CHF Assessment (OSCE)

Inspection

General Comfort

• SOB, Orthopnea
• Full sentences

Vitals

• BP (assess Cardiac output, ↓ in heart failure)
• Pulse (rate, rhythm, character - normal, small, bounding)
• Respiration (rate, Cheyne-Stokes)
• pulsus paradoxus - ↓ strength of pulse and systolic BP during inspiration
  • + in severe asthma and cardiac tamponade

Poor Perfusion (Forward Failure)

• ↓ LOC
• pallor, cold or clammy skin, acrocyanosis
• urine output

JVP

• Kussmaul’s sign - ↑ JVP on inspiration (due to ↓ RA filling: constrictive pericarditis, not readily seen in cardiac temponade)
  • HJR

Palpation

Apex beat(palpable in ~50% of population)

• Position - normally in 5th ICS MCL
• Size < $0.25
• Character (sustained/diffuse, duration)

Ventricular heaves

• Enlarged apex or laterally displaced → LVH
• subxiphoid → RVH

Palpable Thrill

• same location as auscultation for heart sounds

Peripheral

• Edema
  • sacral, tibial tuberosity
• peripheral pulses

Abdomen

• palpate for tenderness, palpable hepatomegaly (RHF), ascites

Auscultation

• Heart Sounds
  • S3, S4, murmurs (MR due to mitral annular dilation from a dilated heart)

• Lung (with patient sitting upright)
  • ↓ A/E, crackles, dullness to percussion, bronchial breath sounds → pulmonary edema or effusion