Cardiac Symptoms in Different AGE GROUPS
A look at how cardiac Disease affects people In different age groups, Its symptoms and its prevalence in India
Heart disease does not only strike the middle aged and elderly. It is not uncommon in children, adolescents and young adults. Symptoms may very depending upon the type and severity of disease; yet many symptoms are common in different age groups. It should also be understood that heart disease may be present without symptoms.
In children who generally suffer from congenital heart disease or valvular disease, recurrent respiratoryinfections, falure to thrive or gain weight, difficulty in breathing or blue spells may be present. Older children may complain of palpitation or rapid heart beating, fatigue, difficulty in breathing while making physical effort, joint pains or swelling in the feet or face. Sudden loss of consciousness or unexplain sudden death may be familial, inherited disorder.
The most common symptom in adults or the elderly in breathing difficulty or chest discomfort on exertion. Sometimes chest pain or difficulty in breathing may occur at rest or with minimal effort, after meals, bathing and defecation, or at night. Chest discomfort (pain) due to angina is usually behind the breast bone rather than on the left side, it may radiate to the left or right arm, neck, lower jaw, back or sometimes the upper abdomen, where it is mistaken as “ gas” or “indigestion” . If it last longer than thirty minutes, it signifies the possibility of a heart attack, particularly when associated with sweating and nausea. In diabetics, women and the elderly, heart attacks may be silent or may occur with atypical symptoms such as unexplained sweating, difficulty in breathing, undue fatigue, etc. It is not the location of the pain or discomfort but the circumstances that cause the symptoms that determine the diagnosis of angina. Sudden emotional upset or stress may precipitate a heart attack.
Other symptoms linked with cardiac disease in adults are swelling of the feet or face, fever, joint pain, sudden loss of consciousness; cough especially in supine position or in early hours of morning (usually 2-4 hours after sleep) and blood in the sputum.
A careful discussion and analysis of the symptoms coupled with the presence or absence of risk factors such as high blood pressure, diabetes, smoking, abnormal lipid profile, tobacco use and family history form the most important aspect of diagnosis of coronary artery disease. However, valve disease is not uncommon. In younger age (children and adolescents) it is caused by streptococcal sore throat and is often associated with joint pain (rheumatic fever and rheumatic heart disease). In the elderly, degenerative disease causes narrowing of the aortic valve, or leakage of mental valves. Other ailments include viral fever causing damage to heart muscle, or insidious or hereditary disorders of heart muscle which present with similar symptoms.
Thus, the symptoms of heart disease are more or less common to all diseases. But the underlying disease or cause of symptom varies greatly from individual to individual, and requires a good clinical judgment as well as investigations to diagnose correctly.
About the Author
This article is written by Padmashree Dr K K Sethi (MBBS, MD, FACC, FHRS), Former President, Cardiology Society of India; Member Executive Council, Asia Pacific Society of Cardiology; and Chairman & Director, Delhi Heart and Lung Institute (dhli).