Physical Diagnosis, M-2 Course

Cardiovascular

Merle McAlevy, M.D.

 

OBJECTIVES

Following this lecture, students should have a grasp of the following:

1) The meaning of left-sided heart failure and the importance of diagnosis.

2) Commonly employed history and physical exam findings for diagnosing heart failure and the accuracy of each

3) The difference between systolic and diastolic dysfunction and methods used to distinguish them clinically.

 

CASE PRESENTATION

     A 68-year-old male presents with a two week history of increasing fatigue, weight gain, new onset pedal edema, dyspnea on exertion and a non-productive cough. Past medical history is positive for CAD and an MI three years ago. The CAD has been treated with beta blockers, an ACE inhibitor and daily ASA.

Working Diagnosis: Ischemic heart disease presenting as congestive heart failure

 

CONGESTIVE HEART FAILURE

- A symptom complex, not an etiologic diagnosis

- Right sided heart failure

- Left sided heart failure

- Braunwald's definition: The pathological state in which an abnormality of cardiac function is responsible for failure of the heart to pump blood at a rate commensurate with the requirements of the metabolizing tissues, or to do so only from an elevated filling pressure.

- Classic historical features of chronic, left-sided CHF

- Physical exam findings

- Chronic CHF

- Accuracy of the physical exam in diagnosing CHF (Badgett, et al., JAMA, vol. 277, no. 21, June 4, 1997, pp. 1712-19.)

- Other diagnostic modalities

- Systolic vs diastolic dysfunction

- Summary