Symptoms
"I can't breath when I walk, doc. But I'm ok when sitting."
What is dyspnea?
You place your stethoscope on their back and you hear small popping sounds with inspiration.
What are crackles?
Pt is able to go grocery shopping and can walk around the store for hours without problems. At rest, they feel fine.
What is Class I?
Class I - No limitation of physical activity. Ordinary physical activity does not cause symptoms. No symptoms at rest.
These three medications are used as combination therapy to manage this condition. (pharmacological class)
What are diuretics, angiotensin blockers, and beta-blockers?
"I've started to see some swelling around my lower legs."
What is edema?
You sit the patient at a 45 degree angle and inspect a pulsating mass on their neck.
What is the jugular venous pressure?
Pt has SOB when they go grocery shopping. The SOB occurs towards the end of their grocery shopping trip. Once they rest in their car, they are ok.
What is Class II?
Class II - Slight limitation of physical activity. Ordinary physical activity results in symptoms. No symptoms at rest.
"I can't take this pill during work... I'm spending more time in the bathroom than at my desk!"
What are diuretics?
"Doc, my belly is getting bigger, but I'm actually not eating that much. I don't have much appetite."
What is ascites?
You palpate the apex of the heart lateral to the midclavicular line and on the 6th intercoastal space.
What is displaced point of maximal impulse (PMI)?
Pt is having a hard time grocery shopping. Walking to the store from their car already gives them SOB. Once they get there, they rest at a bench and feel better.
What is Class III?
Class III - Marked limitation of physical activity. Less than ordinary activity causes symptoms. No symptoms at rest.
You must educate your patient about insulin and glucose control when they are taking this medication. A hypoglycemic event can really creep up on them!
What are beta-blockers?
"Last night I started coughing and couldn't breathe after I went to sleep. It happened a few hours into the night."
What is paroxysmal nocturnal dyspnea?
You hear "Lub dub-rab" during your cardiac auscultation. It's a third heart sound in early diastole.
What is S3 gallop?
Pt has SOB at home regardless of physical activity. When they walk their dog, the SOB gets even worse. Even after resting, it doesn't go away.
What is Class IV?
Class IV - Unable to carry on any physical activity. Symptoms at rest. Any physical activity increases severity of those symptoms.
"I've been having this dry cough for a while after starting the treatments. Google said it could be throat cancer. Is that right?"
What are ACE inhibitors?
"I've been getting RUQ pain, doc. But I don't have my gallbladder anymore. Why is that?"
What is hepatic congestion?
You press down on the right upper quadrant and you see an elevation in the jugular venous pressure.
What is hepatojugular reflux?
Pt has severe fatigue after climbing 1 out of 2 sets of stairs. Their apartment is on the third floor. The fatigue resolved after sitting down. Normally, they're able to climb both sets of stairs.
What is Class III?
The patient can't tolerate any of the angiotensin blockers. This combination of meds is a good alternative.
What is hydralazine + nitrate?