1, abdominal pain, nausea and vomiting Case: We met a patient with stomach pain who went to the gastroenterology clinic. After the clinician performed a routine physical examination, the patient underwent an electrocardiogram and was found to have an acute inferior wall myocardial infarction. Explanation: This is the state of some patients with heart disease when it first occurs. Since it is difficult to clearly locate the pain of internal organs, some patients show gastrointestinal symptoms, which requires special vigilance. 2.Blackness in front of the eyes, sudden fall Case: An outpatient, an old lady in her 70s, always dizzy and weak, black haze, drinking white wine at every meal, but her family would not let her drink; hospitalized and found to have second degree type II AV block, heart rate always at 30-40 beats/min, later fitted with a permanent pacemaker, all these symptoms got better. Explanation: Slow arrhythmias and a few fast-acting arrhythmias cause hemodynamic disturbances and lead to insufficient blood supply to the brain, which are easily confused with cerebrovascular disease, and some patients will first consult the encephalopathy department to see if it is cerebrovascular disease; the cause of cerebral ischemia in these patients is arrhythmias, so the symptoms are gradually relieved after the arrhythmias are corrected. We all know that alcohol has an excitatory sympathetic effect. This patient actually drank alcohol to make her heart rate faster and feel more comfortable, and we hope that patients with discomfort should go to the hospital for examination in a timely manner. 3, shortness of breath, coughing and sputum Case: In winter, there was an outpatient clinic came to an old gentleman, from the Department of inhalation to the Department of Cardiology, always wheezing in the cold at home, lying unevenly, the family when it is pneumonia, to the point of buying some anti-inflammatory drugs, cold medicine, and some cough and sputum medicine, ate a little did not see good, and then there was blood in the sputum, the family rushed to the Department of inhalation clinic, inhalation doctor that is not the problem of pneumonia, recommended to see the Department of Cardiology. The family members rushed to the outpatient clinic of the Department of Whistling, the doctor of the Department of Whistling did not think it was a problem of pneumonia, but suggested to see the cardiology department. Explanation: Wheezing is a common clinical manifestation of heart failure, which we call cardiogenic dyspnea, and often has to be distinguished from pulmonary dyspnea. In addition to the common manifestations, triggers like cold and infection also have something in common. The difference is that cardiogenic dyspnea, which is what we call heart failure is often prone to hypertension, arrhythmias, coronary artery disease patients, while pulmonary dyspnea is more often seen in patients with chronic lung disease; other more detailed identification will be left to the professional doctor. 4, weight gain lower extremity edema Explanation: The patient introduced earlier, came with swollen legs, the family said that he gained 5 or 6 pounds in a week, the whistle doctor also found lower extremity edema to consider heart failure before being referred to the cardiology department. Edema is another common clinical manifestation of heart failure. Leg swelling is a very common sign and can be seen in a variety of different conditions and diseases. Some patients may have swollen legs due to venous thrombosis, which may be bilateral and asymmetrical; patients with hypothyroidism may have mucinous edema; patients with renal insufficiency, as mentioned by the presenters, may also have swollen legs; Some patients may also have leg swelling because of allergies or because they have taken some medications. We say that leg swelling in heart failure has its characteristics, for example, the swelling starts from the lowest hanging part and gradually increases upward, it is usually depressed, most of them are painless and symmetrical bilaterally, diuretic treatment will reduce leg swelling rapidly, in addition, it is usually easy to appear in people with heart disease, it often appears together with whooping difficulty and will be reduced together with whooping difficulty after treatment. Leg swelling that fits these characteristics is often associated with heart failure.