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CONDITION/DISORDER SYNONYMS
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Heart failure (HF)
Systolic heart failure
Diastolic heart failure
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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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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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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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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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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
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