Episodes of hyperventilation can sometimes cause symptoms similar to those of heart disease, e.g., chest discomfort, numbness and tingling of the fingers, lightheadedness and shortness of breath that may even be misinterpreted as due to acute pulmonary edema. Reproducing the patient’s symptoms by having him or her over-breathe confirms the diagnosis. Read more about pitfalls in the recognition of cardiovascular diseases and Blood Pressure Chart here.
Lending further confusion to interpreting shortness of breath is the presence of rales. There is truth to the saying that most patients with rales do not have heart failure and conversely most patients with heart failure do not have rales. Rales are nonspecific for heart failure and are most often due to secretions in the airways in the presence of pulmonary disease. Likewise edema of the lower extremities secondary to obesity or venous insufficiency may be wrongly attributed to congestive heart failure. During pregnancy, dyspnea and orthopnea, due to elevation of the diaphragm and gestational hormonal changes, lightheadedness, caused by decreased vena caval return to the heart and palpitations are common complaints in the absence of cardiopulmonary abnormality. Fatigue and palpitations commonly present in patients with heart disease can be seen in many illnesses, both organic and psychiatric . Normal individuals may have premature atrial or ventricular contractions, particularly associated with fatigue alcohol, tobacco and caffeine intake.
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