Heart Failure with Johnny Crash: LEFT VENTRICULAR EJECTION FRACTION (LVEF) SYMPTOMATOLOGY: Assess VENTRICULAR DYSFUNCTION HEART FAILURE:

Size: px
Start display at page:

Download "Heart Failure with Johnny Crash: LEFT VENTRICULAR EJECTION FRACTION (LVEF) SYMPTOMATOLOGY: Assess VENTRICULAR DYSFUNCTION HEART FAILURE:"

Transcription

1 Heart Failure with Johnny Crash: Joan E. King, PhD, ACNP-BC, ANP-BC Melissa Smith, DNP, ANP-BC Vanderbilt University School of Nursing HEART FAILURE: Heart Failure (HF): a complex clinical syndrome resulting from any structural or functional cardiac disorder that impairs the ability of the ventricle to FILL with blood or EJECT blood. (Yancy, et al. 2013) LEFT VENTRICULAR EJECTION FRACTION (LVEF) A measure of how well the Heart is pumping Percentage of blood volume ejected with each contraction Normal is >55% HEART FAILURE WITH REDUCED EJECTION FRACTION HFrEF HEART FAILURE WITH PRESERVED EJECTION FRACTION HFpEF VENTRICULAR DYSFUNCTION HFrEF SYSTOLIC FAILURE Poor contractility can t squeeze well Ejection Fraction </= 45% HFpEF DIASTOLIC FAILURE Ventricle noncompliant and can not fill well Ejection Fraction > 45% Frequently the result of hypertrophy SYMPTOMATOLOGY: Assess HOW WELL THE HEART IS PUMPING HOW WELL THE PATIENT IS PERFUSING WHERE IS THE FLUID BACKING UP? LUNGS? SYSTEMIC CIRCULATION? BOTH? 1

2 GENERAL SIGNS SYMPTOMS: FATIGUE (INSUFFICIENT BLOOD SUPPLY TO MUSCLES) EDEMA WEIGHT GAIN (2.2 POUNDS = 1 LITER OF FLUID) EARLY SATIETY SIGNS SYMPTOMS OF FLUID BACKING UP INTO THE PULMONARY BED EXERTIONAL DYSNPNEA COUGH (Chronic non-productive cough) ORTHOPNEA (requires elevation of HOB) PAROXYSMAL NOTURNAL DYSPNEA (PND) CRACKLES (may or may not be present) PULMONARY CONGESTION (X-RAY) EXTRA HEART SOUNDS (S3 or S4 or both) SIGNS SYMPTOMS: BACKUP INTO THE VENOUS CIRCULATION: ELEVATED VENOUS PRESSURES Elevated central venous pressures (CVP) Elevated jugular venous pressures (JVD) HEPATOMEGALY POSITIVE HEPTOJUGULAR REFLUX PERIPHERAL or DEPENDENT EDEMA ANOREXIA inadequate blood supply to the gut EARLY SATIETY inadequate blood supply to the gut ASCITES fluid leaks out into peritoneal cavity SOB Air Hungry Changes on Chest x-ray: Increase in cardiac silhouette May or may not have crackles Elevated CVP Hepatomegaly Venous Distension (JVD 8cm) Peripheral Edema Cyanosis 2

3 THE HISTORY: PRESENCE OR CHANGES SHORTNESS OF BREATH DYSPNEA ON EXERTION ORTHOPNEA # pillows or elevation HOB PND COUGH (NON-PRODUCTIVE) PEDAL EDEMA NOCTURIA CHEST PAIN SATIETY FATIGUE ACTIVITY LEVEL PHYSICAL EXAM: HEAD TO TOE NEURO: LEVEL OF CONSCIOUSNESS AWAKE, ALERT ORIENTED X 4 CARDIAC ECG: HEART RATE RHYTHM BP: HYPOTENISVE? HYPERTENSIVE? INSEPCTION: LIFT or HEAVE PALPATION: THRILL, HEAVE PALPATION: PMI (DISPLACED OR SUSTAINED) ASCULTATION: S1, S2, S3, S4, MURMURS CAROTIDS: ASCULTATE FOR BRUITS JUGULAR VENOUS DISTENSTION (JVD) ( V WAVE WITH INCREASE IN RIGHT ATRIAL PRESSURE) AUSCULTATION OF HEART SOUNDS S3 THE THIRD HEART SOUND DIFFICULTY WITH PASSIVE FILLING OF A NONCOMPLIANT VENTRICLE S4 THE FOURTH HEART SOUND DIFFICULTY WITH ACTIVE FILLING (Atrial Kick) OF A NONCOMPLIANT VENTRICLE SUMMATION GALLOP (S3 S4) MURMURS ( WHICH MAY BE THE RESULT OR THE CAUSE OF THE HEART FAILURE) RESPIRATORY SaO2 RESPIRATORY RATE, DEPTH & EFFORT BREATH SOUNDS (ANTERIOR & POSTERIOR) CRACKLES AT THE BASES (TRANSUDATION OF FLUID INTO ALVEOLI) EXPIRATORY WHEEZES (SECONDARY TO FLUID BACKED UP INTO THE LUNGS) BIBASILAR DULLNESS TO PERCUSSION (PLEURAL EFFUSIONS) DON T BE FOOLED!! IF YOUR PATIENT HAS CLEAR BREATH SOUNDS, THEY CAN STILL BE IN HF A PATIENT CAN BE VOLUME OVERLOADED HAVE CLEAR BREATH SOUNDS 3

