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Heart Failure (Risk Factors (Hx of MI/IHD, Arrythmia (eg. AF), Pulmonary…
Heart Failure
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Investigation
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Serum chemistry: kidney failure, fluid retention, heart failure
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CXR: signs of congestive heart failure
:check:Cardiomegaly
:check:Signs of increased pulmonary venous pressure
:check:Pleural effusion
ECG: signs of MI, arrythmia, LVH
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Management
goals: to improve cardiac function when possible, reduce the risk of death, and improve the patient's quality of life
Diuretics: reduce edema by reduction of blood volume and venous pressures and salt restriction (to reduce fluid retention) in patients with current or previous heart failure symptoms for symptomatic relief
Angiotensin-converting enzyme inhibitors (ACEIs): for vasodilatation, improvement in LVEF, and survival benefit
Beta-adrenergic blockers: for improvement in symptoms and LVEF, survival benefit, arrhythmia prevention, and control of ventricular rate
Digoxin: lead to a small increase in cardiac output, improvement in heart failure symptoms, and decreased rate of heart failure hospitalizations
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Clinical Features
Symptoms
L Heart Failure
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abdominal fullness (hepatic congestion, ascites)
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Signs
Mild heart failure:
:red_flag: Tachypnea at rest is usually absent
:red_flag: Rales at lung bases (often absent)
:red_flag: Positive hepatojugular reflux
:red_flag: Faint gallop rhythm (S3or S4)
Moderate heart failure:
:red_flag: Tachypnea and dyspnea at rest
:red_flag: Elevated jugular venous pressure (jugular venous distention)
:red_flag: Cool extremities
:red_flag: Diastolic hypertension
:red_flag: Cardiomegaly
:red_flag: Pleural effusion
:red_flag: Prominent rales at lung bases that may extend to the mid-lung fields
:red_flag: Peripheral edema, initially in dependent areas (feet and ankles in ambulatory patients, the sacrum in bedridden patients) and then in other areas as the heart failure worsens
:red_flag: Gallop rhythm
Physical examination
assessed for resting dyspnea, cyanosis, cachexia, and severe mental distress/confusion
Blood pressure and heart rate should be recorded. Blood pressure may range from high to low in patients with heart failure.
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Bubbling rales accompanied by wheezes, which occur in patients with acute pulmonary edema
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Types
Left-sided heart failure
:arrow_down: in LV output; :arrow_down: cardiac output (CO) and :arrow_up: in LA and pulmonary venous pressure, due to backward flow of blood into LA & lungs causing pulmonary congestion
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heart cannot pump sufficient oxygenated blood to meet the metabolic needs of the body tissues or can do so only from an elevated filling pressure
Heart failure may be left sided, with pulmonary edema as a predominant symptom
right sided, often with hepatomegaly and systemic edema