Fatigue and weakness may be due to many causes and therefore are not specific symptoms for heart disease. The most common cause of these symptoms is anxiety and depression. Anemia, thyrotoxicosis, and other chronic disease states may be associated with fatigue and weakness.
When a patient with heart disease is volume overloaded, or when there is pulmonary congestion due to heart disease, the patient is likely to complain of dyspnea. With vigorous diuretic therapy, this complaint may be replaced by symptoms of fatigue and weakness,2 probably related to inadequate cardiac output (see Chap. 21). The heart fails in its prime objective of nourishing all the tissues and organs of the body, including the skeletal muscles. As congestive heart failure worsens, fatigue may replace dyspnea as the major symptom. Beta blockers used to treat angina or hypertension often cause fatigue and lethargy. Hypotension or hypokalemia caused by diuretics can result in fatigue and weakness, as can relative hypovolemia due to the use of angiotensin-converting enzyme inhibitors.
Severe fatigue related to effort may result from transient global myocardial ischemia in patients with extensive CAD. Dyspnea and hypotension also may occur at the same time as the severe fatigue as angina equivalents.2
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