4 PERIPHERAL VASCULAR PERIPHERAL VASCULAR PULSES: UPPER LOWER EXTREMITIES BILATERALLY EQUAL: STRONG, WEAK, THREADY CAPILLARY REFILL (< 3 SECONDS) PRESENCE OF PRETIBIAL EDEMA (PERIPHERAL EDEMA DEPENDENT EDEMA) CYANOTIC NAILBEDS (Integument) EXTREMITIES (VASOCONSTRICTION) BOWEL SOUNDS ASCITES ASSESS THE LIVER: HEPATMEGALY (PASSIVE CONGESTION) MAY OR MAY NOT HAVE ABDOMINAL TENDERNESS HEPATOJUGULAR REFLUX (>1 CM INCREASE IN JVD WITH A SUSTAINED PRESSURE OVER THE LIVER) GI RENAL PERFUSION VS VOLUME STATUS: HF ASSESSEMNT CONCEPTUAL MODEL UOP Labs: Cr+, BUN PERFUSION VOLUME WHERE IS JOHNNY CRASH? VOLUME = FLUID RETENTION PERFUSION = CARDIAC OUTPUT EXAM TECHNIQUES AUSCULTATION 4

5 POINT OF MAXIMUN IMPULSE AUSCULTATING FOR CAROTID BRUITS JUGULAR VENOUS DISTENSTION MEASURING JVD 5

6 V WAVE WITH JVD WITH TRICUSPID REGURGITATION HEPATOMEGALY PERCUSSION OF THE LIVER PERCUSSING FOR HEPATOMEGALY ASSESSING FOR ASCITES HEPATOMEGALY REFLUX FIRM PRESSURE ON THE LIVER PRODUCES A RISE IN THE JVD 6

7 ASSESSING FOR PERIPHERAL EDEMA PERIPHERAL EDEMA: BEFORE AFTER GRADE IT FROM 1 TO 4 PUTTING IT ALL TOGETHER PERFUSION VS VOLUME STATUS: HF ASSESSEMNT CONCEPTUAL MODEL PERFUSION VOLUME VOLUME = FLUID RETENTION PERFUSION = CARDIAC OUTPUT 7

Congestive Heart Failure Patient Profile. Patient Identity - Mr. Douglas - 72 year old man - No drugs, smokes, moderate social alcohol consumption

Congestive Heart Failure Patient Profile. Patient Identity - Mr. Douglas - 72 year old man - No drugs, smokes, moderate social alcohol consumption Congestive Heart Failure Patient Profile Patient Identity - Mr. Douglas - 72 year old man - No drugs, smokes, moderate social alcohol consumption Chief Complaint - SOB - When asked: Increasing difficulty

More information

Heart Failure Dr ahmed almutairi Assistant professor internal medicin dept

Heart Failure Dr ahmed almutairi Assistant professor internal medicin dept Heart Failure Dr ahmed almutairi Assistant professor internal medicin dept (MBBS)(SBMD) Introduction Epidemiology Pathophysiology diastolic/systolic Risk factors Signs and symptoms Classification of HF

More information

Copyright 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc. Normal Cardiac Anatomy

Copyright 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc. Normal Cardiac Anatomy Mosby,, an affiliate of Elsevier Normal Cardiac Anatomy Impaired cardiac pumping Results in vasoconstriction & fluid retention Characterized by ventricular dysfunction, reduced exercise tolerance, diminished

More information

Heart Failure. Subjective SOB (shortness of breath) Peripheral edema. Orthopnea (2-3 pillows) PND (paroxysmal nocturnal dyspnea)

Heart Failure. Subjective SOB (shortness of breath) Peripheral edema. Orthopnea (2-3 pillows) PND (paroxysmal nocturnal dyspnea) Pharmacology I. Definitions A. Heart Failure (HF) Heart Failure Ezra Levy, Pharm.D. HF Results when one or both ventricles are unable to pump sufficient blood to meet the body s needs There are 2 types

More information

Cardiovascular System

Cardiovascular System Cardiovascular System Chapter 8 1 Cardiovascular System Functions: pump saturated oxygenated blood into arterial system cells pump desaturated deoxygenated blood to lungs via veins for reoxygenation Heart

More information

Presenter: Steven Brust, HCS-D, HCS-H Product Manager, Home Health Coding Center

Presenter: Steven Brust, HCS-D, HCS-H Product Manager, Home Health Coding Center Presenter: Steven Brust, HCS-D, HCS-H Product Manager, Home Health Coding Center Pinpoint & properly assign the appropriate heart failure codes Left- vs. Right-sided Left ventricular failure (LVF) may

More information

Case 1 Organ Set 3. Case 1 (for Organ Sets 1 3) 10/2/2015 CARIOVASCULAR II LABORATORY

Case 1 Organ Set 3. Case 1 (for Organ Sets 1 3) 10/2/2015 CARIOVASCULAR II LABORATORY MHD I CRIOVSCULR II LORTORY 0/5/5 Case Organ Set Organ Set 2 Organ Set 3 Case (for Organ Sets 3) 72 year old man with a history of diabetes mellitus type 2, HTN, and hyperlipidemia presents with progressive

More information

Cor pulmonale. Dr hamid reza javadi

Cor pulmonale. Dr hamid reza javadi 1 Cor pulmonale Dr hamid reza javadi 2 Definition Cor pulmonale ;pulmonary heart disease; is defined as dilation and hypertrophy of the right ventricle (RV) in response to diseases of the pulmonary vasculature

More information

Assessment and Diagnosis of Heart Failure

Assessment and Diagnosis of Heart Failure Assessment and Diagnosis of Heart Failure Heart failure (HF) is a complex clinical syndrome resulting from any structural or functional impairment of ventricular filling or ejection of blood and is characterized

More information

HISTORY. Question: How do you interpret the patient s history? CHIEF COMPLAINT: Dyspnea of two days duration. PRESENT ILLNESS: 45-year-old man.

