because of the deposition of calcium in their walls.

Arteriosclerosis differs from atherosclerosis, which involves the buildup of fatty deposits in the innermost lining of large and medium-sized arteries. Atherosclerosis often leads to coronary heart disease, strokes, and other disorders because of the occurrence of blood clots which form in the narrowed arteries; hardening of the arteries, on the other hand occur only in advanced stages.

Signs & Symptoms of Low blood pressure

Low blood pressure is an abnormal condition where a person's blood pressure (the pressure of the blood against the walls of the blood vessels during and after each beat of the heart) is much lower than usual, which can cause symptoms such as dizziness or lightheadedness.
When the blood pressure is too low, there is inadequate blood flow to the heart, brain, and other vital organs.

A blood pressure level that is borderline low for one person may be normal for another. The most important factor is how the blood pressure changes from the normal condition. Most normal blood pressures fall in the range of 90/60 mm Hg to 130/80 mm Hg, but a significant change, even as little as 20 mm Hg, can cause problems for some people.
Symptoms of Hypotension, Low Blood Pressure.

When blood pressure is too low, the first organ to malfunction is usually the brain because it is located at the top of the body and blood has to fight gravity to reach the brain. Consequently, most people with low blood pressure feel dizzy or light-headed when they stand, and some may even faint. However, if blood pressure is low enough, brain damage can still occur.

Low blood pressure occasionally causes shortness of breath or chest pain due to an inadequate blood supply to the heart muscle (angina). All organs begin to malfunction if blood pressure becomes sufficiently low and remains low; this condition is called shock (see Shock).

Some symptoms occur when the body's compensatory mechanisms try to increase blood pressure that is low. For example, when arterioles constrict, blood flow to the skin, feet, and hands decreases. These areas may become cold and turn blue. When the heart beats more quickly and more forcefully, a person may feel palpitations (awareness of heartbeats).

A systemic, febrile disease that is inflammatory & non-suppurative in nature & variable in severity, duration & sequelae.
It is acute febrile illness following streptococcal sore throat & characterised by fleeting arthritis, pancarditis, leucocytosis & raised ESR.
Following a streptococcal infection the patient will experience the sudden occurrence of fever & joint pain; this is the most common type of onset. Rheumatic fever may occur without any sign or symptom of joint involvement. Acute rheumatic fever usually affects children (5-15years) or young adults.

Etiology of Rheumatic Fever:
• Streptococcal-A infection.

Predisposing factors:
• Age: 5-15 years
• Sex: more common in females.
• Malnutrition.
• Genetic predisposition noted.
• Over crowding.
• Poor sanitation.
• Cold weather.
Clinical feature of Rheumatic Fever:
Prodormal phase: Tonsillitis or sore throat 1-4 weeks prior to onset of acute rheumatic fever. Vague prodromata include growing pain, anorexia, pallor, fatigability & nervous irritability & low grade febrile attacks.

Latent period: When antibodies to the preceding streptococcal infection are produced.

May vary in length from a few days to several weeks.

Phase of onset of acute rheumatic fever.

Symptoms
• History of sore throat over last 2 weeks.
• Fever with chill.
• Sour perspiration.
• Malaise.
• Anorexia.
• Acute excruciating pain in big joints.
• Swelling of joints.
• Fleeting arthritis:
• Single joint.
• Seldom involved for more than few days.
• No residual trace or deformity remains.
•Another joint gets involved.

Signs
• Pallor.
• Fast pulse.
• Temperature: 38-39'C
• Rheumatic nodules:- small subcutaneous nodules at bony prominences.
• Erythema marginatum on trunk.
• Knee, ankle, elbow joint affected.
• Affected joint red, hot & swollen.
• Affected joint extremely tender.
Cardiac examination
• Apex: Feeble.
: In fifth intercostals space, lateral to midclavicular line.
• S1 accentuated in mitral area.
• Soft systolic murmur in mitral area.

Dignosis(DUCKET JONES CRITERIA) for Rheumatic Fever
One major & two minor, or two major & one minor criteria.
Major criteria
• Carditis.
• Polyarthritis.
• Subcutaneous nodules.
• Erythema marginatum.
• Sydenham’s chorea.

Minor criteria
• Fever.
• Polyarthritis.
• History of rheumatic fever.
• Raised ASO titre.
• Raised ESR, CRP, TLC, prolonged P-R interval.

Investigation for Rheumatic Fever Blood
• TLC: raised.
• DLC: increased polymorphs.
• ESR: raised.
• ASO titre: raised.
• CRP: raised.
Throat swab
• Positive for group-A ?-haemolytic streptococcus.

ECG shows sign of
• Conduction defects.
• Myocarditis.
• Pericarditis.
X-Ray joint
• Nothing abnormal.
X-Ray chest
• Cardiac enlargement.

Differential diagnisis for Rheumatic Fever
• Juvenile rheumatoid arthritis.
• Acute osteomyelitis.
• Henoch-schonlein purpura.
• Acute poliomyelitis.
• Acute leukaemia.
• Streptococcal tonsillitis.
• Sensitivity reaction.
• Collagen disease.
COMPLICATIONS of Rheumatic Fever
• Sydenham’s chorea.
• Cardiac arrhythmia.
• Pericarditis.
• Congestive cardiac failure.
• Mitral stenosis.

General managment of Rheumatic Fever
• Complete bed rest till pulse rate & ESR are high.
• Rest to joint by splints, in position of comfort.
• Gradually initiate activity.
• Diet:- maintain nutrition.
• Restriction of physical activity.