Can cardiovascular issues cause functional symptoms, rather than just localized sharp or dull pain in a tender spot?

From the Guidelines

Yes, cardiovascular issues can cause functional symptoms, rather than just localized sharp or dull pain in a tender spot, and these symptoms often affect overall body performance. These symptoms can include shortness of breath, fatigue, dizziness, palpitations, and generalized weakness, as cardiovascular problems impact the heart's ability to pump blood effectively, which in turn affects the entire body's function 1. While chest pain (angina) can be a symptom of heart disease, it's usually described as a pressure or squeezing sensation rather than a sharp, localized pain. However, it's essential to note that some heart conditions, like pericarditis, can cause localized chest pain, and not all chest pain is cardiac in origin; it can be caused by musculoskeletal issues, gastrointestinal problems, or anxiety 1. The characteristics of angina include deep, poorly localized chest or arm discomfort that is reproducibly associated with physical exertion or emotional stress and is relieved promptly with rest and/or the use of sublingual NTG 1. Some patients may have no chest discomfort but present solely with jaw, neck, ear, arm, shoulder, back, or epigastric discomfort or with unexplained dyspnea without discomfort, which should be considered equivalent to angina if they have a clear relationship to exertion or stress or are relieved promptly with NTG 1. The diagnosis of cardiovascular issues should be based on a comprehensive evaluation, including assessment of cardiovascular risk factors, comorbid conditions, and noninvasive testing, such as resting ECG and chest radiography 1. If you're experiencing any concerning symptoms, whether localized or systemic, it's crucial to seek medical evaluation to determine the cause and appropriate treatment. Key points to consider in the diagnosis and management of cardiovascular issues include:

• Estimating the probability of significant CAD based on patient age, sex, cardiovascular risk factors, and pain characteristics 1
• Considering comorbid conditions that may precipitate “functional” angina, such as hyperthyroidism, hyperthermia, cocaine use, valvular disease, and severe uncontrolled hypertension 1
• Using noninvasive testing, such as resting ECG and chest radiography, to diagnose CAD 1
• Referring patients with intermediate or high probability of CAD for risk stratification through further testing 1

From the Research

Cardiovascular Issues and Functional Symptoms

• Cardiovascular issues can cause functional symptoms, which are not limited to localized sharp or dull pain in a tender spot 2, 3.
• These functional symptoms can include chest pain, feelings of weakness, fatigue, breathing difficulties, and perception of changes in cardiac activity, such as tachycardia, heart palpitations, irregular heartbeat, or arrhythmias 2.
• Functional cardiac symptoms can be accompanied by anxiety, depressive states, and other psychological factors, making it essential to consider a holistic approach in diagnosis and treatment 2, 4.

Diagnosis and Management

• The diagnosis of functional cardiovascular symptoms requires a thorough exclusion of physical causes, followed by an assessment of psychological and social factors 2, 3, 4.
• A brief anamnesis and a focused interview can help identify potential causes and contribute to a trusting doctor-patient relationship 2.
• Management of functional cardiovascular symptoms depends on recognizing and confirming the reality and seriousness of the symptoms, despite the absence of a clear structural organic cause 3.
• Stepped care strategies, including supportive communication, biopsychosocial self-help activities, and formal psychotherapy, can be effective in managing these symptoms 3.

Relationship Between Cardiovascular Disease and Functional Symptoms

• Cardiovascular disease can manifest as functional symptoms, such as facial pain, which may be related to ischemic heart disease 5.
• The association between cardiovascular disease and functional symptoms highlights the importance of considering cardiovascular causes in patients presenting with functional complaints 5, 4.
• A comprehensive diagnostic evaluation, including a series of diagnostic tests, can help identify the underlying cause of functional symptoms and guide appropriate treatment 5.