Physical exam heart failure

(“2-minute” hemodynamic profile; JAMA 1996;275:630 & 2002;287:628)

Physical exam (“2-minute” hemodynamic profile; JAMA 1996;275:630 & 2002;287:628)

• Congestion (“dry” vs. “wet”): ↑ JVP (~80% of the time JVP >10 → PCWP >22)

⊕ hepatojugular reflux: ≥3 cm ↑ in JVP for ≥10–15 sec w/ abdominal pressure Se/Sp 73/87% for RA >8 and Se/Sp 55/83% for PCWP >15 (AJC 1990;66:1002)

Abnl Valsalva response: square wave (↑ SBP w/ strain), no overshoot (no ↑ BP after strain)

S3 (in Pts w/ HF → ~40% ↑ risk of HF hosp. or pump failure death; NEJM 2001;345:574)

Rales, dullness at base 2° pleural effus. (often absent in chronic HF due to lymphatic compensation) ± hepatomegaly, ascites and jaundice, peripheral edema

• Perfusion (“warm” vs. “cold”)

narrow pulse pressure (<25% of SBP) → CI <2.2 (91% Se, 83% Sp; JAMA 1989;261:884);

soft S1 (↓ dP/dt), pulsus alternans, cool & pale extremities, ↓ UOP, muscle atrophy

• ± Other: Cheyne-Stokes resp., abnl PMI (diffuse, sustained or lifting depending on cause of HF), S4 (diast. dysfxn), murmur (valvular dis., ↑ MV annulus, displaced papillary muscles)