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Excellence In The Physical Exam | Congestive Heart Failure

Rick Pescatore, DO and Mike Weinstock, MD
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16:23

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Heart failure is a common illness with a high mortality, in fact higher than AIDS and many malignancies. We need to make the diagnosis on a previously well pt w SOB as well as make the diagnosis on a pt w a hx of HF who has an exacerbation.

Pearls:

  • We can reliably assess patients for the presence of congestive heart failure with a good history and physical exam.

 

Historical Features

  • Prior history of MI or CAD.

  • Dyspnea on exertion.

  • Orthopnea - shortness of breath when laying flat.

  • Paroxysmal nocturnal dyspnea - bouts of shortness of breath at night improved when sitting up.

 

Physical Exam Findings

  • Bibasilar crackles or wheezing can be present secondary to pulmonary edema.

  • An S3 gallop is an extremely specific finding (>90%) for heart failure because it demonstrates an increased amount of fluid within the cardiopulmonary system.

  • Jugular venous distension occurs when there is increased central venous pressure.

  • The hepatojugular reflux is when there is increased distension of the jugular vein with palpation of the liver.

  • Bilateral, symmetric, lower extremity dependent edema can occur secondary to increased water retention.

 

REFERENCES:

  • Ponikowski P, Voors AA, Anker SD, et al, for the Authors/Task Force Members. 2016 ESC guidelines for the diagnosis and treatment of acute and chronic heart failure: The task force for the diagnosis and treatment of acute and chronic heart failure of the European Society of Cardiology (ESC). Developed with the special contribution of the Heart Failure Association (HFA) of the ESC. Eur Heart J. 2016 Jul 14. 37 (27):2129-200

  • Gheorghiade M, Pang PS. Acute heart failure syndromes. J Am Coll Cardiol. 2009 Feb 17. 53 (7):557-73

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The Half Somersault Full episode audio for MD edition 190:30 min - 89 MB - M4AHippo Urgent Care RAP - July 2019 Written Summary 498 KB - PDF

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