CHF Assessment (OSCE)

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Inspection[edit]

General Comfort

Vitals[edit]

  • 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)[edit]

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

JVP[edit]

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

Palpation[edit]

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[edit]

  • Edema
    • sacral, tibial tuberosity
  • peripheral pulses

Abdomen[edit]

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

Auscultation[edit]

  • 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

Other OSCE modules[edit]