CHF Assessment: Difference between revisions
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==Vitals== | ==Vitals== | ||
*BP (assess [[wikipedia:Cardiac output|Cardiac output]], ↓ in heart failure) | *BP (assess [[wikipedia:Cardiac output|Cardiac output]], ↓ in heart failure) | ||
* | *[[wikipedia:Pulse|Pulse]] (rate, rhythm, character - normal, small, bounding) | ||
* | *[[wikipedia:Respiratory_system#Ventilation|Respiration]] (rate, Cheyne-Stokes) | ||
*pulsus paradoxus - ↓ strength of pulse and systolic BP during inspiration | *'''pulsus paradoxus''' - ↓ strength of pulse and systolic BP during inspiration | ||
**+ in severe asthma and cardiac tamponade | **+ in severe asthma and cardiac tamponade | ||
{{ntnes}} | |||
==Poor Perfusion (Forward Failure)== | ==Poor Perfusion (Forward Failure)== | ||
*↓ LOC | *↓ LOC | ||
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'''Apex beat'''(palpable in ~50% of population) | '''Apex beat'''(palpable in ~50% of population) | ||
* | *Position - normally in 5th ICS MCL | ||
* | *Size < $0.25 | ||
* | *Character (sustained/diffuse, duration) | ||
'''Ventricular heaves''' | '''Ventricular heaves''' | ||
* | *Enlarged apex or laterally displaced → LVH | ||
*subxiphoid → RVH | *subxiphoid → RVH | ||
| Line 40: | Line 40: | ||
===Abdomen=== | ===Abdomen=== | ||
*palpate for | *palpate for tenderness, palpable hepatomegaly (RHF), ascites | ||
==Auscultation== | ==Auscultation== | ||
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==Other OSCE modules== | ==Other OSCE modules== | ||
{{OSCE2}} | {{OSCE2}} | ||
[[Category:Medicine]][[Category:OSCE]] | [[Category: Cardiovascular Medicine]][[Category:OSCE]] | ||
Latest revision as of 23:08, 8 November 2009
Inspection
General Comfort
- SOB, Orthopnea
- Full sentences
Vitals
- BP (assess Cardiac output, ↓ in heart failure)
- Pulse (rate, rhythm, character - normal, small, bounding)
- Respiration (rate, Cheyne-Stokes)
- pulsus paradoxus - ↓ strength of pulse and systolic BP during inspiration
- + in severe asthma and cardiac tamponade
Poor Perfusion (Forward Failure)
- ↓ LOC
- pallor, cold or clammy skin, acrocyanosis
- urine output
JVP
- Kussmaul’s sign - ↑ JVP on inspiration (due to ↓ RA filling: constrictive pericarditis, not readily seen in cardiac temponade)
- HJR
Palpation
Apex beat(palpable in ~50% of population)
- Position - normally in 5th ICS MCL
- Size < $0.25
- Character (sustained/diffuse, duration)
Ventricular heaves
- Enlarged apex or laterally displaced → LVH
- subxiphoid → RVH
Palpable Thrill
- same location as auscultation for heart sounds
Peripheral
- Edema
- sacral, tibial tuberosity
- peripheral pulses
Abdomen
- palpate for tenderness, palpable hepatomegaly (RHF), ascites
Auscultation
- Heart Sounds
- S3, S4, murmurs (MR due to mitral annular dilation from a dilated heart)
- Lung (with patient sitting upright)
- ↓ A/E, crackles, dullness to percussion, bronchial breath sounds → pulmonary edema or effusion
Other OSCE modules
Acute Confusion - Acute Coronary Syndrome Orders - Anemia - Arterial Blood Gasses - Asthma - Blood Pressure - Chest pain - Chest XRay - CHF - Coma - COPD - Cranial Nerves - Diabetic History - Diabetic Foot - Dysphagia - EKGs - Gallbladder and Liver - Liver Disease - Gait and Balance - Headache - Hematemesis - Hypertension - Jugular Venous Pulses - Knee Exam - Lymph Nodes - Community Acquired Pneumonia - Parkinson Disease - Peripheral Arterial Insufficiency - Pneumonia Examination - Precordial Exam - STD's - Spleen - Swollen Leg Exam - Thyroid Exam - Upper vs Lower Motor Neuron Lesions - Urinary Incontinence