HISTORY. Question: How do you interpret the patient s history? CHIEF COMPLAINT: Dyspnea of two days duration. PRESENT ILLNESS: 45-year-old man. HISTORY 45-year-old man. CHIEF COMPLAINT: Dyspnea of two days duration. PRESENT ILLNESS: His dyspnea began suddenly and has been associated with orthopnea, but no chest pain. For two months he has felt

More information

Protocol Identifier Subject Identifier Visit Description. [Y] Yes [N] No. [Y] Yes [N] N. If Yes, admission date and time: Day Month Year

Protocol Identifier Subject Identifier Visit Description. [Y] Yes [N] No. [Y] Yes [N] N. If Yes, admission date and time: Day Month Year PAST MEDICAL HISTORY Has the subject had a prior episode of heart failure? o Does the subject have a prior history of exposure to cardiotoxins, such as anthracyclines? URGENT HEART FAILURE VISIT Did heart

More information

CARDIAC EXAMINATION MINI-QUIZ

CARDIAC EXAMINATION MINI-QUIZ CARDIAC EXAMINATION MINI-QUIZ 1. Sitting bolt upright, your dyspneic (short of breath) patient has visible jugular venous pulsations to the angle of his jaw, which is 12 cm above his sternal angle. What

More information

Means failure of heart to pump enough blood to satisfy the need of the body.

Means failure of heart to pump enough blood to satisfy the need of the body. Means failure of heart to pump enough blood to satisfy the need of the body. Due to an impaired ability of the heart to adequately to fill or eject blood. HEART FAILURE Heart failure (HF) means decreased

More information

Heart Failure. Cardiac Anatomy. Functions of the Heart. Cardiac Cycle/Hemodynamics. Determinants of Cardiac Output. Cardiac Output

Heart Failure. Cardiac Anatomy. Functions of the Heart. Cardiac Cycle/Hemodynamics. Determinants of Cardiac Output. Cardiac Output Cardiac Anatomy Heart Failure Professor Qing ZHANG Department of Cardiology, West China Hospital www.blaufuss.org Cardiac Cycle/Hemodynamics Functions of the Heart Essential functions of the heart to cover

More information

Building Higher Order Thinking Skills in Tomorrow s Health Care Professionals A Quality Enhancement Plan for the GSBS

Building Higher Order Thinking Skills in Tomorrow s Health Care Professionals A Quality Enhancement Plan for the GSBS Building Higher Order Thinking Skills in Tomorrow s Health Care Professionals A Quality Enhancement Plan for the GSBS Focus of the QEP at UNTHSC: To improve students Higher Order Thinking (HOT) skills

More information

CASE PRESENTATION. By: Sarah Khalil Zeina Shamil Supervised By: DR.ABDULHAK AL_NUAIMI

CASE PRESENTATION. By: Sarah Khalil Zeina Shamil Supervised By: DR.ABDULHAK AL_NUAIMI CASE PRESENTATION By: Sarah Khalil Zeina Shamil Supervised By: DR.ABDULHAK AL_NUAIMI Name :Manal A. AGE : 22 years Marital status : married Occupation : housewife حي العامل Mosul Residence : DOA : 10 th,

More information

Presentation, symptoms and signs of heart failure

Presentation, symptoms and signs of heart failure 3 Presentation, symptoms and signs of heart failure What will I learn? In this section you will learn: Who is at risk of heart failure The symptoms of heart failure The signs of heart failure The importance

More information

Improving Transition of Care in Congestive Heart Failure. Mark J. Gloth, DO, MBA. Vice President, Chief Medical Officer HCR ManorCare

Improving Transition of Care in Congestive Heart Failure. Mark J. Gloth, DO, MBA. Vice President, Chief Medical Officer HCR ManorCare Improving Transition of Care in Congestive Heart Failure Mark J. Gloth, DO, MBA. Vice President, Chief Medical Officer HCR ManorCare Heart Failure Fastest growing clinical cardiac disease in the United

More information

CHF and Pulmonary Edema. Rod Hetherington

CHF and Pulmonary Edema. Rod Hetherington CHF and Pulmonary Edema Rod Hetherington Objectives Given a lecture and group discussion, the paramedic will be able to: Identify and name the key anatomical structures of the heart and vessels Describe

More information

Diagnosis & Management of Heart Failure. Abena A. Osei-Wusu, M.D. Medical Fiesta

Diagnosis & Management of Heart Failure. Abena A. Osei-Wusu, M.D. Medical Fiesta Diagnosis & Management of Heart Failure Abena A. Osei-Wusu, M.D. Medical Fiesta Learning Objectives: 1) Become familiar with pathogenesis of congestive heart failure. 2) Discuss clinical manifestations

More information

CASE DISCUSSION. Dr JAYASREE VEERABOINA 2nd yr PG MS OBG

CASE DISCUSSION. Dr JAYASREE VEERABOINA 2nd yr PG MS OBG CASE DISCUSSION Dr JAYASREE VEERABOINA 2nd yr PG MS OBG Normal Cardiovascular changes in Pregnancy CARDIAC OUTPUT 5 th wk -- starts 12 wks -- 30-35% 30-32 wks -- 40% During labour -- 50% After delivery

More information

Contemporary Clinical Pearls in Physical Diagnosis: A Multi-Media Look at Actual Findings & Sounds, Hemodynamics, and What the Literature Has to Say

Contemporary Clinical Pearls in Physical Diagnosis: A Multi-Media Look at Actual Findings & Sounds, Hemodynamics, and What the Literature Has to Say Contemporary Clinical Pearls in Physical Diagnosis: A Multi-Media Look at Actual Findings & Sounds, Hemodynamics, and What the Literature Has to Say James C. Fang, MD Harrington Heart and Vascular Institute

More information

LITERATURE REVIEW: HEART FAILURE. Chief Residents

LITERATURE REVIEW: HEART FAILURE. Chief Residents LITERATURE REVIEW: HEART FAILURE Chief Residents Heart Failure EF 40% HFrEF Problem with contractility EF 40-50% HFmrEF EF > 50% HFpEF Problem with filling/relaxation RISK FACTORS Post MI HTN DM Obesity

More information

Pulmonary-Vascular Disease. Howard J. Sachs, MD.

