Lecture on Heart Failure

Left Ventricular Failure

Respiratory Signs: Increased respiratory rate (tachypnea) is a primary sign.
Cardiovascular Assessments:
- History of angina.
- Jugular vein distension.
- Increased heart rate.
- Blood pressure changes: Decreased systolic, increased diastolic.
- Heart Sounds:
  - S3 (ventricular gallop): Indicates rapid passive ventricular filling, sounds like "Kentucky."
  - S4 (atrial gallop): Indicates non-compliant ventricles, sounds like "Tennessee."
- Echocardiogram: Preferred for assessing ventricular wall movement, valves, and ejection fraction.
Other Indicators:
- Edema, cardiomegaly, weight gain (monitor trends).
- Fatigue due to inadequate tissue perfusion.
- Positional dizziness, diaphoresis, pallor, circumoral and peripheral cyanosis.

Causes: Often linked to pulmonary diseases such as COPD, interstitial lung disease, pulmonary hypertension, etc.
Symptoms:
- Dependent or generalized peripheral edema.
- Jugular vein distension.
- Weight gain, fatigue, cyanosis (look for bluish nail beds), anorexia, nausea.
- Chronic signs may include hepatomegaly and splenomegaly.

Electrocardiogram (ECG/1280KG):
- Useful for identifying ischemia, infarction, hypertrophy, arrhythmias (25% may have atrial fibrillation).
- Axis deviation can be seen on an EKG.
Chest X-Ray: Often reveals heart enlargement.
Echocardiogram: Essential for diagnosing heart failure, checking ventricular function, and valves.

B-Type Natriuretic Peptide (BNP):
- Released due to ventricular stress from volume/pressure overload.
- Indicates chronic fluid overload.
- Normal values:
  - Under 100 is typical.
  - 450 and up is considered high for individuals 50+.
  - Extremely high levels (>78,000) reflective of long-standing hypervolemia.

Heart Failure Impact: Affects multiple organs due to reduced cardiac output.
Progression: Left or right-sided heart failure can lead to global heart failure.
Management: Echocardiogram and monitoring trends in symptoms and laboratory markers are crucial for management.