0521779407-01 CUNY1086/Karliner 0 521 77940 7 June 4, 2007 20:45
24 Acute Heart Failure➣Cardiogenic shock (1%)
➣High-output failure (1%)
➣Right heart failure (?)
Signs & Symptoms
■Dyspnea: exertional, orthopnea, paroxysmal nocturnal, “cardiac
asthma”
■Non-productive cough
■Reduced exercise capacity
■Generalized weakness and fatigue
■Nocturia, oliguria
■Confusion, poor memory, insomnia, anxiety, headache, delirium
■Nausea, abdominal discomfort, anorexia
■Consistent with underlying or inciting pathophysiology
■General: distressed, dyspneic, pallor, diaphoresis, cardiac cachexia,
jaundice (acute hepatic congestion)
■Vital signs: tachycardia (frequent), hypotension or transient hyper-
tension, narrow pulse pressure, tachypnea, low grade fever.
■Respiratory: rales, pleural effusion, Cheyne-Stokes respiration pat-
tern
■CV: jugular venous distension, hepato/abdominojugular reflux, pul-
sus alternans (severe), cardiomegaly, LV heave, RV lift, soft S1, loud
P2, S3, S4, systolic murmur (functional MR/TR)
■Abd: hepatomegaly, ascites
■Extrem: peripheral, sacral and scrotal edematests
■Basic Blood Tests
➣Often normal, except for other comorbidities, especially indica-
tors of CHF or myocardial infarction
➣Electrolytes: Hyponatremia (dilutional or secondary hyperaldos-
teronism), hypokalemia (diuretic use), hyperkalemia (K-sparing
diuretic, K replacement, renal failure), hypophosphatemia,
hypomagnesemia (diuretics use, alcohol)
➣BUN/ creatinine: Prerenal azotemia
➣Cardiac enzymes: elevated troponin or CK-MB (myocardial
injury)
➣BNP (B-type natriuretic peptide) or nt-pro-BNP: suggestive of
elevated cardiac filling pressures or ventricular wall stress; in
patents with dyspnea, high levels supportive of heart failure
etiology; may be elevated in right-sided heart failure (i.e., cor
pulmonale, pulmonary embolus)