Pulmonary-Vascular Disease. Howard J. Sachs, MD. Pulmonary-Vascular Disease Howard J. Sachs, MD www.12daysinmarch.com Dyspnea Cardiac Pulmonary CAD Pump Failure Chest Wall Airways Valve Disease Pericardial Disease Alveoli Interstitium Rhythm Disturbance

More information

Impedance Cardiography (ICG) Application of ICG in Intensive Care and Emergency

Impedance Cardiography (ICG) Application of ICG in Intensive Care and Emergency Impedance Cardiography (ICG) Application of ICG in Intensive Care and Emergency Aim of haemodynamic monitoring in ICU and ED Detection and therapy of insufficient organ perfusion Answers to common cardiovascular

More information

ARIC HEART FAILURE HOSPITAL RECORD ABSTRACTION FORM

ARIC HEART FAILURE HOSPITAL RECORD ABSTRACTION FORM ARIC HEART FAILURE HOSPITAL RECORD ABSTRACTION FORM ID NUMBER: FORM NAME: H F A DATE: 10/01/2015 VERSION: D CONTACT YEAR NUMBER: FORM SEQUENCE NUMBER: General Instructions: The Heart Failure Hospital Record

More information

See below for descriptions of the waveform

See below for descriptions of the waveform The internal jugular vein (IJV) connects to the right atrium without any intervening valves. The pulsation of the right atrium therefore causes the column of blood in the IJV to rise and fall this is called

More information

Charles Spencer MD, FRCP Consultant Cardiologist Mid Staffs NHSFT

Charles Spencer MD, FRCP Consultant Cardiologist Mid Staffs NHSFT Charles Spencer MD, FRCP Consultant Cardiologist Mid Staffs NHSFT Key Messages Heart Failure is Common Heart failure is complex Heart Failure is a major issue for the NHS Heart Failure has a worse prognosis

More information

New CHF Patient in my Office: What Should I Do?

New CHF Patient in my Office: What Should I Do? New CHF Patient in my Office: What Should I Do? Joseph Mishkin MD FACC Advanced Heart Failure, Transplantation and Mechanical Circulatory Support No disclosures Disclosures Clinical Presentation 38 year

More information

Chapter 1. Perioperative Evaluation and Management of Surgical Patients. Oral Exam Questions

Chapter 1. Perioperative Evaluation and Management of Surgical Patients. Oral Exam Questions Chapter 1 Perioperative Evaluation and Management of Surgical Patients Oral Exam Questions Case 1 A 62-year-old man with a PMH significant for hypertension, and a 40-pack-year history of smoking is found

More information

Can be felt where an artery passes near the skin surface and over a

Can be felt where an artery passes near the skin surface and over a 1 Chapter 14 Cardiovascular Emergencies 2 Cardiovascular Emergencies Cardiovascular disease has been leading killer of Americans since. Accounts for 1 of every 2.8 deaths Cardiovascular disease (CVD) claimed

More information

Chapter 14 Cardiovascular Emergencies Cardiovascular Emergencies Cardiovascular disease has been leading killer of Americans since.

Chapter 14 Cardiovascular Emergencies Cardiovascular Emergencies Cardiovascular disease has been leading killer of Americans since. 1 2 3 4 5 Chapter 14 Cardiovascular Emergencies Cardiovascular Emergencies Cardiovascular disease has been leading killer of Americans since. Accounts for 1 of every 2.8 deaths Cardiovascular disease (CVD)

More information

What Is Valvular Heart Disease? Heart valve disease occurs when your heart's valves do not work the way they should.

What Is Valvular Heart Disease? Heart valve disease occurs when your heart's valves do not work the way they should. What Is Valvular Heart Disease? Heart valve disease occurs when your heart's valves do not work the way they should. How Do Heart Valves Work? MAINTAIN ONE-WAY BLOOD FLOW THROUGH YOUR HEART The four heart

More information

Physiology #14. Heart Failure & Circulatory Shock. Mohammad Ja far Tuesday 5/4/2016. Turquoise Team. Page 0 of 13

Physiology #14. Heart Failure & Circulatory Shock. Mohammad Ja far Tuesday 5/4/2016. Turquoise Team. Page 0 of 13 45 Physiology #14 Heart Failure & Circulatory Shock Mohammad Ja far Tuesday 5/4/2016 Turquoise Team Page 0 of 13 Heart Failure: It s a condition in which the heart can t perform its function properly;

More information

SAMPLE HLTEN610A. TAFE NSW Training and Education Support Industry Skills Unit, Meadowbank. Practise in the cardiovascular nursing environment

SAMPLE HLTEN610A. TAFE NSW Training and Education Support Industry Skills Unit, Meadowbank. Practise in the cardiovascular nursing environment TAFE NSW Training and Education Support Industry Skills Unit, Meadowbank HLTEN610A Practise in the cardiovascular nursing environment Version 1.0 Flexible Learner Resource Product Code: ISO 9001 HLTEN610A

More information

Heart failure. Tamás Fenyvesi MD 3rd Department of Medicine

Heart failure. Tamás Fenyvesi MD 3rd Department of Medicine Heart failure Tamás Fenyvesi MD 3rd Department of Medicine 1 Circulatory Heart failure Insufficient oxygen and nutrient supply to the tissues, and cells + insufficient removal of the metabolic endproducts

More information

Valvular Heart Disease Mitral Stenosis

Valvular Heart Disease Mitral Stenosis Valvular Heart Disease Mitral Stenosis A 75 year old woman with loud first heart sound and mid-diastolic murmur Chronic dyspnea Class 2/4 Fatigue Recent orthopnea/pnd Nocturnal palpitation Pedal edema

More information

Dr Dinna Soon. Consultant Cardiologist, Department of Cardiology. GP symposium 2 April 2016

Dr Dinna Soon. Consultant Cardiologist, Department of Cardiology. GP symposium 2 April 2016 Dr Dinna Soon Consultant Cardiologist, Department of Cardiology GP symposium 2 April 2016 Case presentation 76 years old male, chronic smoker, hypertension, previous MI 3/7 SOB and chest tightness BP

