in breathing. Labored breathing, tightness in the chest, heart palpitations, and wheezing are often the indications of a person experiencing dyspnea. It can occur after intense exercise or from traveling to a high altitude. However, it can be directly related to severe health conditions such as pneumonia, heart failure, or low blood pressure. Dyspnea on exertion can be a normal occurrence unless it accompanies an activity that can be considered to be within the tolerance limits of the individual.
Since dyspnea is often characterized by the subjective experience or sensation reported by the patient, it is quite distinguishable from tachypnea, hyperventilation, and hyperpnea, which refer to respiratory variations. The latter conditions exist irrespective of the patients’ subjective sensations. Tachypnea is an increase in the respiratory rate, which is indicated by rapid shallow or deep breathing, often unnoticed by the patient. Hyperventilation is the increased and rapid breathing that occurs due to an unbalance between inhalation and exhalation. The increased exhalation results in reduced carbon dioxide levels in the blood, which in turn leads to the symptoms such as dizziness, shortness of breath, etc. Hyperpnea is also a condition of deep breathing but not necessarily faster. The forced respiration causes the inhalation of an increased air volume and the respiratory rate can even stay within normal limits. This is an indication of the body’s demand for more oxygen. These medical conditions might not always be associated with dyspnea.
The sensation of breathlessness that occurs only in the specific posture of lying down is referred to as orthopnea. It can result in tightness in the chest that makes breathing uncomfortable. However, it subsides when the patient stands upright or sits down. Still, it might be a symptom of heart or lung disease. The presence of increased heart rate, wheezing, or nausea along with orthopnea is an indicator for heart failure. A condition that is closely related to orthopnea is paroxysmal nocturnal dyspnea. It is a sensation of shortness of breath that makes the patient wake up after 1 or 2 hours of sleep. Similar to orthopnea, this condition is usually relieved after getting back to the upright position.
Apart from the aforementioned conditions of breathing difficulties, there are two uncommon types of breathlessness: trepopnea and platypnea. Trepopnea is typically dyspnea or breathlessness in either lateral decubitus position. The shortness of breath when lying on the left side can be attributed to chronic heart diseases. On the other hand, breathlessness experienced while lying on the right side may be due to a lung disease or a major bronchus. Platypnea is the reverse condition of orthopnea. This refers to breathlessness that occurs in the upright position (sitting or standing) and gets improved when lying down.
2.3.5 Claudication
Claudication is a pain, cramp, or sense of fatigue that results from the lower blood flow to the muscles during exercise. This affects the muscle group of the lower extremities and causes pain in the legs depending on the pace and duration of the walk. It is relieved promptly within a few minutes of rest in positions such as standing evenly on both feet. This condition can occur anywhere in the body, but is predominantly in the legs. Even though the pain is not constant and subsides with rest, it can be a symptom of peripheral artery disease.
2.3.6 Recording History of Heart Disease
In many heart patients, mostly adults, the heart disease or discomfort related to the heart won’t begin suddenly in a day. A detailed study about the history of any chest discomfort or heart disease experienced by the patient in the past can provide additional information about the underlying disease for the cardiologist. The history recording procedure investigates whether the patient has suffered any heart attack or coronary artery diseases, whether they have undergone any heart surgery in the past, their medication history, etc. The cardiologist will also ask when an incident happened, how it was diagnosed, about the patient’s lifestyle after that incident, etc. Furthermore, the history recording procedure will inquire into whether the patient was healthy during their childhood, whether they were very active and took part in soft or vigorous sports activities, etc.
2.3.7 Family History
The cardiologist enquires about the family history of the patient including whether any cases of heart attacks, strokes, coronary artery diseases, acute heart diseases, and early death linked to heart disease have occurred in the patient’s family. The family history of heart disease recording is based on the fact that, if family members have suffered from any heart or cardiovascular disease, then the patient is more likely to have the heart disease. The brothers or sisters of a patient with heart disease are 40% more likely to suffer heart disease in the future, while the offspring of patients with early heart disease are 60 –75% more prone to heart diseases [7].
2.3.8 Blood Pressure and Pulse
The amount of force used by the heart to pump blood across the body is referred to as blood pressure; in other words, the pressure generated when the heart pumps blood into the circulatory system. Blood pressure is measured using a sphygmomanometer or blood pressure monitor in millimeters of mercury unit (mmHg). There will be two components for each reading of blood pressure, the systolic and diastolic pressures. The force exerted on the walls of arteries by the heart during systole is called systolic pressure. The systole is a short span where the ventricles of the heart are contracted, and it happens in between the first and second heart sound. Diastolic pressure is the force exerted on the walls of arteries between the beats. Generally, blood pressure levels between 120 and 80 mmHg are considered normal. Blood pressure level measurement has significant importance in the heart disease examination procedure. Several studies have found that high blood pressure levels have a clear link with the risk of strokes as well heart diseases in individuals irrespective of their ages [8]. However, a study [9] conducted in different age groups of the Framingham heart study participants observed that in individuals aged less than 50 the diastolic blood pressure levels are a clear indicator for predicting heart disease. On the other hand, systolic pressure levels along with pulse pressure levels are the clear predictor of heart diseases in individuals over 50 years old.
The heart rate, or the cumulative number of times the heart beats in a minute, is referred to as pulse. If the person is resting, 60–100 beats per minute are considered natural. The heart rate can elevate up to 150 if the person is involved in any highly vigorous activity. If the resting heart rate of an individual is less than 60, then it is called bradycardia and, if it is greater than 100/120, then it is called tachycardia. Bradycardia is often linked with underlying heart diseases such as heart failure. Similarly, tachycardia can be an early symptom of heart failure or stroke.
2.3.9 Total Cholesterol, Triglycerides, and Associated Lipid Profiles
The lipid fraction of the human body is made up of cholesterol, triglycerides, and high-density lipoproteins (HDLs). Elevated cholesterol levels in the human body can increase the chances of developing heart diseases and stroke. The cholesterol level of a human body is measured by drawing blood samples. The cholesterol level examination generates the measurement of four types of fats (lipids) in the blood: total cholesterol; HDL cholesterol; low-density lipoprotein (LDL) cholesterol; and triglycerides. The overall amount of cholesterol in the blood is known as total cholesterol. HDL cholesterol is known as the “good” cholesterol as it aids in the removal of LDL cholesterol, allowing arteries to remain open and blood to circulate freely. A higher amount of HDL in the blood lowers the rate of heart disease risk [10]. LDL cholesterol is known as “bad” cholesterol since a higher amount of LDL in blood induces atherosclerosis, which is the accumulation of fatty deposits (plaques) in arteries. These plaques may hinder blood flow and cause a heart attack or stroke. Therefore, a higher LDL level represents a higher risk of heart disease [11]. Triglycerides are a type of fat that occurs naturally in the body. Extra calories consumed over the total energy expenditure of a body get converted into triglycerides. These triglycerides are contained in fat cells and are later released into the blood when the body requires energy to do any activity. The elevated level of triglycerides
