GCS neuro scale LOC E-Eye resp 4 Spontaneous

V- Verbal resp 4 Confused M- Motor 6 Obeys command resp. Disoriented 14/15

+ S4 sound- is a low pitched sound coincident w/ late diastolic filling of Ventr due to atrial contrac’n,t s d
result of vibr’n generated w/in the V, Commonly, indicates inc.resistnce filling

Third heart sound: The normal heartbeat has two sounds made as the heart contracts (pumps blood)
and expands (fills with blood). With heart failure, a third sound becomes apparent: The walls of the
heart's ventricles vibrate when blood fills the heart.

S4 can occur w/ hypertension, systolic& diastolic murmurs can indicate the presence of valvular stenosis
or insufficiency, causing exacerbating heart failure.

Bipedal edema grade 2- least type of pitting edema. The pressure leaves an indentation of 3-4mm that
rebounds in fewer than 5 sec.

Muscle strength of 3.5 on both lower extre-is measured and ranged fro 0 to 5.

0 no musc. Contrac’n, 1- Visible musc. Con w/no or trace movement, 2-Limb movmnt but not agaist
gravity, 3-Movmnt ag grav but not resistance 4-Movmnt against at leastsome resistancesupplied by d
examinr. 5 Full strength

+ hepatojugular vein maybe present in R sided HF

Class 3 HF- Marked limitationin activity due to symptoms, even during less ordinary than ordinary
activity e.g walking 20-100m. Comfortable only at rest

Class 2mild shortness of breath/angina slight limitation.

BNP is a neurohormone secreted from cardiac ventricles a a response to ventricular volume & fluid
overload.

BNP- The level of BNP in the blood increases when symptoms of HF worsen & decreases when symp
improve to stable. Elevation of BNP corelates w/both the severity of th symptoms and the prognosis in
CHF. A level that is greater than 100pg/ml is predictive of HF & inc risk of sudden death & 1 yr. mortality

Heart failure symptoms

Symptoms provide the key to detecting heart failure in its earliest stages

Heart failure symptoms depend on the area of the heart that's damaged or weakened:

 Left-sided heart failure: This is most likely to involve edema (swelling) congestion in the lungs,
accompanied by difficulty breathing.

 Right-sided heart failure: This typically results in edema in the feet, ankles, legs, fingers,
abdomen and abdominal organs. Because a weakened heart cannot pump out enough blood, it
has less room to accommodate blood returning from other parts of the body. Sudden weight
gain resulting from this swelling is common.
While symptoms involving heart failure may be isolated to one area of the body, heart failure effects can
be felt throughout the body and severely impair your quality of life.

Left-sided heart failure indications

Left-sided heart failure is related to pulmonary congestion. The left side of the heart receives oxygen-
rich blood from the lungs. When the left side is not pumping correctly, blood backs up in the blood
vessels of the lungs — pulmonary edema. As blood backs up in the lungs, pressure in the veins of the
lungs increases. Fluids within the lungs are pushed into breathing spaces, interrupting the normal flow
of oxygen.

Related symptoms include:

 Shortness of breath: Shortness of breath often becomes a problem during physical activity, but
also can happen during rest. Difficulty breathing may occur suddenly at night, but may subside
by moving around. Extra pillows to prop up your upper body can help you breathe more easily in
bed.

 Persistent cough: A seemingly unexplained cough produces pink phlegm containing blood.

 Pulmonary crackles: Popping sounds occur when air is forced through lung passages narrowed
by fluid build-up.

 Third heart sound: The normal heartbeat has two sounds made as the heart contracts (pumps
blood) and expands (fills with blood). With heart failure, a third sound becomes apparent: The
walls of the heart's ventricles vibrate when blood fills the heart.

 Reduced urine output: With heart failure, the kidneys cannot function properly. Sodium remains
in the body, causing water retention.

 Low oxygen saturation levels: This results from the heart's inability to receive oxygen-rich blood
from the lungs.

 Altered digestion.

 Dizziness, lightheadedness and confusion.

 Restlessness and anxiety.

 Fatigue and weakness.

Right-sided heart failure indications

Edema (persistent swelling) of the feet, ankles and legs is the most common symptom of heart failure in
the right side of the heart. Edema also can occur in the fingers, abdomen and abdominal organs. Sudden
weight gain resulting from swelling is common.

Other symptoms involving the right side of the heart include:

  Enlargement of the liver.

 Ascites: Excess fluid between the tissues lining the abdomen and abdominal organs.

 Severe loss of appetite, accompanied by abdominal pain and nausea.

 Weakness.

Congestive heart failure (CHF)

What is it?

The term "heart failure" is admittedly scary. Heart failure means simply that the heart does not pump as
well as it normally should. Heart failure is usually classified into two types:

 Heart failure with reduced left ventricular function (HF-rEF)

The lower left chamber of the heart enlarges, and cannot squeeze hard enough to pump the right
amount of oxygenated blood to the body.

 Heart failure with preserved left ventricular function(HF-pEF)

The heart squeezes and pumps normally; however, the bottom chamber is thicker and/or stiffer than a
normal heart. This causes the heart to not be able to relax properly and the heart cannot fill up
completely. Because of the heart’s stiffness, there is less blood passing through, and less blood pump
out to the body.

Heart failure is a chronic, long-term condition that cannot be cured. But it can be managed — through a
doctor-prescribed combination of lifestyle changes, heart medications and surgical treatment.
Symptoms

 Persistent dry cough.

