The prevalence and significance of increased gastric wall radiotracer uptake in sestamibi myocardial perfusion SPECT. Fluid in your lungs makes it hard to breathe, especially when youre lying down. Circulatory system mainly includes the heart, blood vessels, blood, lymph and lymph vessels. Knudsen CW, Clopton P, Westheim A, et al. When evaluating a patient with a possible psychiatric component of dyspnea, it is helpful to know if the feelings of dyspnea and anxiety are concurrent, if associated paresthesias of the mouth and fingers exist, and if the anxiety precedes or follows dyspnea. Congestive heart failure (right, left or biventricular), Myocardial infarction (recent or past history), COPD with pulmonary hypertension and cor pulmonale, Cardiac or pulmonary disease, deconditioning, Severe cardiopulmonary disease or noncardiopulmonary disease (e.g., acidosis), Orthopnea, paroxysmal nocturnal dyspnea, edema, Congestive heart failure, chronic obstructive pulmonary disease, Beta blockers may exacerbate bronchospasm or limit exercise tolerance. Differentiating cardiac and pulmonary causes of dyspnea This material may not otherwise be downloaded, copied, printed, stored, transmitted or reproduced in any medium, whether now known or later invented, except as authorized in writing by the AAFP. - 208.113.161.207. As I indicated in my recent paper [2], weight gain usually indicates it is well accepted by the French cardiologists [9]. In contrast, the H3N2 flu virus has an incubation period of 1-4 days, whereas the incubation period of malaria can extend from 7 days to multiple months. It means it cant keep up with your bodys demand for blood. The physiology of normal respiration and gas exchange is complex, and that of dyspnea is even more so. Aphasia vs. dysarthria: Differences, types, and more Fever increases the likelihood of infection. Treatment for cardiac asthma involves addressing the underlying heart failure and fluid buildup in the lungs. A coronary angiogram is indicated if the exercise test or an ECG during pain show that a lot of live heart muscle is at risk. Diagnostics | Free Full-Text | The Use of Brain Natriuretic Peptide in Pulmonary fibrosis is a rare side effect of some medications, Allergies, wheezing, family history of asthma, Left ventricular hypertrophy, congestive heart failure, Lightheadedness, tingling in fingers and perioral area, Pneumothorax, chest-wall pain limiting respiration, Occupational exposure to dust, asbestos or volatile chemicals, Peripheral vascular disease with concomitant coronary artery disease, Anemia, hypoxia, heart failure, hyperthyroidism, Hepatomegaly, hepatojugular reflux, edema. Blaivas M. Incidence of pericardial effusion in patients presenting to the emergency department with unexplained dyspnea. While contemporary . Tachycardia or tachypnea may be present with any of the serious causes of pleuritic chest pain but should raise suspicion for pulmonary embolism, pneumothorax, or myocardial infarction. in elderly patients with chronic obstructive pulmonary disease (COPD). Since heart failure causes cardiac asthma, lowering your risk of heart failure cuts your risk of cardiac asthma, too. . As an adjective cardiac is pertaining to the heart. Keep taking medicines your provider prescribes. Acad Emerg Med. In humans, the circulatory system is a closed system that consists of the heart, and two circulatory branches, namely, the pulmonary circulation and systemic circulation.The main role is similar to that of the cardiovascular system. However, these treatments arent necessary if youre able to breathe well enough to get adequate oxygen. Dyspnea: Causes, diagnosis, and treatment Drazner MH, Rame JE, Stevenson LW, et al. descriptive, though somewhat awkward combination of Latin and Greek, Google Scholar. Learn about tips for having a heart-healthy diet and what the research says about the effects of alcohol, calcium, sugar, and caffeine on your heart. Use of B-type natriuretic peptide in the evaluation and management of acute dyspnea. Most potentially lethal causes of pleuritic chest pain (i.e., pulmonary embolism, myocardial infarction, aortic dissection, and pneumothorax) typically have an acute onset over minutes. measurement is helpful in CHF diagnosis [1] with a sensitivity of 90%, the The test is usually performed on a treadmill or bicycle ergometer and requires that the patient breathe into a mouthpiece during exercise. Some people will need surgical interventions, such as an angioplasty or coronary bypass surgery, to improve blood flow to the heart and make the heart stronger. Is Shortness Of Breath A Heart Or Lung Problem? - Ossaward A number of systemic diseases, such as rheumatoid arthritis, systemic lupus erythematosus and sarcoidosis, can