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CONDITION/DISORDER SYNONYMS

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  • Heart failure (HF)

  • Systolic heart failure

  • Diastolic heart failure

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ICD-9-CM CODE

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  • 428 Heart failure

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ICD-10-CM CODES

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  • I50 Heart failure

  • I50.2 Systolic (congestive) heart failure

  • I50.3 Diastolic (congestive) heart failure

  • I50.9 Heart failure, unspecified

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PREFERRED PRACTICE PATTERN

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  • Pattern 6D: Impaired Aerobic Capacity/Endurance Associated With Cardiovascular Pump Dysfunction or Failure 1

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PATIENT PRESENTATION

An 80-year-old female presents with shortness of breath and chest pain with exertion and cough. She states that she has to sleep with four pillows at night or she gets short of breath. She has a history of long-standing hypertension and noncompliance with her medication. Vitals are: Pulse: 120, Respiration: 22, Temperature: 97.8° F, Blood Pressure: 150/80, and SpO2% of 94%. The patient appears diaphoretic with cool pale extremities. There are audible rales in the lungs bilaterally and +2 edema of the legs bilaterally. There is an audible S3 gallop. EKG shows some left ventricular strain. Chest X-ray shows fluid in the bases of the lungs bilaterally and enlargement of the heart. Brain natriuretic peptide (BNP) level in the blood is 500 pg/mL.

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KEY FEATURES

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Description
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  • Heart is unable to produce sufficient cardiac output (CO) to meet demands of the body.

  • HF is a syndrome caused by several pathophysiologic conditions, resulting in left ventricular and/or right ventricular dysfunction (cardiac pump dysfunction).

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Essentials of Diagnosis
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  • EKG/ECG2

  • Echocardiogram

  • Chest X-ray

  • Elevated BNP levels

  • Elevated pulmonary artery catheter readings

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General Considerations
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  • HF is a result of cardiac muscle dysfunction or damage.

  • Education on disease management reduces hospitalization.

  • Vital signs should be monitored before, during, and after exercise.

  • Both aerobic and resistive exercises have shown positive benefits.

  • Signs and symptoms should be monitored.

  • Emphasis on wellness and prevention.

  • Physiologic changes associated with HF.3

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Demographics
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  • Affects three million people in the United States3

  • 400,000 new cases annually3

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CLINICAL FINDINGS

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SIGNS AND SYMPTOMS

  • Left-sided HF

    • Dyspnea on exertion

    • Shortness of breath3

    • Paroxysmal nocturnal dyspnea3

    • Orthopnea3

    • Fatigue, weakness3

    • Crackles

    • S3 heart sound

    • Cold, pale, cyanotic extremities

  • Right-sided HF

    • Weight gain

    • Peripheral edema

    • Jugular venous distention3

    • Hepatomegaly

    • Ascites

    • Fatigue3

    • Cyanosis

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FIGURE 9-1

Drugs used in the treatment of heart failure. Several pharmacologic classes have a combination of physiologic effects and do not fall into a single category. ACE, angiotensin-converting enzyme inhibitors; PDE, phosphodiesterase. Spironolactone is a potassium-sparing diuretic that inhibits the aldosterone receptor in the collecting tubes of the kidney and nonrenal tissue sites. (From Panus PC, Jobst EE, Masters SB, Katzung B, Tinsley SL, Trevor AJ,. Pharmacology for the Physical Therapist. New York, NY: McGraw-Hill; 2009.)

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