CHF Assessment

Inspection

General Comfort

• SOB, ORTHOPNEA
• FULL SENTENCES

Vitals

• BP (assess CO, ↓ in heart failure)
• PULSE (rate, rhythm, character - normal, small, bounding)
• REPIRATION (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

• LSB → LVH
• subxiphoid → RVH

Palpable Thrill

• same location as auscultation for heart sounds

Peripheral

• Edema
  • sacral, tibial tuberosity
• peripheral pulses

Abdomen

• palpate for tender, 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

Observed structured clinical examination

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