Brcathlessness on effort is physiological. It becomes a symptom of disease if it occurs at exercise levels below those expected for the patient's age and degree of previous fitness. Dyspnoea 011 exertion may be the only symptom of heart failure caused by left ventricular systolic dysfunction. Such patients frequently give a history consistent with previous myocardial infarction, Other common cardiac causes of exertional brealhlessness include hypertension, valvular heart disease, cardiomyopathies and arrhythmias such as atrial fibrillation.
As with chest pain, it is important to assess the degree of symptomatic limitation caused by exertional brealhlessness. This can be graded using the New York Heart Association (NYHA) classification (Table 3.12).
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