Download - Congestive cardiac failure
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Congestive Heart Failure
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Classification
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Generally classified as the following:
• Left vs right failure
• Systolic vs diastolic dysfunction
• Backward vs forward failure
• Low output vs high output cardiac failure
• The degree of functional impairment conferred by the abnormality (as in the NYHA functional classification)
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New York Heart Association Functional Classification
• Class I: No limitation experienced in any activity and no symptoms from ordinary activities.
• Class II: Mild limitation of activity and comfortable at rest or mild exertion
• Class III: Marked limitation of any activity and comfortable only at rest
• Class IV: Any physical activity brings discomfort and symptoms appear at rest
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Signs and symptoms
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Left Sided Failure- Symptoms
Backward Failure: Respiratory compromise
• Dyspnea on exertion• Dyspnea at rest (severe)• Orthopnea (on lying flat)• Paroxysmal nocturnal dyspnea
(cardiac asthma)• Nocturnal cough
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Left Sided Failure- Symptoms
Forward Failure: Poor systemic circulation
• Dizziness• Confusion• Cool extremities at rest• Easy fatigueability• Exercise intolerance
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Right Sided Failure- SymptomsBackward Failure: Congestion of
systemic capillaries
• Excess fluid accumulation in the body
• Peripheral edema/ anasarca• Dependent edema (foot, ankle,
sacral)• Nocturia • Ascites• Liver congestion (hepatomegaly,
jaundice and coagulopathy)
Forward Failure: Hypotension
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Left Sided Failure- Signs
Non specific signs of respiratory distress:
• Tachypnea• Increased work of breathing• Decreased vital capacity Development of pulmonary
edema:• Rales/Crackles – initially at base,
throughout the lung when severe
Extremely severe pulmonary edema:
• Cyanosis (severe hypoxemia)
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Left Sided Failure- Signs
• Laterally displaced apex beat (heart enlargement)
• S3 gallop rhythm (increased blood flow/ increased intra cardiac pressure)
• Heart murmurs- indicative of valvular diseases (Cause or result of heart failure)
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Right Sided Failure- Signs
• Peripheral pitting edema• Hepatomegaly• Jugular venous pulse
accentuated by hepatojugular reflux (marker of fluid status)
• Positive abdominojugular test• Parasternal heave (increased
RV pressure)• Ascites (late onset)
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Ascites
Pitting Edema of Ankle
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Cardiomegaly
Pulmonary Edema
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Biventricular Failure
• Pleural effusions- more common in biventricular failures.
• Unilateral failures cause right sided effusions (large area of right lung)
Signs:• Dullness of lung fields• Reduced breath sounds at lung
bases
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Other signs
• Cardiomegaly
• Weight loss
• Tachycardia (>120 bpm)
• Pink frothy sputum (severe)
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Measuring elevated JVP
Common symptoms of CCF (overview)
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References
• Internet www.wikipedia.org www.wrongdiagnosis.com www.medicinenet.com
• Davidson’s Principles and Practice of Medicine, 20th Ed.
• Harrison’s Manual of Internal Medicine, 17th Ed.
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Thank You