cause interstitial lung disease, which leads to a restrictive pattern on spirometry. BRIAN V. REAMY, MD, PAMELA M. WILLIAMS, MD, AND MICHAEL RYAN ODOM, MD. I Nonsteroidal anti-inflammatory drugs should be used to control pleuritic pain. Loss of consciousness. The two major forms of disordered lung mechanics that result in pulmonary dyspnea are obstructive lung . We aimed to assess the utility of easily applicable diagnostic tools in the differential diagnosis of cardiac and pulmonary causes of dyspnea in patients presenting with shortness of breath. Department of Respiratory Disease, Saint-Louise Teaching Hospital, Paris, France, Department of Respiratory Disease, Saint-Louis Teaching Hospital, Assistance Publique-Hpitaux de Paris, Universit Paris Diderot, Paris, France, You can also search for this author in [Is a more efficient operative strategy feasible for the emergency management of the patient with acute chest pain?]. This is a buildup of fluid in your lungs that impairs your ability to oxygenate your blood. Covid-19 vs H3N2 influenza vs Malaria: How to differentiate between the Gallavardin L. Les syndromes deffort dans les affections Cardiol, in press. Heart failure. This content is owned by the AAFP. According to Schwinger (2021), heart failure is characterized by symptoms like the ones experienced by the 72-year-old male patient in this case study, such as dyspnea, elevated jugular venous pressure, edema of the ankles, pulmonary crackles and more. Accessibility Cardiac asthma is a condition caused by heart failure that leads to asthma-like symptoms, such as wheezing, coughing, and trouble breathing. Jane Carissa Ali Dr. Bahadori NR 507 November 1, 2022 Week 2: Discussion 1.) The differential diagnosis is presented in Table 1.9,10, Studies of pleuritic chest pain have shown that pulmonary embolism is the most common life-threatening cause and the source of the pain 5% to 21% of the time.11,12 A recent prospective trial of 7,940 patients evaluated for pulmonary embolism revealed that pleuritic-type chest pain was significantly associated with confirmed pulmonary embolism (adjusted odds ratio of 1.53).13 The most commonly occurring symptoms of pulmonary embolism were dyspnea and pleuritic chest pain in 73% and 66% of patients, respectively.11 Physicians should use validated clinical decision rules (e.g., Wells, PERC [pulmonary embolism rule-out criteria], Geneva) to evaluate for pulmonary embolism, as discussed in a previous article in American Family Physician.14, Physicians can evaluate patients for myocardial infarction and coronary artery disease using electrocardiography and troponin levels. Thyroid abnormalities rarely present with dyspnea and can be assessed by measurement of the serum thyroid-stimulating hormone level.4,8. Waking up with difficulty breathing after several hours of sleep at night. Neck bruits are indicative of macrovascular disease and suggest concomitant disease of the coronary arteries, especially if the patient has a history of diabetes, hypertension or smoking. Because heart failure gets worse with time, its important to keep your provider updated on your symptoms. If the ECG is abnormal at rest, the patient should undergo a thallium stress test or exercise echocardiography. It is a symptom of many conditions that affect the respiratory system. . Jang T, Aubin C, Naunheim R, et al. Pleuritic chest pain is caused by inflammation of the parietal pleura and can be triggered by a variety of causes. It's kind of tricky to differentiate between heart and lung conditions behind dyspnea, but you can still come to a verdict by checking the associated symptoms with shortness of breath e.g. For example, if youre having a lot of trouble breathing, would you want a breathing tube in your throat? An official website of the United States government. A validated clinical decision rule for pulmonary embolism should be employed to guide the use of additional tests such as d-dimer assays, ventilation-perfusion scans, or computed tomography angiography.3033 Table 3 integrates red flag symptoms of serious causes of pleuritic chest pain, physical examination, and diagnostic findings to aid in the evaluation of pleuritic chest pain.9,10,34,35, After excluding the six serious causes of pleuritic chest pain that require emergent evaluation, there are two primary management considerations: controlling the pain and treating the etiology of the underlying condition. We do not endorse non-Cleveland Clinic products or services. Uncovering heart failure in patients with a history of pulmonary disease: rationale for the early use of B-type natriuretic peptide in the emergency department. In the cardiac patient, dyspnea during exercise results from metabolic acidosis, secondary