More information

A study of Brain Natriuretic Peptide levels in acute cardiac failure

A study of Brain Natriuretic Peptide levels in acute cardiac failure Original Research Article A study of Brain Natriuretic Peptide levels in acute cardiac failure Bhavik Prajapati 1*, Anirudh Kulkarni 2 1 Assistant Professor, Department of Medicine, SMS Multispecialty

More information

Topics to be Covered. Cardiac Measurements. Distribution of Blood Volume. Distribution of Pulmonary Ventilation & Blood Flow

Topics to be Covered. Cardiac Measurements. Distribution of Blood Volume. Distribution of Pulmonary Ventilation & Blood Flow Topics to be Covered MODULE F HEMODYNAMIC MONITORING Cardiac Output Determinants of Stroke Volume Hemodynamic Measurements Pulmonary Artery Catheterization Control of Blood Pressure Heart Failure Cardiac

More information

ARIC HEART FAILURE HOSPITAL RECORD ABSTRACTION FORM. General Instructions: ID NUMBER: FORM NAME: H F A DATE: 10/13/2017 VERSION: CONTACT YEAR NUMBER:

ARIC HEART FAILURE HOSPITAL RECORD ABSTRACTION FORM. General Instructions: ID NUMBER: FORM NAME: H F A DATE: 10/13/2017 VERSION: CONTACT YEAR NUMBER: ARIC HEART FAILURE HOSPITAL RECORD ABSTRACTION FORM General Instructions: The Heart Failure Hospital Record Abstraction Form is completed for all heart failure-eligible cohort hospitalizations. Refer to

More information

DAY1_CARDIOVASCULAR PRACTICE QUESTIONS

DAY1_CARDIOVASCULAR PRACTICE QUESTIONS DAY1_CARDIOVASCULAR PRACTICE QUESTIONS 1 P age 1. A 59-year-old male is admitted complaining of chest pain and dyspnea. ST elevation and T-wave inversion were seen on the ECG in V2, V3, and V4. IV thrombolytic

More information

HEART FAILURE. Study day November 2018 Sarah Briggs

HEART FAILURE. Study day November 2018 Sarah Briggs HEART FAILURE Study day November 2018 Sarah Briggs Overview and Introduction This course is an introduction and overview of heart failure. Normal heart function and basic pathophysiology of heart failure

More information

Pre-discussion questions

Pre-discussion questions Amanda Bartlett, PA-C Dustin Bartlett, PA-C Andrea Applegate, PA-C Leslie Yearta Brown, NP CHF Round Table Discussion Objectives ANDREA- Discuss the definition and different categories of CHF DUSTIN- Define

More information

LEFT HEART AND EXACERBATION OF LEFT HEART FAILURE

LEFT HEART AND EXACERBATION OF LEFT HEART FAILURE LEFT HEART AND EXACERBATION OF LEFT HEART FAILURE Concept Map Aetiology: left heart failure is a severe fatal state in which the left side of the human heart fails to properly pump adequate amount of blood

More information

Heart Failure CTSHP Fall Seminar

Heart Failure CTSHP Fall Seminar Heart Failure CTSHP Fall Seminar Laurajo Ryan, PharmD, MSc, BCPS, CDE Pharmacist Learning Objectives Outline the pathophysiology of heart failure List triggers for decompensated heart failure Describe

More information

And Then There is Failure

And Then There is Failure Heart Failure And Then There is Failure Heart Failure Brenda Phipps BSN Nurse Educator Minneapolis VA Tina Wright MSN Clinical Nurse Leader Minneapolis VA Symptoms SOB, use of accessory muscles Crackles,

More information

Index of subjects. effect on ventricular tachycardia 30 treatment with 101, 116 boosterpump 80 Brockenbrough phenomenon 55, 125

Index of subjects. effect on ventricular tachycardia 30 treatment with 101, 116 boosterpump 80 Brockenbrough phenomenon 55, 125 145 Index of subjects A accessory pathways 3 amiodarone 4, 5, 6, 23, 30, 97, 102 angina pectoris 4, 24, 1l0, 137, 139, 140 angulation, of cavity 73, 74 aorta aortic flow velocity 2 aortic insufficiency

More information

Pericardial Disease: Case Examples. Echo Fiesta 2017

Pericardial Disease: Case Examples. Echo Fiesta 2017 Pericardial Disease: Case Examples Echo Fiesta 2017 2014 2014 MFMER MFMER 3346252-1 slide-1 Objectives Have a systematic approach to evaluation of constriction 2014 MFMER 3346252-2 CASE 1 2013 MFMER 3248567-3

More information

HEALTH ASSESSMENT. Afnan Tunsi BSN, RN, MSc.

HEALTH ASSESSMENT. Afnan Tunsi BSN, RN, MSc. HEALTH ASSESSMENT Afnan Tunsi BSN, RN, MSc. Learning Outcomes 2 After completion of this lecture, the student will be able to: Describe suggested sequencing to conduct a thorax and lungs physical health

More information

Μαρία Μπόνου Διευθύντρια ΕΣΥ, ΓΝΑ Λαϊκό

Μαρία Μπόνου Διευθύντρια ΕΣΥ, ΓΝΑ Λαϊκό Μαρία Μπόνου Διευθύντρια ΕΣΥ, ΓΝΑ Λαϊκό Diastolic HF DD: Diastolic Dysfunction DHF: Diastolic HF HFpEF: HF with preserved EF DD Pathophysiologic condition: impaired relaxation, LV compliance, LV filling

More information

Advanced Pathophysiology Unit 5 CV Page 1 of 24. Learning Objectives:

Advanced Pathophysiology Unit 5 CV Page 1 of 24. Learning Objectives: Advanced Pathophysiology Unit 5 CV Page 1 of 24 Learning Objectives: 1) What is the definition of HF? How can we get it? Is it just the failing heart? 2) AHA/ACC stages of HF compared to older NYHA classes

