Congestive heart failure physical examination: Difference between revisions

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(/* ACC/AHA Guidelines- Serial Clinical Assessment Recommendation Hunt SA, Abraham WT, Chin MH, Feldman AM, Francis GS, Ganiats TG, Jessup M, Konstam MA, Mancini DM, Michl K, Oates JA, Rahko PS, Silver MA, Stevenson LW, Yancy CW, Antman EM, Smith ...)
(/* ACC/AHA Guidelines- Serial Clinical Assessment Recommendation Hunt SA, Abraham WT, Chin MH, Feldman AM, Francis GS, Ganiats TG, Jessup M, Konstam MA, Mancini DM, Michl K, Oates JA, Rahko PS, Silver MA, Stevenson LW, Yancy CW, Antman EM, Smith ...)
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| bgcolor="LightGreen"|'''1.''' Assessment should be made at each visit of the ability of a patient with [[heart failure]] to perform routine and desired activities of daily living. ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: C]])''
| bgcolor="LightGreen"|<nowiki>"</nowiki>'''1.''' Assessment should be made at each visit of the ability of a patient with [[heart failure]] to perform routine and desired activities of daily living. ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: C]])'' <nowiki>"</nowiki>


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| bgcolor="LightGreen"|'''2.''' Assessment should be made at each visit of the volume status and weight of a patient with [[heart failure]]. ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: C]])''
| bgcolor="LightGreen"|<nowiki>"</nowiki>'''2.''' Assessment should be made at each visit of the volume status and weight of a patient with [[heart failure]]. ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: C]])'' <nowiki>"</nowiki>
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Revision as of 20:44, 4 October 2012

Congestive Heart Failure Microchapters

Home

Patient Information

Overview

Historical Perspective

Classification

Pathophysiology

Systolic Dysfunction
Diastolic Dysfunction
HFpEF
HFrEF

Causes

Differentiating Congestive heart failure from other Diseases

Epidemiology and Demographics

Risk Factors

Screening

Natural History, Complications and Prognosis

Diagnosis

Clinical Assessment

History and Symptoms

Physical Examination

Laboratory Findings

Electrocardiogram

Chest X Ray

Cardiac MRI

Echocardiography

Exercise Stress Test

Myocardial Viability Studies

Cardiac Catheterization

Other Imaging Studies

Other Diagnostic Studies

Treatment

Invasive Hemodynamic Monitoring

Medical Therapy:

Summary
Acute Pharmacotherapy
Chronic Pharmacotherapy in HFpEF
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

Exercise Training

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

Congestive heart failure physical examination On the Web

Most recent articles

Most cited articles

Review articles

CME Programs

Powerpoint slides

Images

Ongoing Trials at Clinical Trials.gov

US National Guidelines Clearinghouse

NICE Guidance

FDA on Congestive heart failure physical examination

CDC on Congestive heart failure physical examination

Congestive heart failure physical examination in the news

Blogs on Congestive heart failure physical examination

Directions to Hospitals Treating Congestive heart failure physical examination

Risk calculators and risk factors for Congestive heart failure physical examination

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-In-Chief: Lakshmi Gopalakrishnan, M.B.B.S. [2]

Overview

Physical Examination Findings in Congestive Heart Failure

General

  • The patient's weight should be recorded to ascertain how far they are from their "dry" weight.
  • 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

Neck

Lungs

Abdomen

Heart

aortic regurgitation and mitral regurgitation may be auscultated.

Extremities

Neurologic

Signs that represent left sided failure include cool clammy skin, cyanosis, rales, a gallop rhythm, and a laterally displaced PMI. Signs that represent right sided failure include an elevated JVP, pedal edema, ascites, hepatomegaly, a parasternal heave and hepatojugular reflux. Commonly signs of both left and right sided failure are present.

ACC/AHA Guidelines- Initial Clinical Assessment Recommendation [1][2]

Class I
"1. A thorough history and physical examination should be obtained/performed in patients presenting with heart failure to identify cardiac and noncardiac disorders or behaviors that might cause or accelerate the development or progression of heart failure. (Level of Evidence: C) "
"2. In patients presenting with heart failure, initial assessment should be made of the patient’s ability to perform routine and desired activities of daily living. (Level of Evidence: C) "
"3. Initial examination of patients presenting with heart failure 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) "

ACC/AHA Guidelines- Serial Clinical Assessment Recommendation [1][2]

Class I
"1. Assessment should be made at each visit of the ability of a patient with heart failure to perform routine and desired activities of daily living. (Level of Evidence: C) "
"2. Assessment should be made at each visit of the volume status and weight of a patient with heart failure. (Level of Evidence: C) "

Vote on and Suggest Revisions to the Current Guidelines

Guidelines Resources

References

  1. 1.0 1.1 1.2 Hunt SA, Abraham WT, Chin MH, Feldman AM, Francis GS, Ganiats TG, Jessup M, Konstam MA, Mancini DM, Michl K, Oates JA, Rahko PS, Silver MA, Stevenson LW, Yancy CW, Antman EM, Smith SC Jr, Adams CD, Anderson JL, Faxon DP, Fuster V, Halperin JL, Hiratzka LF, Jacobs AK, Nishimura R, Ornato JP, Page RL, Riegel B; American College of Cardiology; American Heart Association Task Force on Practice Guidelines; American College of Chest Physicians; International Society for Heart and Lung Transplantation; Heart Rhythm Society. ACC/AHA 2005 Guideline Update for the Diagnosis and Management of Chronic Heart Failure in the Adult: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Writing Committee to Update the 2001 Guidelines for the Evaluation and Management of Heart Failure): developed in collaboration with the American College of Chest Physicians and the International Society for Heart and Lung Transplantation: endorsed by the Heart Rhythm Society. Circulation. 2005 Sep 20; 112(12): e154-235. Epub 2005 Sep 13. PMID 16160202
  2. 2.0 2.1 2.2 Jessup M, Abraham WT, Casey DE, Feldman AM, Francis GS, Ganiats TG et al. (2009) 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. Circulation 119 (14):1977-2016. DOI:10.1161/CIRCULATIONAHA.109.192064 PMID: 19324967


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