Heart failure can be defined as a clinical syndrome characterized by impaired ventricular function and elevated diastolic filling pressures which result in decreased exercise tolerance. The approach to heart failure involves diagnosis of the underlying cause of the heart failure as well as identification of the acute precipitant of the presentation. Today in morning report we had a more unique opportunity to discuss the etiology of heart failure as a new presentation.
We made the diagnosis initially based on symptoms of heart failure which include (but are not limited to):
- dyspnea
- paroxysmal nocturnal dyspnea
- orthopnea
- increasing peripheral edema (or ascites / weight)
- abdominal pain (RUQ)
Physical Exam supported the diagnosis by findings of:
- tachycardia
- hypoxia and respiratory distress
- postural respiratory distress
- distended neck veins
- elevated JVP
- S3, S4
- peripheral edema, ascites
Chest X-ray findings will also support the diagnosis with findings including:
- cardiomegaly
- cephalization of blood vessels (vascular redistribution)
- interstitial pattern of increased opacity with Kerley B lines
- bilateral hilar 'cloudiness' with a butterfly or batwing appearance due to alveolar edema
- peribronchial cuffing
- pleural effusions (right>left)
Finally, we discussed on approach to etiology of heart failure which includes primary vs secondary causes. Primary causes of heart failure are defined anatomically as problems with the valves, pericardium, myocardium, blood vessels and the electrical systems.
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