More information

Cardiovascular Patient Assessment. Dr. Gary Mumaugh Western Physical Assessment

Cardiovascular Patient Assessment. Dr. Gary Mumaugh Western Physical Assessment Cardiovascular Patient Assessment Dr. Gary Mumaugh Western Physical Assessment Objectives Outline a systematic approach to cardiovascular assessment. Differentiate normal from abnormal findings when assessing

More information

more than 50% of adults weigh more than 20% above optimum

more than 50% of adults weigh more than 20% above optimum In the US: more than 50% of adults weigh more than 20% above optimum >30 kg m -2 obesity >40 kg m -2 morbid obesity BMI = weight(kg) / height(m 2 ) Pounds X 2.2 Inches divided by 39, squared From 2000

More information

Chapter 16 Cardiovascular Emergencies Cardiovascular Emergencies Cardiovascular disease has been leading killer of Americans since 1900.

Chapter 16 Cardiovascular Emergencies Cardiovascular Emergencies Cardiovascular disease has been leading killer of Americans since 1900. 1 2 3 4 5 6 Chapter 16 Cardiovascular Emergencies Cardiovascular Emergencies Cardiovascular disease has been leading killer of Americans since 1900. Accounts for of every 3 deaths Cardiovascular disease

More information

UNIT 08: ASSESSMENT OF CARDIOVASCULAR SYSTEM

UNIT 08: ASSESSMENT OF CARDIOVASCULAR SYSTEM In The Name of God (A PROJECT OF NEW LIFE COLLEGE OF NURSING KARACHI) UNIT 08: ASSESSMENT OF CARDIOVASCULAR SYSTEM Shahzad Bashir RN, BScN, DCHN Instructor New Life College of Nursing December 01, 2015

More information

HISTORY. Question: What category of heart disease is suggested by the fact that a murmur was heard at birth?

HISTORY. Question: What category of heart disease is suggested by the fact that a murmur was heard at birth? HISTORY 23-year-old man. CHIEF COMPLAINT: Decreasing exercise tolerance of several years duration. PRESENT ILLNESS: The patient is the product of an uncomplicated term pregnancy. A heart murmur was discovered

More information

Cardiovascular system Physiology Sheet (1)

Cardiovascular system Physiology Sheet (1) Cardiovascular system Physiology Sheet (1) In any patient the most important thing is the cardiorespiratory system, if any patient comes to you with a car accident for example the first thing that you

More information

Images have been removed from the PowerPoint slides in this handout due to copyright restrictions.

Images have been removed from the PowerPoint slides in this handout due to copyright restrictions. Heart Failure Heart Failure Introduction and History AHA 2015 Statistics About 6 million Americans 870,000 new cases each year 1 in 9 deaths related to HF Almost 1 million hospitalizations each year (cost

More information

Restrictive Cardiomyopathy in Cats (a Type of Heart-Muscle Disease) Basics

Restrictive Cardiomyopathy in Cats (a Type of Heart-Muscle Disease) Basics Restrictive Cardiomyopathy in Cats (a Type of Heart-Muscle Disease) Basics OVERVIEW The heart of the cat is composed of four chambers; the top two chambers are the left and right atria and the bottom two

More information

Incidence. 4.8 million in the United States. 400,000 new cases/year. 20 million patients with asymptomatic LV dysfunction

Incidence. 4.8 million in the United States. 400,000 new cases/year. 20 million patients with asymptomatic LV dysfunction Heart Failure Diagnosis According to the Working Group in Heart Failure, CHF is a syndrome where the diagnosis has the following essential components: A combination of: Symptoms, typically breathlessness

More information

Ventricular Septal Defect (VSD)

Ventricular Septal Defect (VSD) Ventricular Septal Defect (VSD) BRIEFLY, HOW DOES THE HEART WORK? The heart has four chambers. The upper chambers are called atria. One chamber is called an atrium, and the lower chambers are called ventricles.

More information

ALLHAT. U.S. Department of Health and Human Services. National Institutes of Health. National Heart, Lung, and Blood Institute

ALLHAT.   U.S. Department of Health and Human Services. National Institutes of Health. National Heart, Lung, and Blood Institute U.S. Department of Health and Human Services National Institutes of Health National Heart, Lung, and Blood Institute Review of Heart Failure Events in the Antihypertensive and Lipid Lowering Treatment

More information

Topic Page: congestive heart failure

Topic Page: congestive heart failure Topic Page: congestive heart failure Definition: congestive heart f ailure from Merriam-Webster's Collegiate(R) Dictionary (1930) : heart failure in which the heart is unable to maintain an adequate circulation

More information

Susan P. D Anna MSN, APRN BC February 14, 2019

Susan P. D Anna MSN, APRN BC February 14, 2019 Is there Equal Opportunity in Heart Failure?? Susan P. D Anna MSN, APRN BC February 14, 2019 Disclosures: I have no financial disclosures. I am not an expert on this topic, but see a lot of women with

More information

Pathophysiology: Left To Right Shunts

Pathophysiology: Left To Right Shunts Pathophysiology: Left To Right Shunts Daphne T. Hsu, MD dh17@columbia.edu Learning Objectives Learn the relationships between pressure, blood flow, and resistance Review the transition from fetal to mature

More information

CCRN Review Cardiovascular

CCRN Review Cardiovascular CCRN Review Cardiovascular Leanna R. Miller, RN, MN, CCRN-CMC, PCCN-CSC, CEN, CNRN, CMSRN, NP Education Specialist LRM Consulting Nashville, TN Angina Definition discomfort that occurs when oxygen demand