to diminished cardiac output and insufficient oxygen delivery to exercising mus- cles. Chronic dyspnea has been defined as shortness of breath lasting longer than one month. People with cardiac asthma typically experience symptoms such as coughing, trouble breathing, and shortness of breath due to pulmonary congestion. What treatments would you recommend for my specific situation? Unlike bronchial asthma, cardiac asthma is difficulty breathing because of pulmonary edema or fluid in your lungs. Atypical chest pain must be differentiated from other types of chest pain, including chest wall pain, pleurisy, gallbladder pain, hiatal hernia, and chest pain associated with anxiety disorders. Taboulet P, Feugeas JP. The rate and pattern of breathing are also influenced by signals from neural receptors in the lung parenchyma, large and small airways, respiratory muscles and chest wall. Aphasia occurs when a part of the brain that is responsible for language suffers damage, affecting a person's ability to speak or understand language. Causes and Evaluation of Chronic Dyspnea | AAFP All Rights Reserved. CAS Psychiatric examination can reveal anxiety accompanied by tremulousness, sweating or hyperventilation.2,4,8, Many diagnostic modalities used to evaluate dyspnea can be performed in the family physician's office.10 The basic evaluation is directed by the probable causes suggested in the history and physical examination. A simple and quick way of discrimination between cardiac and pulmonary causes of dyspnea is essential in patients admitted to the emergency department. Pain that is described as sharp and stabbing is typical of noncardiac chest pain.22 Radiation of pain to the shoulders or arms has a positive likelihood ratio of 4.07 (95% confidence interval, 2.53 to 6.54) for acute myocardial infarction.22 In contrast, pain that radiates to the back and is maximal in intensity at onset is more commonly associated with aortic dissection than cardiac ischemia.22. On the basis of the medical investigations, the patients were classified, independently of the BNP value, into two categories: cardiac dyspnea and respiratory dyspnea. Inflamed, narrow airways make you wheeze and cough. This fluid makes it hard for you to breathe (cardiac asthma). Pulse oximetry uses an infrared light source to determine the hemoglobin oxygen saturation. Heart failure can cause fluid to build up in the lungs (pulmonary edema) and in and around the airways. Weakness. A number of disorders cause dyspnea, including acute heart failure syndrome (AHFS), chronic obstructive pulmonary disease (COPD), asthma, pulmonary embolism, pneumonia, metabolic acidosis, neuromuscular weakness, and others. Subsequently, clinical data were correlated with BNP values, which proved not to improve the discrimination between cardiac or respiratory etiology of dyspnea. Patients may demonstrate shallower breaths as they attempt to avoid deep breathing that triggers pain.23 Likewise, hypotension and a markedly widened pulse pressure should raise concerns for aortic dissection or severe myocardial infarction. Unable to load your collection due to an error, Unable to load your delegates due to an error. Bookshelf the measure that best distinguished cardiac from pulmonary dyspnea. Clipboard, Search History, and several other advanced features are temporarily unavailable. They both also progress over time and tend to affect smokers over the age of 60. The .gov means its official. In respiratory arrest, there is still blood flow and a pulse for the first few minutes. Because of the prevalence of chronic heart failure (CHF), COPD, and asthma in the general population (2%, 5% to 10%, and 5%, respectively), differentiation among these three disorders is frequently needed13. Dyspnea is a common symptom and, in most cases, can be effectively managed in the office by the family physician. 1 ), %DDI showed highest sensitivity for cardiac dyspnea whereas P aCO 2 was found to be the most specific test for . Anything that can help medics in the field differentiate cardiac from pulmonary causes of dyspnea is a good thing. Underlying heart disease may be signified by ST-segment changes, by arrhythmias or by inappropriate blood pressure changes during exercise. This is called advanced heart failure. In patients with persistent symptoms, persons who smoke, and those older than 50 years with pneumonia, it is important to document radiographic resolution with repeat chest radiography six weeks after initial treatment. Most cases of dyspnea are due to cardiac or pulmonary disease, which is readily identified with a careful history and physical examination. Nonsteroidal anti-inflammatory drugs are appropriate for pain management in those with virally triggered or