Signs and Symptoms of Congestion

Question 1

Clinical Presentation of Congestion

Answer 1

Weight Gain
• SOB
• Orthopnea
• Paroxysmal nocturnal dyspnea
• Pleural effusion on CXR
• Crackles/rales on auscultation
• S3 and S4
• Peripheral edema (pitting)
• B-type natriuretic peptide
(BNP)
• Jugular venous distention (JVD)

Question 2

What happens during congestion?

Answer 2

Blood backs up
from the LV to
the lungs,
possibly the RV,
and beyond

Question 3

When looking at a patient with acute decompensated HF patient and congestion, how would you classify them?

Answer 3

Wet

Question 4

When looking at a HF patient with congestion, how would you classify them?

Answer 4

Wet

Question 5

How would you treat a heart failure patient with congestion?

Answer 5

Diuretics to dry them out.
Give 1.5-2.5 times their home dose as IV. If their urine output is less than 600mL after 6 hours, then double the diuretic dose.

Question 6

What classes could someone with congestion and ADHF fall into?

Answer 6

Class II: warm and wet

Class IV: cold and wet

Question 7

What causes fluid retention in CHF?

Answer 7

Baroreceptor activation leads to increased aldosterone release along with sodium and water retention

Question 8

What is the role of aldosterone?

Answer 8

Promotes K and Mg excretion and fluid retention

Question 9

What causes baroreceptor activation?

Answer 9

A decrease in cardiac output, baroreceptor activation functions as a short term solution to increase CO

Question 10

When treating someone who is “wet and cold” (class IV ADHF), which presentation would you treat first?

Answer 10

We want to perfuse the patient first! (treat the “cold”)