Shortness of Breath in Heart Failure

Signs of Shortness of Breath

• Dyspnea on exertion: This is the most common sign of heart failure.

• Orthopnea: Shortness of breath that occurs when lying flat. It’s caused by blood pooling in the lungs when lying down.

• Paroxysmal nocturnal dyspnea: This is a sudden onset of shortness of breath that occurs at night.

What is the Severity of Dyspnea in Heart Failure Patients admitted to the Hospital?

Dyspnea on admission to the hospital due to heart failure is usually class 4.

What Should You Ask When Inquiring About Leg Edema in Heart Failure?

Ask whether edema affects one or both legs to assess the severity of the condition.

What are Other Symptoms Associated with Heart Failure Besides Dyspnea?

Besides dyspnea, heart failure can be accompanied by other symptoms such as:

• Right upper quadrant pain, epigastric pain: This is caused by an enlarged liver.

• Nausea, vomiting, constipation, poor appetite: These are due to liver and gastrointestinal congestion.

• Abdominal pain, distention, blood in stool: These may appear in the late stages of the disease.

Why Does Heart Failure Cause Right Upper Quadrant Pain and Epigastric Pain?

Due to liver enlargement caused by blood congestion in the liver.

Why Does Heart Failure Cause Gastrointestinal Disorders (Nausea, Vomiting, Anorexia, etc.)?

Due to congestion in the liver and gastrointestinal tract.

Why Does Heart Failure Cause Dyspnea (Normally with Increased Heart Rate) But in What Situations Can the Pulse Rate Decrease?

In the following situations, pulse rate may decrease despite shortness of breath due to heart failure:

• Use of medications that slow the heart rate: These drugs decrease the heart rate.

• Hypothyroidism: Hypothyroidism reduces the heart rate.

• Hypokalemia: Low potassium levels can lead to irregular heartbeat.

• Sinus node dysfunction: The sinus node controls the heart rhythm.

What is One of the Contributing Factors to Chronic Dyspnea?

Obesity and abdominal distention are among the contributing factors to chronic dyspnea.

When Assessing a Patient with Dyspnea, What Should You Ask?

You should ask the patient if this is their first episode of dyspnea or if it has been ongoing for some time.

What Sign is Equivalent to Orthopnea?

Coughing when lying down and easing when sitting up is equivalent to orthopnea.

What Should You Ask When Inquiring About Cardiovascular History?

When inquiring about cardiovascular history, you should ask about:

• Hypertension: Hypertension is a risk factor for cardiovascular disease.

• Diabetes mellitus: Diabetes mellitus is a risk factor for cardiovascular disease.

• Kidney disease: Kidney disease can affect heart function.

• Gastrointestinal disorders (abdominal pain, vomiting, anorexia, gastrointestinal bleeding): These symptoms can be associated with cardiovascular disease.

• Asthma, wheezing: Asthma and wheezing can be signs of lung disease.

• Habits: Alcohol, fatty foods, salty foods, sweets, smoking.

• Allergies, lifestyle: These factors can affect cardiovascular health.

• Surgeries: Surgeries can affect cardiovascular health.

Examination Factors to Consider in the Head, Neck, and Chest for Cardiovascular Assessment

• Accessory muscle use, intermittent speech: Indicates oxygen deficiency.

• Prominent neck veins: This could be a sign of heart failure.

• Carotid bruit: Could be a sign of carotid artery stenosis.

• Thyroid gland, cervical lymph nodes: Check thyroid function and lymph node inflammation.

Methods of Lung Examination

• Inspection: Observe the chest.

• Palpation: Touch the chest to check for vibrations.

• Percussion: Tap on the chest to assess the sound.

• Auscultation: Listen to the lungs with a stethoscope to evaluate breathing sounds.

Methods of Heart Examination

• Inspection: Observe the chest.

• Palpation: Touch the chest to check for the heart rate.

• Auscultation: Listen to the heart with a stethoscope to evaluate heart rate and sounds.

What Does a Three-Limb Blood Pressure Check Include When Assessing Chest Pain?

A three-limb blood pressure check includes blood pressure measurements in both arms and one leg to rule out coarctation of the aorta.

Neurological Examination

• Sensory disturbances: Check for numbness, tingling, and crawling sensation.

• Kernig’s sign: Check for hamstring stiffness.

• Paresthesia, deep sensory disturbances: Check for deep sensation, for example, vibration sensation.

How Long Does Chronic Dyspnea Last?

Chronic dyspnea lasts for more than four weeks.

Signs of Right Heart Failure

• Prominent neck veins: Sign of heart failure.

• Leg edema: Sign of heart failure.

Isolated Right Heart Failure

• Clear lungs: Isolated right heart failure does not affect the lungs.

Causes of Acute Dyspnea (3 Heart, 5 Lungs)

• Heart: Acute heart failure, constrictive pericarditis, rapid heart rate, arrhythmias.

• Lungs: Asthma, COPD, pulmonary embolism, upper airway obstruction, anaphylaxis, pneumonia, pneumothorax.

• Acute respiratory muscle paralysis:

Causes of Chronic Dyspnea

• Chronic lung disease: Pulmonary fibrosis, pulmonary hypertension.

• Chronic heart disease: Heart failure, constrictive pericarditis.

• Obesity: Obesity puts pressure on the chest.

• Sedentary lifestyle: A sedentary lifestyle weakens heart and lung function.

• Abnormalities in oxygen transport: Chronic anemia.

Signs of Valvular Heart Disease

• Murmur: A murmur can be a sign of valvular heart disease.

Where Can Angina, Heart Failure, and Myocardial Infarction Occur Without Chest Pain?

Angina, heart failure, and myocardial infarction can occur without chest pain in women, older adults, and diabetics.

What Symptoms May Suggest Pulmonary Embolism in the Absence of Specific Symptoms?

Pulmonary embolism lacks specific symptoms and cannot be ruled out in the presence of symptoms such as:

• Dyspnea:

• Nausea, vomiting:

• Chest pain:

• Leg edema:

When is Dyspnea Most Severe?

Dyspnea is most severe at the onset, then gradually decreases.

What Tests are Used to Rule Out Pulmonary Embolism?

Tests to rule out pulmonary embolism include D-dimer.

What Does a Normal Troponin I Level Rule Out?

A normal troponin I level rules out myocardial infarction.

What is the Normal Range for Troponin I?

The normal range for troponin I is < 0.033.