Peri-partum female who p/w 4 days SOB found to have high-output CHF
Dr. Yee-ping Sun | Morning Report | 06/16/2016
Differential for heart failure in a young female with no PMH: - Post-partum (risk factors include multiparity, pre-eclampsia, gestational daibetes, and prior history of post-partum cardiomyopathy); also high risk of spontaneous dissection in this setting - Myocarditis - Genetics/Hereditary - Drugs/Exposures
Posted 06/16/16 10:52:41 AM by Ying Liu
History Findings suggestive of CHF - PND (Paroxysmal nocturnal dyspnea), orthopnea, and LE Edema (least specific)
Physical Exam Findings - S3 --> Low frequency sound (heard best with bell), represents extra flow in LV and a high volume status. Comes after S2 - JVD --> Will likely be high, so start with patient sitting upright and then slowly bring them down.
Hepatojugular Reflex --> push on liver for 10-15 seconds and then let go and vein should remain elevated for another 10-15 seconds after you stop pushing
- LE swelling (least specific)
Posted 06/16/16 11:05:37 AM by Ying Liu
High Output Heart Failure - defined as CHF in a patient with CO >8L/min or CI >3.5 - Low SVR is the final pathway of all causes --> This activates the RAASa nd sympathetic system, leading to fluid retentio and symptoms - Diagnosis with RHC showing "step-up" of PA sat from SVC to RA to RV indicating shunting - Differential:
Shunts (such as splenic shunt in our patient)
Posted 06/16/16 11:08:36 AM by Ying Liu
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