Heart failure
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Heart failure
- 1. Approach to HEART FAILURE Dr. Subroto Mandal, MD, DM Assistant Professor, Cardiology NRI Heart Centre & Research Institute
- 11. Rapid classification of hemodynamic states
- 14. Evaluation of HF patient
- 19. JVP Normal upper limit of JVP are 4 cm from sternal angle TR V wave and Y descend are prominent Kussumal sign in constrictive pericarditis
- 24. Myocarditis
- 25. Cardiomegaly
- 26. Dextrocardia – Acute pulmonary edema
- 27. CCF
- 28. Mitral stenosis
- 30. Mitral Stenosis
- 31. Mitral Stenosis Pre PBMV Post PBMV
- 32. MVP - MR
- 33. Aortic Stenosis
- 34. LA Myxoma
- 35. Post MI-VSD
- 36. DCM
- 37. DCM
- 38. DCM
- 41. HCM
- 42. Framingham Criteria for Congestive Heart Failure Major criteria: Paroxysmal nocturnal dyspnea Neck vein distention Rales Radiographic cardiomegaly Acute pulmonary edema S3 gallop Increased central venous pressure (>16 cm H2O at right atrium) Hepatojugular reflux Weight loss >4.5 kg in 5 days in response to treatment Minor criteria: Bilateral ankle edema Nocturnal cough Dyspnea on ordinary exertion Hepatomegaly Pleural effusion Decrease in vital capacity by one third from maximum recorded Tachycardia (heart rate>120 beats/min.)
Editor's Notes
- Figure 7-17. Rapid classification of hemodynamic states. Stevenson [42] popularized the concept of tailoring therapies to the hemodynamic status of patients. This approach can be coupled to a noninvasive diagnostic evaluation of patients admitted to the hospital with congestive heart failure with therapeutic approaches, perhaps directed by varying combinations of fluid retention states and peripheral organ perfusion. The two basic components outlined in this figure are, indeed, congestion (B and C) and low perfusion (C and D). Perhaps the most complex patient is the individual who is substantially volume overloaded with low flow states (D). These patients as well as those with simply low perfusion states are generally in cardiogenic shock. Signs and symptoms of congestion to review include orthopnea, paroxysmal nocturnal dyspnea, jugular venous distention, hepatomegaly, particularly with hepatojugular reflux, peripheral edema, presence of rales (remembering that they can be rare in chronic heart failure), and the Valsalva square wave blood pressure sign. Signs of low perfusion include a narrow pulse pressure, a sleepy or obtunded patient, periodic respirations, cool extremities, hypotension after angiotensin-converting enzyme inhibitor introduction, and renal dysfunction or a low serum sodium [42].
- Figure 7-1. Specific goals of patient evaluation when heart failure is suspected. First, one must appropriately recognize the heart failure syndrome and differentiate heart and circulatory failure from problems that cause similar complaints and findings. Second, by staging the severity of heart failure, the clinician can establish prognosis with reasonable accuracy. This is important in the design of therapeutic protocols to treat certain aspects of the syndrome. Finally, identifying the primary etiology of myocardial dysfunction and determining the precipitating causes of decompensation are extremely important. The interplay of patient history, physical examination, laboratory tests, and specific diagnostic studies helps the clinician achieve these goals.