Diagnosis

Upon an objective examination, a physician will be able to discern the following:

The ictus cordis (the apex of the heart) is displaced to the bottom left (this is observed upon auscultation with a stethoscope). There are no cardiac sounds in this direction because of the hypertrophy of the left ventricle, whereas later on when the ventricle becomes dilated, global cardiovascular insufficiency emerges. The lack of cardiac sounds is expanded in all directions.

Heart sounds are muted, audible as if from far away, almost inaudible, especially the first sound. The second sound in the aorta is more enhanced due to the aorta becoming sclerotic. Often a systolic noise can be heard at the apex of the heart, as a consequence of functional mitral insufficiency caused by the enlargement of the left ventricle.

How is atherosclerotic cardiosclerosis diagnosed?

A diagnosis is based on the age of the patient, the clinical symptoms of the disease, the potential accompaniment by hypertensive disease, diabetes or atherosclerosis of other organs, etc.

Several examinations commonly used include:

1. Radiological examinations which would indicate that the cardiac shadow is enlarged, especially to the left, where it extends over the diaphragm, due to the lowered muscle tonus.
2. From the very onset, an electrocardiogram can indicate the signs of chronic coronary insufficiency by exhibiting lower S-T intervals, localized below the isoelectric line, as well as a flattening or negative T-tooth in certain derivations. At other times, the lowering of the S-T tooth can become evident only after an exertion test (where the patient is put under physical duress in order to observe how the heart is coping with the stress).
3. Blood examinations which would indicate a perturbation of the lipid metabolism and other indicators which are relevant to heart failure.

A differential diagnosis for this condition is usually run against the following conditions:

1. Primitive cardiomyopathy. This condition may exhibit similar clinical signs, but usually affects younger ages, which means the usual factors which aid in the emergence of atherosclerosis are not present. There are no indications from the patient history that may lead the doctor to consider the presence of conditions such as stenocardia, infarctions or hypertensive disease. There are no evident lipid metabolism disruptions visible in the lipid profile.

2. Conditions of the mitral valve associated with fibrillation. In order to differentiate between the two conditions, it is necessary to review the patient history, which in cases of a condition of a mitral valve would include rheumocarditis. The configuration of the heart would be viewed via a radiological exam, etc.

3. Chronic pulmonary heart disease.  Easier to differentiate because these patients usually suffer from chronic pulmonary diseases such as chronic bronchitis, pulmonary emphysema, etc for a long period of time. Cyanosis is especially evident, the heart usually becomes enlarged on the right side and not on the left as for atherosclerotic cardiosclerosis.

Complications that may occur during atherosclerotic cardiosclerosis include:

1. Rhythm and circulation issues
2. Acute left ventricle insufficiency (this manifests with cardiac asthma or acute pulmonary edema)
3. Cardiovascular insufficiency (heart failure) of various degrees

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