nonspecific pleuritic chest pain. A thorough history and physical examination should be performed to diagnose or exclude life-threatening causes of pleuritic chest pain. You may breathe better when you sit or stand up. The distinguishing feature of blockpnea is its acute onset [6]. For example, in a patient with pulmonary edema, the accumulated fluid activates neural fibers in the alveolar interstitium and reflexively causes dyspnea.2 Inhaled substances that are irritating can activate receptors in the airway epithelium and produce rapid, shallow breathing, coughing and bronchospasm. Airphysio Gallavardin in as early as 1924 [7]. It often has multiple etiologies. No breathing. This area of the heart normally acts as a gatekeeper to the flow of electricity from the upper atria to the lower ventricles. Difference Between Cardiovascular and Circulatory System It can help to ask yourself the following questions while youre waiting to see a doctor to help determine whether its cardiac asthma: Cardiac asthma is caused by heart failure. PubMed [Chest pain in women: a multicenter study of the National Association of Hospital Cardiologists (ANMCO) of the Lazio Region]. Acute dyspnea is mostly due to potentially life-threatening cardiac or respiratory conditions, and treating it promptly requires understanding of the underlying mechanisms. JAMA 1997;277:17129. Most cases of dyspnea are due to cardiac. Strangely enough, this prominent equivalent of angina Understanding The Differences Between Asthma And COPD: A Comprehensive The patient performs progressively more difficult exercise to the point of exhaustion. Treatment methods. Symptoms of cardiac asthma may be the initial symptoms of heart failure, or they may be present along with other signs of heart failure, such as: Cardiac asthma can be difficult to diagnose due to its similarity to asthma. A total of 243 citations were identified using the key words pleurisy and pleuritic chest pain, and the search was limited to human studies. Cardiac asthma: An old term that may have new meaning. Colchicine (1.2 to 2.0 mg orally once per day or divided twice per day) is the standard treatment for familial Mediterranean fever.38 Biologic agents such as anti-interleukin-1, interleukin-6 inhibitor, and tocilizumab may have utility in refractory cases of familial Mediterranean fever.39,40 Pleural effusions that rapidly reaccumulate after initial thoracentesis may require pleurodesis. Covid-19 symptoms usually manifest between 2 to 14 days following exposure, with an average incubation time of 5-6 days. Cardiac asthma is a collection of asthma-like respiratory symptoms caused by congestive heart failure. Searches were conducted from February 2016 to June 2016. In: Mebazaa, A., Gheorghiade, M., Zannad, F.M., Parrillo, J.E. Cardiac or pulmonary dyspnea in patients admitted to the emergency department. However, as Coats Respir Med 2003;97:127781. We avoid using tertiary references. In addition to fever and higher respiratory tract infections, respiratory difficulties are one of the most common problems that the patient will have. Heart failure may eventually develop, as evidenced by an enlarged heart (cardiomegaly) and liver (hepatomegaly) and by peripheral edema. Chest 1999;116:11004. 9500 Euclid Avenue, Cleveland, Ohio 44195 |, Important Updates + Notice of Vendor Data Event, (https://pubmed.ncbi.nlm.nih.gov/23337063/), (https://www.nhlbi.nih.gov/health-topics/heart-failure), Heart, Vascular & Thoracic Institute (Miller Family). The patient exhales fully, then takes a maximum inhalation and blows out as hard and as fast as possible, continuing the exhalation as long as possible to ensure that maximal volumes are measured. Heart failure, which causes cardiac asthma, keeps getting worse with time. All rights reserved. The differential diagnosis is composed of four general categories: cardiac, pulmonary, mixed cardiac or pulmonary, and noncardiac or nonpulmonary. Turnipseed SD, Trythall WS, Diercks DB, Laurin EG, Kirk JD, Smith DS, Main DN, Amsterdam EA. DYSPNEA is an uncomfortable awareness of the act of breathing, leading to a sensation most conveniently described as breathlessness. Week 2 Discussion-NR 507.doc - Jane Carissa Ali Dr. how to differentiate between cardiac and respiratory dyspnea Cardio-pulmonary exercise testing can help define whether an abnormality lies in the pulmonary, cardiac or skeletal muscle systems.2,4. Rales or wheezing can indicate congestive heart failure, and expiratory wheezing alone may indicate obstructive lung disease. 