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
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