Gastro-Intestinal Manifestations of Cardiovascular Disease
Symptoms referable to the gastro-intestinal tract frequently are present in patients with cardiovascular disease and at times are of such prominence that they dominate the clinical picture. Since their misinterpretation may lead to serious errors in diagnosis, proper understanding of the mechanism of their production is of considerable importance. It will be the purpose of this communication to review the pathogenesis of the gastro-intestinal manifestations of cardiovascular disease and to point out the manner in which the correct evaluation of accompanying symptoms and signs will assist in differential diagnosis.
Dysphagia is an unusual symptom of cardiovascular disease but occasionally it occurs as the result of pressure upon the esophagus by an aortic aneurysm or a greatly enlarged left auricle. Less frequently it is produced by pressure from a large pericardial effusion.
The esophagus is situated in close anatomical relationship to both the aortic arch and the descending aorta, and an aneurysm in either of these portions may exert considerable pressure upon it. Recognition of the cause of the resulting dysphagia is seldom difficult. Aneurysms of the aortic arch may be accompanied by inequality of the pupils, venous congestion of the head and neck, a tracheal tug, dyspnea, disturbances in phonation, and inequality of the radial pulse wave and brachial blood pressure in the two arms. Aneurysms of the descending aorta frequently cause severe pain from pressure upon the spine and nerve roots, and at times they may be responsible for cough and expectoration due to pressure upon the left. . .