Hypertensive heart disease

Symptoms:

It may take years before symptoms develop from elevated blood pressure (hypertension). When heart disease develops, the symptoms are those of congestive heart failure or ischemic heart disease (angina or heart attack).

Congestive heart failure symptoms include:

• shortness of breath, especially with activity
• waking at night short of breath
• need to sleep with the head elevated to avoid shortness of breath
• rapid or irregular pulse
• sensation of feeling the heart beat (palpitations)
• cough, may produce frothy or blood-tinged mucus
• fatigue, weakness, faintness
• swelling of the feet and ankles
• increased frequency of urination at night

Ischemic heart disease symptoms include:

• chest pain, pressure-type, particularly with exertion
• chest pain associated with:
  • nausea
  • sweating
  • dizziness
  • shortness of breath

Signs and tests:

Signs of heart disease are found on physical examination. The blood pressure is elevated. Enlargement of the heart may be noted. There may be signs of heart failure including systemic (body) or pulmonary (lung) congestion. Listening to the chest with a stethoscope may show fluid in the lungs or abnormal heart sounds.

An ECG may be abnormal, showing enlarged heart, irregular heart beat, and/or evidence of ischemia (lack of oxygen to the heart muscle).

Enlargement of the heart or decreased heart functioning may be seen on:

• a chest X-ray
• a chest CT scan (rarely performed for this diagnosis)
• a coronary angiography
• an echocardiogram

Updated Date: 05/08/00

Updated by: Thomas O. Staiger, MD Assistant Professor of Medicine, Division of General Internal Medicine, University of Washington School of Medicine