More information

Form 136 WHI WOMEN S HEALTH INITIATIVE HEART FAILURE HOSPITAL RECORD ABSTRACTION FORM

Form 136 WHI WOMEN S HEALTH INITIATIVE HEART FAILURE HOSPITAL RECORD ABSTRACTION FORM Form 136 WHI WOMEN S HEALTH INITIATIVE HEART FAILURE HOSPITAL RECORD ABSTRACTION FORM FORM NAME: H T F DATE: 10/31/2012 VERSION: A MEMBER ID NUMBER: General Instructions: This form should be completed

More information

The right heart: the Cinderella of heart failure

The right heart: the Cinderella of heart failure The right heart: the Cinderella of heart failure Piotr Ponikowski, MD, PhD, FESC Medical University, Centre for Heart Disease Clinical Military Hospital Wroclaw, Poland none Disclosure Look into the Heart

More information

Exam 1 Review. Cardiopulmonary Symptoms Physical Examination Clinical Laboratory Studies

Exam 1 Review. Cardiopulmonary Symptoms Physical Examination Clinical Laboratory Studies Exam 1 Review Cardiopulmonary Symptoms Physical Examination Clinical Laboratory Studies WBC Count Differential A patient had been admitted to the hospital for acute shortness of breath. A CXR examination

More information

Hemodynamic Monitoring

Hemodynamic Monitoring Perform Procedure And Interpret Results Hemodynamic Monitoring Tracheal Tube Cuff Pressure Dean R. Hess PhD RRT FAARC Hemodynamic Monitoring Cardiac Rate and Rhythm Arterial Blood Pressure Central Venous

More information

ACUTE HEART FAILURE in the ED. Pr. Samir Nouira Emergency Department Fattouma Bourguiba University Hospital Monastir Tunisia

ACUTE HEART FAILURE in the ED. Pr. Samir Nouira Emergency Department Fattouma Bourguiba University Hospital Monastir Tunisia ACUTE HEART FAILURE in the ED Pr. Samir Nouira Emergency Department Fattouma Bourguiba University Hospital Monastir Tunisia ACUTE HEART FAILURE 80% Acute Heart Failure Syndrome Sensitivity Specificity

More information

Pericardial diseases

Pericardial diseases Pericardial diseases Anatomy of the pericardium Consists of parietal and visceral membranes. The space between them(pericardial space is normally filled by a lymph like fluid. The fluid s normal quantity

More information

Nora Goldschlager, M.D. SFGH Division of Cardiology UCSF

Nora Goldschlager, M.D. SFGH Division of Cardiology UCSF CLASSIFICATION OF HEART FAILURE Nora Goldschlager, M.D. SFGH Division of Cardiology UCSF DISCLOSURES: NONE CLASSIFICATION C OF HEART FAILURE NYHA I IV New paradigm Stage A: Pts at high risk of developing

More information

Prevention of Atrial Fibrillation and Heart Failure in the Hypertensive Patient

Prevention of Atrial Fibrillation and Heart Failure in the Hypertensive Patient Prevention of Atrial Fibrillation and Heart Failure in the Hypertensive Patient The Issue of Primary Prevention of A.Fib. (and Heart Failure) and not the Prevention of Recurrent A.Fib. after Electroconversion

More information

Leicester Medical School

Leicester Medical School Leicester Medical School THE CARDIOVASCULAR SYSTEM PHYSICAL EXAMINATION Overview The cardiovascular examination should include the following: - General inspection from the end of the bed. - General examination

More information

DUKECATHR Dataset Dictionary

DUKECATHR Dataset Dictionary DUKECATHR Dataset Dictionary Version of DUKECATH dataset for educational use that has been modified to be unsuitable for clinical research or publication (Created Date and Time: 28OCT16 14:35) Table of

More information

Cardiac Emergencies. Jim Bennett Paramedic and Clinical Education Coordinator American Medical Response Spokane, Washington

Cardiac Emergencies. Jim Bennett Paramedic and Clinical Education Coordinator American Medical Response Spokane, Washington Cardiac Emergencies Jim Bennett Paramedic and Clinical Education Coordinator American Medical Response Spokane, Washington The Heart -------Aorta Pulmonary Veins---- Superior Vena Cava------ Right Atrium-----

More information

DIAGNOSING HEART FAILURE IN DOGS

DIAGNOSING HEART FAILURE IN DOGS Vet Times The website for the veterinary profession https://www.vettimes.co.uk DIAGNOSING HEART FAILURE IN DOGS Author : Mike Martin Categories : Vets Date : November 7, 2011 Mike Martin offers advice

More information

What every Nurse should know to care for Older Adults with Heart Failure

What every Nurse should know to care for Older Adults with Heart Failure What every Nurse should know to care for Older Adults with Heart Failure Rebecca Boxer, MD, MS Assistant Professor of Medicine Harrington McLaughlin Heart and Vascular Institute Case Western Reserve University

More information

Heart failure 1: pathogenesis, presentation and diagnosis

Heart failure 1: pathogenesis, presentation and diagnosis Heart failure Keywords Cardiac dysfunction/ Ejection fraction/nyha classification This article has been double-blind peer reviewed In this article... Pathophysiology and aetiology of heart failure Different

More information

THE PROPER APPROACH TO DIAGNOSING HEART FAILURE WITH PRESERVED EJECTION FRACTION

THE PROPER APPROACH TO DIAGNOSING HEART FAILURE WITH PRESERVED EJECTION FRACTION THE PROPER APPROACH TO DIAGNOSING HEART FAILURE WITH PRESERVED EJECTION FRACTION James C. Fang, MD, FACC Professor and Chief Cardiovascular Division University of Utah School of Medicine Disclosures Data

More information

Lecture Notes. Chapter 4: Chronic Obstructive Pulmonary Disease (COPD)

Lecture Notes. Chapter 4: Chronic Obstructive Pulmonary Disease (COPD) Lecture Notes Chapter 4: Chronic Obstructive Pulmonary Disease (COPD) Objectives Define COPD Estimate incidence of COPD in the US Define factors associated with onset of COPD Describe the clinical features

