Heart Failure Lecture Flashcards
Pertinent + and Pertinent -
Disease specific findings to ‘rule in’ or ‘rule out’ a disease
Pertinent positives used to “rule in” a particular diagnosis
Pertinent negatives used to “rule out” other diagnostic possibilities
Typically require more analytical and creative thinking and are gleaned from the differential diagnosis
SCHOLAR-MAC of heart failure
Symptoms: What are main and associated sxs?
_______? DOE? PND? Orthopnea? _______? Edema?
Characteristics: What are the symptoms like?
History: Done so far? Happened before?
* Class of HF?
Onset: When did particular problem start?
How long have had HF?
Location: Location of edema? Discomfort?
Aggravating factors: What makes it worse (higher)?
Is edema, discomfort, SOB? worse at certain times of day?
Remitting factors: What makes it better (lower)?
Is edema, discomfort, SOB? better at certain times of day?
Medications: rx and non-rx, natural, herbals, generic
Allergies: medication and other with reaction
Conditions: other medical conditions (HTN, DM, ED, thyroid, CVD hx)
fatigue
cough
Family History & Social History
FH (Family History)
HTN? (Hypertension) Premature CHD? (Congenital heart disease)
CVA? (Cerebrovascular accdient)
CVD? (cardiovascular disease)
Dyslipidemia? Diabetes Mellitus?
SH (Social History)
Tobacco? Alcohol? Illicit drugs? Recreational drugs?
Employed? Family situation? Working conditions?
Physical activity? Dietary intake? Sodium intake?
Symptoms of Heart failure
______pupils, a sympathetic nervous system response
Skin pale, gray, or _________
Dyspnea, SOBOE is early symptom from pulmonary congestion
__________,cannot breathe unless sitting up
Crackles, __________are adventitious breath sounds
Decreased___________,stimulates sympathetic nervous system, which acts on heart to increase rate and increase force contraction
Nausea and vomiting as peristalsis slows and bile and fluids back up into stomach
__________,fluid in peritoneal cavity
Dependent, __________ in sacrum, legs
Dilated pupils
Cyanotic
Orthopnea
wheeze
Cough, frothy pink or white sputum
____________,stimulates sympathetic nervous system, which acts on heart to increase rate and increase force contraction
Decreased blood pressure
Ascites
Dependent,pitting edema
Symptoms of Heart Failure
__________,gasping from pulmonary congestion
Falling O2 saturation
_____________, unconsciousness from decreased O2 to brain
__________,from venous congestion
Infarct,may be cause of decreased cardiac output
__________,weakness from decreased cardiac output
S3 gallop, tachycardia
_______________ from venous congestion. This causes pressure on breathing
Decrease ________urine output
Weak pulse, cool,moist skin
Anxiety
Confusion
Jugular vein distention
Fatigue
Enlarged spleen and liver
Decreased urine output
ROS-Heart Failure
Fatigue
DOE-level
PND-frequency
Orthopnea-#pillows, incline
____________
Productive vs nonproductive
Frothy
Timing
CP,__________
Abdominal pain or bloating
Constipation
Nausea and or anorexia
Nocturia x?
__________-routine
Mental status changes
Confusion,_____________
Cough
Palpitations
Weight gain
memory
Review of Systems(ROS) always goes in subjective
Vital Signs
Weight – daily – changes
_______ right vs. left
RR (Respiratory rate)
Apical pulse
Rhythm regular or irregular
Radial pulse
Rhythm regular or irregular
O2______________
Weight
BP
O2 saturation
HEENT and Neck
Diaphoresis
Cyanosis
JVD
HJR
Lungs
S and S of pulmonary edema
Rales (____________)
Unilateral vs bilateral
Location-at the bases? Mid?
Crackles
CV (Cardiovascular)
Heart sounds
S2 loud-high __________
S3
S4
Murmurs
high pulmonary artery pressure
Comparing the 3rd and 4th sounds
S3-ventricular gallop
Occurs in _______diastole
Occurs during passive LV filling
May be ________ at times
Requires a very ______LV
Can be a sign of _______ CHF
early
normal
compliant
systolic
S4-atrial gallop
Occurs in _______diastole
Occurs during active LV filling
Almost always _______
Requires a ________LV
Can be a sign of __________CHF
late
abnormal
non-compliant
diastolic CHF
A
Abd=Abdominal
BS=diminished?
Ascites
HSM
Extremities
Edema
Location
Graded 1-4+
Symmetric
Labs and Tests
Chem 7-lytes and renal fxn
CBC-Complete blood count
LFT=liver function tests
Thyroid
BNP,CK-MB,troponins
Lipids
ABGs- arterial blood gas
ECHO to differentiate systolic vs diastolic-EF%
ECG (ischemia,arrthymia)
CXR-Chest X-ry
Left sided heart failure
Paroxysmal Nocturnal Dyspnea
Elevated Pulmonary Capillary Wedge Pressure
_________congestion
-Cough, crackles, wheezes, blood-tinged sputum, tachypnea
Restlessness
Confusion
Orthopnea
__________
Exertional Dyspnea
Fatigue
__________
Pulmonary congestion
Tachycardia
Cyanosis
