Congestive Heart Failure
Jahangir Moini, Matthew Adams, Anthony LoGalbo in Complications of Diabetes Mellitus, 2022
RV failure is signified by foot and ankle nontender peripheral pitting edema, in which pressure by the examiner’s fingers leaves imprints that are visible and palpable, and may be very deep. The liver is enlarged and may be pulsatile, and is palpable below the right costal margin. Abdominal swelling and ascites develop. The jugular venous pressure is elevated. An increased jugular venous pressure during inspiration is known as the Kussmaul sign, which indicating right-sided HF. If the liver is congested, it may be enlarged or tender. Hepatojugular or abdominal-jugular reflux may be present. Auscultation can detect murmur of tricuspid regurgitation or the RV third heart sound of the left sternal border. These findings are both changes during inspiration.
Shock
Philip Woodrow in Nursing Acutely Ill Adults, 2015
Cardiogenic shock occurs when more than two fifths of the left ventricle is damaged (Von Rueden et al., 2013). Damage may be from dead, ischaemic or oedematous muscle. Left ventricular failure (low stroke volume and ejection fraction) cause congestive cardiac failure, pulmonary oedema, and therefore impaired oxygenation. Venous overload causes raised jugular venous pressure. Typically, attempted compensatory tachycardia increases myocardial oxygen demand at the same time as oxygen supply is reduced, making a second infarction likely. At least 40% of left ventricular myocardium already being non-functional, further damage usually results in insufficient functional left ventricular myocardium, and rapid death (Hinds and Watson, 2008).
Clinical management
Alistair Burns, Michael A Horan, John E Clague, Gillian McLean in Geriatric Medicine for Old-Age Psychiatrists, 2005
Markedly abnormal vital signs (temperature, pulse, blood pressure) are ominous features in a very breathless patient, indicating the urgency with which the patient needs to be transferred to the acute medical service or accident and emergency (A&E) department. Listen to the lung fields for crackles or wheezes. Wheezing usually indicates asthma, but is common in patients with chronic obstructive pulmonary disease (COPD). Diminished breath sounds on only one side of the chest suggest pneumothorax, a large pleural effusion or lung collapse. In heart failure, pulmonary embolus and pericardial tamponade, the jugular venous pressure will often be obviously raised.
Management of fluid status and cardiovascular function in patients with diffuse skin inflammation
Published in Journal of Dermatological Treatment, 2019
Arash Taheri, Amanda D. Mansouri, Parisa Mansoori, Rahimullah Imran Asad
Acute respiratory distress syndrome should be a differential diagnosis of cardiogenic pulmonary edema in patients with widespread skin inflammation, especially erythrodermic psoriasis (20–23). Acute respiratory distress syndrome is a form of diffuse alveolar injury and is not secondary to increased intravascular volume or heart failure. Clinically, jugular venous pressure is not high in these patients. This syndrome is much rarer than cardiogenic pulmonary edema in general and in patients with erythroderma specifically. Although such patients do not respond to diuresis as well as patients with cardiogenic pulmonary edema, they are very sensitive to increased pulmonary vascular pressure and may worsen rapidly if there is rapid migration of fluid into the intravascular space (24–26). Treatment of these patients should be started as soon as possible in an intensive care unit with possible intubation and mechanical ventilation.
Hydralazine-induced pericardial effusion
Published in Baylor University Medical Center Proceedings, 2019
Mohammed Faisal Rahman, Muhammad Ajmal Panezai, Harold M. Szerlip
His blood pressure was 114/62 mm Hg; pulse, 79 beats/min; respiratory rate, 20 breaths/min; temperature, 97.5°F; and oxygen saturation, 100% in ambient air. The lungs were clear to auscultation. His jugular venous pressure was estimated to be 8 to 10 cm H2O. His heart sounds were audible, with prominent S4 and no murmur. The liver was extended 4 to 5 cm below the right costal margin. There was 1+/4+ lower-extremity edema. The hemoglobin was 7 mg/dL (from a baseline of 9 mg/dL); blood urea nitrogen, 61 mg/dL; creatinine, 8.6 mg/dL; total bilirubin, 1.7 mg/dL; alkaline phosphatase, 278 mg/dL; albumin, 2.9 g/dL; total protein, 7.2 g/dL; serum iron, 59 μg/dL; percent saturation, 44%; ferritin, 2300 ng/mL; and thyroid-stimulating hormone, 1.24 IU/mL. White cell and platelet counts, serum electrolytes, and transaminases were normal, and troponin, serum markers for hepatitis B and hepatitis C infection, and interferon gamma release assay were negative. The erythrocyte sedimentation rate was significantly elevated at 140 mm/h. Antihistone antibody was positive, but ANA was negative. Other autoantibodies were not checked due to negative ANA. Chest x-ray showed an enlarged cardiac silhouette (Figure 1a). Transthoracic echocardiography revealed an ejection fraction of 65% and a large circumferential pericardial effusion without evidence of tamponade (Figure 1b).
Limited value of NT-proBNP as a prognostic marker of all-cause mortality in patients with heart failure with preserved and mid-range ejection fraction in primary care: A report from the swedish heart failure register
Published in Scandinavian Journal of Primary Health Care, 2019
Björn Eriksson, Per Wändell, Ulf Dahlström, Per Näsman, Lars H. Lund, Magnus Edner
The Swedish Heart Failure Registry (SwedeHF) has previously been described in detail [22]. Unselected patients with HF are prospectively registered in PC and in HC at an out-patient visit, or on discharge from hospital. The inclusion criterion is clinician-judged HF. This is based on typical symptoms (e.g. breathlessness, ankle swelling and fatigue) and findings (e.g. elevated jugular venous pressure, pulmonary crackles and peripheral edema). However, diagnosis based only on this is uncertain and should be confirmed with echocardiography. We have therefore chosen, in our study, to include only patients who had undergone echo, especially since we wanted to find patients with EF ≥40% that can only be measured with echo. Approximately 80 variables are recorded and entered into a web-based database managed by Uppsala Clinical Research Center (Uppsala, Sweden). The protocol, registration form and annual reports are available at http://www.rikssvikt.se. Individual patient consent is not required but patients are informed of entry into the national registry and allowed to opt out. The registry and this study were approved by a multisite ethic committee (Dnr 2013/444-32) and conform to the Declaration of Helsinki.
Related Knowledge Centers
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