10. Chest 2004;126:3628. Customize your JAMA Network experience by selecting one or more topics from the list below. In SVT . All Rights Reserved. Cardiac is a related term of cardiology. doi: 10.1016/j.metabol.2010.07.014. These disorders include metabolic conditions such as anemia, diabetic ketoacidosis and other, less common causes of metabolic acidosis, pain in the chest wall or elsewhere in the body, and neuromuscular disorders such as multiple sclerosis and muscular dystrophy. Malas O, Caglayan B, Fidan A, et al. Coats AJS: Dyspnoea in CHF and COPD. 4. Sometimes it's a sign of heart failure. It includes chronic bronchitis and emphysema, which both cause shortness of breath, coughing, and wheezing. In contrast, less immediately lethal causes of pleuritic chest pain (e.g., infection, malignancy, inflammatory processes) progress over hours to days or weeks.4 Pain that worsens when the patient is supine and lessens when the patient is upright and leaning forward should prompt consideration for pericarditis.46 True dyspnea should also increase suspicion for a pulmonary embolus, pneumothorax, or pneumonia.1,7,8 It is clinically useful to distinguish true dyspnea from patient-perceived dyspnea caused by a desire to suppress respirations to avoid pain.22,23, Cardiac symptoms such as diaphoresis, nausea, and palpitations should be elucidated. American Heart Association. Certain heart conditions gradually leave the heart too weak or stiff to fill and pump blood properly. The most common cause of heart failure in adults is coronary artery disease. Coming to a Cleveland Clinic location?Hillcrest Cancer Center check-in changesCole Eye entrance closingVisitation and COVID-19 information, Notice of Intelligent Business Solutions data eventLearn more. doi:10.1001/jama.1977.03280200078032. Measurement of all types of lung volume, such as total lung capacity and residual volume, can show combinations of obstructive and restrictive disease (Table 3). J Med Lyon 1933;14:539-558. Acad Emerg Med 2003;10:198204. Kyphosis and scoliosis can cause pulmonary restriction. Pleuritic chest pain has many etiologies. Breathlessness: Cardiac or Pulmonary? | The BMJ Treatment is guided by the underlying diagnosis. Wang CS, FitzGerald JM, Schulzer M, et al. Keep reading as we break down everything you need to know about cardiac asthma, including what causes it, what symptoms occur, and how its treated. Treat other conditions that make heart failure worse. The outlook for people with heart failure improves the sooner they receive proper treatment. Rees J. ABC of asthma. Am J Cardiol 1989;64:834. PMC Am J Med 2004;116:363-368. Its usually caused by atherosclerosis, or the buildup of cholesterol and plaque in the blood vessels. Heart failure - Symptoms and causes - Mayo Clinic The situation with respect to the restrictive lung diseases is more, Raffin TA, Theodore J. A patient's ability to perform a treadmill test can be limited by poor aerobic conditioning, by lower extremity pathology such as arthritis, claudication or edema, or by coincidental pulmonary disease. Heart attack and heart failure share many of the same risk factors and underlying health conditions. Myocardial infarction, pericarditis, aortic dissection, pneumonia, and pneumothorax are other serious causes that should be ruled out using history and physical examination, electrocardiography, troponin assays, and chest radiography before another diagnosis is made. Coronary artery disease is when the arteries that supply blood to the heart become narrowed or blocked, unable to deliver blood and even closing completely due to a heart attack. The American Thoracic Society defines dyspnea as a subjective experience of breathing discomfort that comprises qualitative distinct sensations that vary in intensity. of dyspnea in patients referred for cardiac stress testing. HHS Vulnerability Disclosure, Help The final treatment option when all other treatments have failed is a heart transplant. In medicine terms the difference between cardiology and cardiac is that cardiology is the study of the structure, function, and disorders of the heart while cardiac is a medicine that excites action in the stomach. Professor of Medicine Dyspnea can also occur as a somatic manifestation of psychiatric disorders, such as an anxiety disorder, with resultant hyperventilation. Noncardiac or nonpulmonary disease must be considered in patients with minimal risk factors for pulmonary disease and no clinical evidence of cardiac or pulmonary disease. When blood isn't pumped out of the heart effectively, fluid levels build up or become congested. Keet CA, et al. Thus, a borderline-normal oxygen saturation percentage may actually reflect an abnormally low PaO2 in some cases.10 Pulse oximetry is, however, valuable as a rapid, widely available and noninvasive means of assessment and is accurate in most clinical situations. An increased cardiac silhouette can be caused by increased pericardial size or increased chamber size. Symptoms such as weight loss, malaise, night sweats, or arthralgias indicate chronic inflammatory causes of pleuritic chest pain, such as tuberculosis infection, rheumatoid arthritis, or malignancy. 