C.

clinical manifestation chronic hearth failure

1. Fatigue
Fatigue is one of the earliest symptoms of chronic HF. The patient notice
fatigue after usual activities and eventually limits these activities. The fatigue is
caused by decreased CO, impaired perfusion to vital organs, decreased oxygenation
of the tissues and anemia. Anemia can result from poor nutrition, renal desease, or
drug therapy (e.g.,angiotensin-converting enzyme [ACE] inhibitor)
2. Dyspnea
Dyspnea (shorthness of breath) is a common manifestation of chronic HF. It is
caused by increased pulmonary preasure secondary to intestitial and alveolar edema.
Dyspnea can occur with mild exertion or at rest. Orthopnea is shorthness of breath
that occurs when the patient is in a recumbent position. Paroximal noctural
dyspnea (PND) occur when the patient is a sleep. It si causd by the reabsorbtion of
fluid from dependent body areas when the patient is recumbent. The patient awakens
in a panic, has feelings of suffocation, an has a strong desire to seek relief by sitting
up. Careful questioning of patient often reveals adaptive behavior such as sleeping
with two or more pillows to aid breathing. Because there a increased pulmonary
preassure and fluid accumulation in the lung tissues, the patient may have a
persistent,dry cough, unrelieved with position change or over the counter cough
suppressant. A dry, hacking cough may be the first clinical symptoms of HF.
3. Tachycardia
Tachycardia is an early sign of HF. One of the bodys first mechanisms to
compensate for a failing ventricle is to increase the HR. Because of diminished CO,
there is increased SNS stimulating, which increases HR. How ever, this respond
may be blocked or reduce in patient taking -blocker medications.
4. Edema
Edema is common sign of HF. It may occur indepenent body areas(peripheral
edema), liver ( hepatomegaly), abdominal cavity(ascites), and lungs ( pulmonary
edema and pleural effution). If the patient is in bed,sacral and scrotal edema may
depeloved. Pressing the edematous skin with the finger may leave a transient
indentation (fitting edema). The depelovment of dependent edema or a suddent
weight gain of more than 3 lb(1.4 kg) in 2 days is often indicativeof exacerbated HF.
It is important to note that not all lowerextremity edema is a result of HF.
Hypoproteinemia, immobility,venous insufficiency, and certain medication can cause
peripheral edema.
5. Nocturial

A person whit chronic HF who has decreased CO will also have impaired
renal perfusion and decreased urinaria output during the day. However, when the
person lies down at night, fluid movemant from interstitial space back into the
circulatory system is anhanced. This caused increased renal blood flow and diuresis.
The patient may complain of having to void 6 or 7 times during the night

6. Skin changes
Because tissues capillary oxygen extraction is increased in a person with
chronic HF, the skin may appear dusky. It may also be cool and damp to the touch
from diaphoresis. Often the lower extremitiesare shiny and swollen, whit dimished
or absent hair growth. Chronic swelling may result in pigment changes causing the
skin to appear brown or brawny in areas covering the ankles and lower legs.
7. Behavioral changes
Cerebral circulation may be impaired whit chronic HF secondary to decreased
CO. The patient or caregiver may report unusual behavior, including restlessness,
confusion, and decreasead attentionspan or memory. This may also be secondary to
poor gas exchange worsening HF.
8. Chest pain
HF can precipitate chest pain due to decreased coronary perfussion from
decreased CO and increased miocardial work. Angina type pain may accompaany
either ADHF or chronic HF.
9. Weight changes
Many factors contribute to weight changes. Initially there may be a
progressive weight gain from fluid retention. However, over time the patient is often
too sick to eat. Abdominal fullness fromm ascites and hepatomegaly frequently
causes anorexia and nausea. Renal failure may also contribute to fluid retention. In
many cases the muscle and fat loss is masked by the patients edematous condition.
The actual weight loss may not be apparent until after the edema subsides