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Ma. Arnee V. Anico-Tondo,M.D., FPCP (CGH)
The diagnosis of heart failure in ambulatory patients derives from attention to:
THREE basic elements of the HISTORY SIX elements of the PHYSICAL EXAMINATION
1. Dyspnea at one flight of stairs 1. Displaced apex beat
2. Orthopnea 2. Rales
Dyspnea occurring in recumbent position 3. An irregularly irregular pulse
3. Paroxysmal nocturnal dyspnea (of cardiac origin) 4. A heart murmur suggestive of MR
Usually occurs 2 to 4 hours after onset of sleep 5. A heart rate greater than 60 beats/min
Dyspnea is of sufficient severity to compel the patient 6. An elevated jugular venous pressure (JVP)
to sit upright or stand and then subsides gradually over
several minutes
THE HISTORY
Major signs and symptoms associated with cardiac disease include:
Chest discomfort
quality, location, radiation, triggers, mode of onset, and duration
Dyspnea
Fatigue
Edema
Palpitations
Syncope
Platypnea Dyspnea occurring in standing position
Pulmonary embolism often is associated with dyspnea of sudden onset
The likelihood of a cardiac arrhythmia modestly increases with a known history of cardiac disease (LR, 2.03; 95% CI, 1.33 to
3.11) and decreases when symptoms resolve within 5 minutes (LR, 0.38; 95% CI, 0.22 to 0.63) or when associated with panic
disorder (LR, 0.26; 95% CI, 0.07 to 1.01)
Likelihood that atrioventricular nodal Regular, rapid-pounding sensation in the neck (LR, 177; 95% CI, 25 to 1251)
reentrant tachycardia (AVNRT) is the Visible neck pulsations associated with palpitations (LR, 2.68; 95% CI, 1.25 to 5.78)
responsible arrhythmia
Cardiac syncope Occurs suddenly, with rapid restoration of full consciousness thereafter
Neurocardiogenic syncope May experience an early warning sign (nausea, yawning)
Appear ashen and diaphoretic
Revive more slowly, albeit without signs of seizure or a prolonged postictal state
(altered state of consciousness after an epileptic seizure)