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 4 main questions one should seek to answer when working a patient up for heart failure?

Is it definitely heart failure? How bad is ________

Heart failure evaluation

GIT symptoms - anorexia, weight loss, bloating, constipation
Leg swelling

What are the symptoms of R heart failure?

Dyspnoea - orthopnea, paroxysmal nocturnal dyspnoea
Fatigue
Nocturia
Oliguria
Cerebral symptoms

What are the symptoms of L 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 NYHA criteria for the 4 stages of heart failure?

Peripheral oedema
Abnormal pulse - sinus tachycardia at rest, pulsus alternans, irregularly irregular (atrial fibrillation)
Cool extremities
Peripheral cyanosis

What are the peripheral signs of heart failure?

What might you notice in a patient with heart failure when you take their blood pressure?

Paradoxical rise in JVP with inspiration
Sometimes seen in heart failure

Apex beat - laterally displaced, dyskinetic, palpable gallop rhythm
On auscultation - murmur, S3 gallop

What might you look for on examination of the praecordium in a patient with suspected heart failure?

Tender hepatomegaly
Hepatojugular reflux
Pulsatile liver (secondary to tricuspid regurgitation)

What might you look for on examination of the abdomen in a patient with suspected heart failure?

Resting sinus tachycardia
Narrow pulse pressure
Peripheral vasoconstriction
Diaphoresis

What are 4 signs that suggest a decline in cardiac output?

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Heart failure evaluation Flashcards

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