Symptoms:

Congestive heart failure is one possible result of hypertensive heart disease. Symptoms of congestive heart failure include:

• Cough, which may produce frothy or bloody mucus
• Fatigue, weakness, faintness
• Increased frequency of urination at night
• Need to sleep with the head elevated to avoid shortness of breath
• Rapid or irregular pulse
• Sensation of feeling the heart beating (palpitations)
• Shortness of breath, especially with activity
• Swelling of the feet and ankles
• Waking at night with shortness of breath

Ischemic heart disease is another possible result of hypertensive heart disease. Symptoms include:

• Chest pain associated with:
  • Dizziness
  • Nausea
  • Shortness of breath
  • Sweating
• Pressure-type chest pain, particularly with activity

A third possible result is hypertrophic cardiomyopathy.

Signs and tests:

During a physical examination, the doctor may find the following signs of heart disease:

• Elevated blood pressure
• Enlargement of the heart
• Fluid in the lungs or abnormal heart sounds (heard by listening to the chest with a stethoscope)

Late in the history of the condition, there may be signs of heart failure, including lung (pulmonary) congestion.

An ECG may be abnormal, showing an enlarged heart, an irregular heart beat, or evidence of lack of oxygen to the heart muscle (ischemia).

Enlargement of the heart or decreased heart function may be seen on:

• A chest CT scan (rarely performed for this diagnosis)
• A chest x-ray
• A coronary angiogram
• An echocardiogram