Heart failure evaluation


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What are the 4 main questions one should seek to answer when working a patient up for heart failure?
Is it definitely heart failure?
How bad is the heart failure?
What is causing the heart failure?
What concurrent conditions might be exacerbating the heart failure?
What are the symptoms of R heart failure?
GIT symptoms - anorexia, weight loss, bloating, constipation
Leg swelling
What are the symptoms of L heart failure?
Dyspnoea - orthopnea, paroxysmal nocturnal dyspnoea
Cerebral symptoms
What are the NYHA criteria for the 4 stages of heart failure?
NYHA I - no limitation of ordinary activity
NYHA II - slight limitation by SOB/fatigue during moderate activity
NYHA III - symptoms on minimal activity
NYHA IV - inability to carry out any physical activity without discomfort, symptoms at rest
What are the peripheral signs of heart failure?
Peripheral oedema
Abnormal pulse - sinus tachycardia at rest, pulsus alternans, irregularly irregular (atrial fibrillation)
Cool extremities
Peripheral cyanosis
What might you notice in a patient with heart failure when you take their blood pressure?
Narrow pulse pressure
What is Kussmaul's sign?
Paradoxical rise in JVP with inspiration
Sometimes seen in heart failure
What might you look for on examination of the praecordium in a patient with suspected heart failure?
Apex beat - laterally displaced, dyskinetic, palpable gallop rhythm
On auscultation - murmur, S3 gallop
What might you look for on examination of the abdomen in a patient with suspected heart failure?
Tender hepatomegaly
Hepatojugular reflux
Pulsatile liver (secondary to tricuspid regurgitation)
What are 4 signs that suggest a decline in cardiac output?
Resting sinus tachycardia
Narrow pulse pressure
Peripheral vasoconstriction
What are 3 major signs of volume overload?
Raised JVP
Peripheral oedema
Lung crackles
What is the first sign of pulmonary oedema on CXR?
Upper lobe diversion (cephalization)
What are the 4 signs of interstitial oedema on CXR?
Kerley B lines
Peribronchial cuffing
Fluid in fissures
Hazy contour of vessels
What are the 4 signs of alveolar oedema on CXR?
Air bronchograms
Cotton wool appearance
Pleural effusion