2000 Feb;1(2):186-201. Furthermore, cardiac diseases contribute to disease severity in patients with COPD, being a common cause of hospitalization and a frequent cause of death. Are there other potential causes for my breathing trouble, like the flu or a respiratory infection? Before you get to this point, its good to let your family and healthcare provider know what kind of care you want. Last reviewed by a Cleveland Clinic medical professional on 03/04/2022. Lahn M, Bijur P, Gallagher EJ. Tachycardia is a fast heart rate -- usually more than 100 beats per minute in an adult. Get useful, helpful and relevant health + wellness information. McCullough PA, Hollander JE, Nowak RM, et al. Hyperinflated lungs, prolonged expiration, a small heart, and the bedside and laboratory evidence of airways obstruction are easily documented. Applying a five-point validated clinical decision rule helps improve diagnostic accuracy for coronary artery disease15,16 (Table 215 ). Heart Problems That Affect Breathing: Heart Failure, Tachycardia, and More Professor of Medicine and Surgery, Associate Chief, Division of Cardiology and Chief, Cardiology Clinical Service, Professor of Medicine, Chief, Department of Medicine Edward D. Viner MD Chair, Department of Medicine and Director, https://doi.org/10.1007/978-1-84628-782-4_16, Tax calculation will be finalised during checkout. Can the clinical examination diagnose left-sided heart failure in adults? The most common organic causes of dyspnea are cardiac and pulmonary disorders.6. What is Circulatory System? The visceral pleura does not contain pain receptors, whereas the parietal pleura is innervated by somatic nerves that sense pain due to trauma or inflammation. Pleuritic chest pain is characterized by sudden and intense sharp, stabbing, or burning pain in the chest when inhaling and exhaling. Be sure to explore your treatment options to get the best care available. DYSPNEA is an uncomfortable awareness of the act of breathing, leading to a sensation most conveniently described as breathlessness. Tsung O. Cheng, M.D. Although a class effect is assumed, studies on the treatment of pleuritic chest pain in humans have focused on the use of indomethacin at dosages of 50 to 100 mg orally up to three times per day. https://doi.org/10.1007/978-1-84628-782-4_16, DOI: https://doi.org/10.1007/978-1-84628-782-4_16. National Library of Medicine Google Scholar. Living an overall healthy lifestyle may help improve your heart failure symptoms or prevent heart failure in the first place. sciencedirect.com/science/article/abs/pii/S0889856112001397, heart.org/en/health-topics/heart-failure/causes-and-risks-for-heart-failure/causes-of-heart-failure, nhs.uk/conditions/heart-failure/diagnosis/, uspharmacist.com/article/cardiac-asthma-not-your-typical-asthma. 1,2 However, in both cardiac and pulmonary disease, the most common cause is disordered lung mechanics. PubMed Fast-beating, fluttering or pounding heart called palpitations. Terms of Use| A chest radiograph can identify skeletal abnormalities, such as scoliosis, osteoporosis or fractures, or parenchymal abnormalities, such as hyperinflation, mass lesions, infiltrates, atelectasis, pleural effusion or pneumothorax. Antimicrobial or antiparasitic agents should be started based on the presumed organism in pneumonia. 2009 Jun;16(6):495-9. doi: 10.1111/j.1553-2712.2009.00420.x. Approach to the adult with dyspnea in the emergency department Congest Heart Fail 2004;10:146. Int J Cardiol 2005;105:351. This content is owned by the AAFP. Your healthcare provider can work with you to find a treatment that makes sense for you. Paroxysmal Nocturnal Dyspnea | Sleep Foundation Some habits you can adopt include: Cardiac asthma is a secondary condition caused by heart failure. Restrictive lung problems include extrapulmonary causes such as obesity, spine or chest wall deformities, and intrinsic pulmonary pathology such as interstitial fibrosis, pneumoconiosis, granulomatous disease or collagen vascular disease. N Engl J Med 2001;345:57481. JAMA 1995;273:3139. Peripheral perfusion of the extremities should be evaluated by assessing pulses, capillary refill time, edema and hair growth pattern. The PubMed wordmark and PubMed logo are registered trademarks of the U.S. Department of Health and Human Services (HHS). Sudden cardiac arrest - Symptoms and causes - Mayo Clinic Multiple heart failure pages. Chest Pain - Cardiovascular Disorders - MSD Manual Professional Edition
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