 Shortness of breath.

 Swelling in your ankles, feet, legs, abdomen, or sudden weight gain.

 Fatigue.

 Lack of appetite, nausea.

 Dizziness, confusion, impaired thinking.

 Racing pulse or heart palpitations.

 Some people have none or very mild symptoms of heart failure, and they may come and go. It is
important to let your doctor know of any new or worsening symptoms.

Causes of heart failure

Coronary artery disease.

 Heart attack.

 Cardiomyopathy.

 Congenital heart disease.

 Hypertension (high blood pressure).

 Certain medications such as chemotherapy drugs can lead to heart failure

Coronary artery disease (CAD)

What is it?

CAD occurs when the blood vessels – the coronary arteries – that bring oxygen and nutrients to the
heart muscle become narrowed and/or blocked by fatty deposits called plaques.

This narrowing or blockage can cause the heart to not receive enough oxygen. Under these conditions,
an injury to the heart muscle can occur. This is what is commonly known as a heart attack or myocardial
infarction.

Symptoms of a heart attack.

 Chest pain (angina pectoris).

 Pain or discomfort in arms, shoulders, upper back, neck, jaw or stomach.

 Shortness of breath.
  Nausea or vomiting.

 Extreme fatigue or weakness, especially with exertion.

If you think you are experiencing symptoms of a heart attack, please call 9-1-1 or go to the nearest
emergency room.

Risk factors.

 High levels of fats - cholesterol and triglycerides - in the bloodstream.

 High blood pressure or hypertension.

 Smoking tobacco.

 Diabetes.

Diagnosing CAD

 Complete medical history and physical examination

 EKG

 Blood tests

 Stress test 

 Imaging such as a chest x-ray or a CT scan

 Cardiac catheterization.

Treating CAD.

 Lower your risk by not smoking, eating a healthy diet, and being active.

 Medications.

o Antiplatelets to prevent clotting.

o Anticoagulants also known as blood thinners.

o Antihyperlipidemics to help lower cholesterol levels.

o Antihypertensives to help lower blood pressure.

 Catheter-based interventional procedures (PCI).

 Surgical procedures such as CABG. Understanding heart attacks

 As a large, muscular pump, the heart relies on a constant supply of oxygen-rich blood to
function. Without a blood supply, heart muscle begins to die. This is exactly what happens
during a heart attack.

 Myocardial infarction, the medical term for heart attack, literally means "heart tissue damage or
death." Heart attacks most commonly occur when one or more of the coronary arteries — a
 network of blood vessels that supply blood to the heart — become blocked. Heart muscle
becomes starved for oxygen and nutrients.

 More than 1.2 million Americans suffer a heart attack each year. Approximately one-third of
those who experience heart attack will die from it.

 Fortunately, you can take several steps to prevent heart attack — starting with healthy lifestyle
choices and seeking preventive medical care.

 The leading cause of heart attack

 The leading cause of heart attack is coronary artery disease — narrowing or blockage of the
coronary arteries. This narrowing process is the result of buildup of fatty substances, called
plaques, on artery walls. The medical term for this process is atherosclerosis, which originates
from the Greek words athero (gruel, or paste) and sclerosis (hardness).

 How do plaques form, and how do arteries become clogged? Throughout your life, fats build up
in streaks on artery walls. Our body's natural healing response is to release chemicals that trap
and seal these fatty deposits into place.

 Unfortunately, these chemicals also attract other substances — inflammatory cells, cellular
waste products, proteins and calcium. This is plaque. A hard covering forms around plaque
deposits; on the inside, they can be soft.

 In time, plaque can rupture, exposing a deposit's fatty interior. In response, bloodclotting
particles called platelets will try to re-seal the rupture. As a blood clot forms within a blood
vessel, there's a chance it can block blood flow to the heart, or break away from the blood
vessel and travel to a smaller artery around the heart. The result is heart attack.

 Coronary spasm

 A less common cause of heart attack is a spasm of a coronary artery, when a coronary artery
closes off (constricts) intermittently, greatly diminishing blood supply to the heart muscle. If
coronary artery spasm occurs for a long period of time, a heart attack can occur. It may occur at
rest and can even occur in people without significant coronary artery disease.

 Heart attack treatments

 Several treatments are available for heart attack patients. Among the most common are:

 Angioplasty and stent placement: A thin, flexible catheter is guided along a blood vessel toward
the blocked artery. A tiny balloon is inflated at the catheter's tip, stretching the clogged artery
open and flattening plaque to restore blood flow. To keep the blood vessel open, a stent — a
miniature wire mesh tube — may be placed in the blood vessel.

 Coronary artery bypass surgery: A blood vessel is harvested from another part of the patient's
body and used to go around — or bypass — the blocked coronary artery. Coronary artery bypass
surgery is typically performed on patients who have more severe blockages, or several
blockages.

 Clot-busting drugs: You may be given thrombolytic agents, such as tissue plasminogen activator
(tPA), which dissolve blood clots, reduce the severity of damage to the heart muscle and
ultimately save lives. These drugs are administered by IV drip and do not require surgery.

 Cardiomyopathy

 Carotid artery disease

 Congenital heart disease - Adult

 Congestive heart failure (CHF)

 Coronary artery disease (CAD)

 Heart valve disease

 Hypertension (high blood pressure)

 Peripheral Vascular Disease (PVD)

 Pulmonary hypertension

 Understanding heart attacks

 Varicose veins