CARDIAC FAILURE

CHIEF COMPLAINT

Left heart failure

Right heart failure

HPI

SYMPTOMS

Left sided failure

• Dyspnea on exertion
• Dyspnea at rest
• Easy fatigueability
• Exercise intolerance
• Orthopnea
• Paroxysmal nocturnal dyspnea
• Dizziness
• Confusion
• Diaphoresis
• Cool extremities at rest

Right sided failure

• peripheral edema /anasarca

• Nocturia
• Ascites
• Hepatomegaly

SEVERITY
• Mild
• Moderate
• Severe
• Absent
• Normal
• Increased
• Decreased
• Stable
• no significant change from prior visit
HISTORY (PMFSH)

PAST HISTORY

Hypertension (high blood pressure)

Aortic and mitral valve disease
Aortic coarctation
Pulmonary hypertension
Pulmonary or tricuspid valve disease
Ischemic heart disease
Chronic arrhythmias
Atrial fibrillation
Cardiomyopathy
Cardiac fibrosis
Chronic severe anemia
Hyperthyroidism
Hypothyroidism

ALLERGY-Drugs
-Environment

FAMILY HISTORY
• Hypertension
• Diabetes
• Heart diseases

SOCIAL History

Habits
• Alcohol
• Tobacco
• Drugs ____
Occupation_____

ROS

PHYSICAL EXAMINATION

SPECIFIC DATA LIKE GRADING ETC

The New York Heart Association Functional Classification

• Class I: no limitation is experienced in any activities; there are

no symptoms from ordinary activities.
• Class II: slight, mild limitation of activity; the patient is
comfortable at rest or with mild exertion.
• Class III: marked limitation of any activity; the patient is
comfortable only at rest.
• Class IV: any physical activity brings on discomfort and
symptoms occur at rest.

American Heart Association four stages of heart failure

• Stage A: a high risk HF in the future but no structural heart

disorder;
• Stage B: a structural heart disorder but no symptoms at any
stage;
• Stage C: previous or current symptoms of heart failure in the
context of an underlying structural heart problem, but managed
with medical treatment;
• Stage D: advanced disease requiring hospital-based support, a
heart transplant or palliative care.

TESTS TO BE ORDERED

•Blood tests
• CBP
• Hb%
• Heamotocriet value
• Serum electrolytes
• Renal function tests
• Liver function tests
• Thyroid function tests
• C-reactive protein
• B-type natriuretic peptide (BNP)
• N-terminal pro-BNP (NTproBNP)
• FBS
• PLBS
• RBS
•Urinalysis
o Macroscopic
  Urine Bilirubin
 Urine Blood
 Urine Casts
 Urine Color
 Urine Glucose
 Urine Ketones
 Urine pH
 Urine Protein
 Specific Gravity
 Urine Urobilinogen
o Microscopic
 Urine WBS/hpf
 Urine RBC/hpf
 Urine Casts
 Urine Other

•Chest X-ray
•USG abdomen
•ECG/EKG
•Echocardiography
•Angiography

ASSESSMENT/PLAN & INSTRUCTIONS/EDUCATION

Diet and lifestyle measures

• Moderate physical activity, when symptoms are mild or
moderate; or bed rest when symptoms are severe.
• Weight reduction
• Monitor weight
• Sodium restriction is recommended for patients with CHF
• Fluid restriction

Devices

• Cardiac resynchronization therapy

• An implantable cardioverter-defibrillator (ICD)
• Left ventricular assist devices (LVADs)

Surgery

• Heart transplantation
• Temporary or prolonged implantation of an artificial heart
approach
MEDICATION

• Furosemide
• Bumetanide
• Hydrochlorothiazide
• Chlorthalidone
• Chlorthiazide
• Amiloride
• Spironolactone
• Eplerenone
• Bisoprolol
• Carvedilol
• Metoprolol
• Digoxin
• Dobutamine
• Milrinone
• Isosorbide dinitrate
• Hydralazine
• Spironolactone
• Eplerenone
• Nesiritide
• Tolvaptan
• Conivaptan

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