Congestive heart failure physical examination

Congestive Heart Failure Microchapters
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Acute Pharmacotherapy
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Chronic Pharmacotherapy in HFrEF Diuretics ACE Inhibitors Angiotensin receptor blockers Aldosterone Antagonists Beta Blockers Ca Channel Blockers Nitrates Hydralazine Positive Inotropics Anticoagulants Angiotensin Receptor-Neprilysin Inhibitor Antiarrhythmic Drugs Nutritional Supplements Hormonal Therapies Drugs to Avoid Drug Interactions Treatment of underlying causes Associated conditions
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Surgical Therapy: Biventricular Pacing or Cardiac Resynchronization Therapy (CRT) Implantation of Intracardiac Defibrillator Ultrafiltration Cardiac Surgery Left Ventricular Assist Devices (LVADs) Cardiac Transplantation
ACC/AHA Guideline Recommendations Initial and Serial Evaluation of the HF Patient Hospitalized Patient Patients With a Prior MI Sudden Cardiac Death Prevention Surgical/Percutaneous/Transcather Interventional Treatments of HF Patients at high risk for developing heart failure (Stage A) Patients with cardiac structural abnormalities or remodeling who have not developed heart failure symptoms (Stage B) Patients with current or prior symptoms of heart failure (Stage C) Patients with refractory end-stage heart failure (Stage D) Coordinating Care for Patients With Chronic HF Quality Metrics/Performance Measures
Implementation of Practice Guidelines
Congestive heart failure end-of-life considerations
Specific Groups: Special Populations Patients who have concomitant disorders Obstructive Sleep Apnea in the Patient with CHF NSTEMI with Heart Failure and Cardiogenic Shock
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-In-Chief: Lakshmi Gopalakrishnan, M.B.B.S. [2]

Physical Examination Findings in Congestive Heart Failure

General

• Tachycardia
• Tachypnea (an increased rate of breathing) and an increased work of breathing
• Narrow pulse pressure (systolic blood pressure minus diastolic blood pressure is < 25 mm Hg)

Appearance

• The patient is often sitting upright and had labored breathing during an acute episode.

Skin

• The skin is cool and clammy consistent with hypoperfusion or cardiogenic shock
• Cyanosis is observed if severe hypoxemia is present
• Anasarca

Neck

• Jugular vein distention
• Central venous pressure > 16 cmH2O

Lungs

• Pleural effusion
• Rales

Abdomen

• Hepatojugular reflux
• Hepatomegaly

Heart

• S3 and a gallop rhythm
• A displaced point of maximum impulse (PMI)
• A functional holosystolic murmur of mitral regurgitation may be heard if the heart dilates excessively
• Underlying valvular heart disease causes of congestive heart failure such as aortic stenosis, aortic regurgitation and mitral regurgitation may be auscultated.

Extremities

• Bilateral ankle edema

Neurologic

• Confusion and altered mentation

ACC/AHA Guidelines- Initial Clinical Assessment of Patients Presenting With Heart Failure (DO NOT EDIT)

“

Class I 1. A thorough history and physical examination should be obtained/performed in patients presenting with HF to identify cardiac and noncardiac disorders or behaviors that might cause or accelerate the development or progression of HF. (Level of Evidence: C) 2. Initial examination of patients presenting with HF should include assessment of the patient’s volume status, orthostatic blood pressure changes, measurement of weight and height, and calculation of body mass index. (Level of Evidence: C)

”

Vote on and Suggest Revisions to the Current Guidelines

• The CHF Living Guidelines: Vote on current recommendations and suggest revisions to the guidelines

Guidelines Resources

• The ACC/AHA 2005 Guideline Update for the Diagnosis and Management of Chronic Heart Failure in the Adult

• 2009 focused update: ACCF/AHA Guidelines for the Diagnosis and Management of Heart Failure in Adults: a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines: developed in collaboration with the International Society for Heart and Lung Transplantation

References

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