Heart Failure

Heart Failure - 2017 Update

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7 Table 3. History and Physical Examination in HF (continued) Physical Examination Comments BMI and evidence of weight loss Obesity may be a contributing cause of HF; cachexia may correspond with poor prognosis. Blood pressure (supine and upright) Assess for hypertension or hypotension. Width of pulse pressure may reflect adequacy of cardiac output. Response of blood pressure to Valsalva maneuver may reflect LV filling pressures. Pulse Manual palpation will reveal strength and regularity of pulse rate. Examination for orthostatic changes in blood pressure and heart rate Consistent with volume depletion or excess vasodilation from medications. Jugular venous pressure at rest and following abdominal compression (http://wn.com/Jugular_Venous_ Distension_Example) Most useful finding on physical examination to identify congestion. Presence of extra heart sounds and murmurs S 3 is associated with adverse prognosis in HFrEF. Murmurs may be suggestive of valvular heart disease. Size and location of point of maximal impulse Enlarged and displaced point of maximal impulse suggests ventricular enlargement. Presence of RV heave Suggests significant RV dysfunction and/or pulmonary hypertension. Pulmonary status: respiratory rate, rales, pleural effusion In advanced chronic HF, rales are oen absent despite major pulmonary congestion. Hepatomegaly and/or ascites Usually markers of volume overload. Peripheral edema Many patients, particularly those who are young, may not be edematous despite intravascular volume overload. In obese patients and elderly patients, edema may reflect peripheral rather than cardiac causes. Temperature of lower extremities Cool lower extremities may reflect inadequate cardiac output.

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