Examples include coronary heart disease congenital heart disease and pulmonary heart disease as well as rheumatic heart disease see rheumatic fever hypertension inflammation of the heart muscle myocarditis or of its inner or outer membrane endocarditis pericarditis and heart valve disease. Pathology the oedematous heart contains small granulomas aschoff bodies throughout the connective tissue mild autoimmune endocarditis causes inflammation along the areas of apposition of the valve cusps and the chordae tendinae each recurrence increases the risk of permanent scarring of the valve download download full size image figure 6 histology the muscle bundles are widely . Classic symptoms of heart disease are chest pain or discomfort dyspnea including orthopnea and paroxysmal nocturnal dyspnea palpitations syncope and edema dyspnea is an uncomfortable awareness of breathing orthopnea is dyspnea when in the recumbent position due to increased venous return and increased pulmonary venous pressure. Layers of the heart wall the layers and blood vessels of the heart wall have the same basic structure the layers of the heart starting from the innermost layer include the endocardium myocardium and epicardium they correspond to the blood vessels tunica intima tunica media and tunica externa respectively. Full text full text is available as a scanned copy of the original print version get a printable copy pdf file of the complete article 183k or click on a page image below to browse page by page