More information

Patient Encounters in the Primary Care Setting

Patient Encounters in the Primary Care Setting Patient Encounters in the Primary Care Setting Carmine D Amico, D.O. Clinical Cases Overview Learning objectives Clinical case presentations Questions for audience participation 1 Clinical Cases Learning

More information

April 2011 CE. Site code # E The Patient With Heart Failure; CPAP as an Intervention

April 2011 CE. Site code # E The Patient With Heart Failure; CPAP as an Intervention April 2011 CE Site code # 107200E-1211 The Patient With Heart Failure; CPAP as an Intervention Prepared by: Lt. Bill Hoover, Medical Officer Wauconda Fire District Reviewed/revised by Sharon Hopkins, RN,

More information

ADVANCED ASSESSMENT Cardiovascular System

ADVANCED ASSESSMENT Cardiovascular System ONTARIO BASE HOSPITAL GROUP QUIT ADVANCED ASSESSMENT Cardiovascular System 2007 Ontario Base Hospital Group ADVANCED ASSESSMENT Cardiovascular System AUTHORS Mike Muir AEMCA, ACP, BHSc Paramedic Program

More information

Note for Jane Doe on 02/10/ Chart 3642

Note for Jane Doe on 02/10/ Chart 3642 Note for Jane Doe on 02/10/2005 - Chart 3642 Consultation was requested by Dr. Smith Chief Complaint (1/1): This 31 year old Caucasian female presents today for evaluation of chest pain. Chest pains HPI:

More information

Exercise Prescription for Patients with CHF

Exercise Prescription for Patients with CHF Exercise Prescription for Patients with CHF LESLIE AYRES, PT, DPT Goals After viewing this presentation the physical therapist will be able to: Discuss and understand the diagnosis of CHF including: Clinical

More information

Estimated 5.7 million Americans with HF. 915, 000 new HF cases annually, HF incidence approaches

Estimated 5.7 million Americans with HF. 915, 000 new HF cases annually, HF incidence approaches Heart Failure: Management of a Chronic Disease Jenny Bauerly RN, CHFN, APRN-BC Heart Failure (HF) Definition A complex clinical syndrome that can result from any structural or functional cardiac disorder

More information

Percussion These 4 techniques are the foundation of the physical exam. Respiration Blood pressure Body

Percussion These 4 techniques are the foundation of the physical exam. Respiration Blood pressure Body 1 Chapter 11: Physical Exam Techniques 2 Introduction Although patient assessment formally starts with the, the physical examination actually begins when you first set eyes on your patient. The purpose

More information

The Causes of Heart Failure

The Causes of Heart Failure The Causes of Heart Failure Andy Birchall HFSN Right heart failure LVSD - HFREF Valve regurgitation or stenosis Dropsy CCF congestive cardiac failure Cor pulmonale Pulmonary hypertension HFPEF LVF Definitions

More information

CongHeartDis.doc. Андрій Миколайович Лобода

CongHeartDis.doc. Андрій Миколайович Лобода CongHeartDis.doc Андрій Миколайович Лобода 2015 Зміст 3 Зміст Зміст 4 A child with tetralogy of Fallot is most likely to exhibit: -Increased pulmonary blood flow -Increased pressure in the right ventricle

More information

HEART FAILURE. Heart Failure in the US. Heart Failure (HF) 3/2/2014

HEART FAILURE. Heart Failure in the US. Heart Failure (HF) 3/2/2014 HEART FAILURE Martina Frost, PA-C Desert Cardiology of Tucson Northwest Medical Center March 2014 Heart Failure in the US Prevalence - ~5 million 650,000 new cases annually 300,000 deaths annually Leading

More information

APPROACH TO CARDIAC HISTORY TAKING. Index

APPROACH TO CARDIAC HISTORY TAKING. Index Christopher Cheung APPROACH TO CARDIAC HISTORY TAKING Index General Presentation...1 2 Table 1 Congenital Heart Conditions...2 Questions to Ask...2 Table 2 PQRSTAAA Mnemonic Approach to Chest Pain...3

More information

2. The heart sounds are produced by a summed series of mechanical events, as follows:

2. The heart sounds are produced by a summed series of mechanical events, as follows: Heart Sounds. Phonocardiography 1 Objectives 1. Phonocardiography - Definition 2. What produces the heart sounds 3. Where to listen for the heart sounds 4. How to record a phonocardiogram 5. Normal heart

More information

CONGESTIVE HEART FAILURE

CONGESTIVE HEART FAILURE CONGESTIVE HEART FAILURE Jassin M. Jouria, MD Dr. Jassin M. Jouria is a medical doctor, professor of academic medicine, and medical author. He graduated from Ross University School of Medicine and has

More information

Cardiac Ausculation in the Elderly

Cardiac Ausculation in the Elderly Cardiac Ausculation in the Elderly 박성하 신촌세브란스병원심장혈관병원심장내과 Anatomy Surface projection of the Heart and Great Vessels Evaluating pulsation Superior vena cava Rt. pulmonary artery Right atrium Right ventricle

More information

Pathophysiology: Left To Right Shunts

Pathophysiology: Left To Right Shunts Pathophysiology: Left To Right Shunts Daphne T. Hsu, MD dh17@columbia.edu Learning Objectives Learn the relationships between pressure, blood flow, and resistance Review the transition from fetal to mature

More information

Simulation 02: 60 Year-Old Man with Wheezing, Hypoxemia (Congestive Heart Failure with Pulmonary Edema) Flow Chart

Simulation 02: 60 Year-Old Man with Wheezing, Hypoxemia (Congestive Heart Failure with Pulmonary Edema) Flow Chart Simulation 02: 60 Year-Old Man with Wheezing, Hypoxemia (Congestive Heart Failure with Pulmonary Edema) Flow Chart Opening Scenario Section 1 Type: IG Section 2 Type: DM Section 3 Type: IG 60 year-old

More information