Fast Five Quiz: Can You Recognize Subtle and Surprising Signs of Heart Conditions?

Yasmine S. Ali, MD, MSci

Disclosures

July 11, 2017

In mild or moderate heart failure, stroke volume is normal at rest; in severe heart failure, it is reduced, as reflected by diminished pulse pressure and dusky discoloration of the skin. With very severe heart failure, particularly if cardiac output has declined acutely, systolic arterial pressure may be reduced. The pulse may be weak, rapid, and thready; the proportional pulse pressure (pulse pressure/systolic pressure) may be markedly reduced.

Patients with recent onset of heart failure are generally well-nourished, but those with chronic severe heart failure are often malnourished and sometimes even cachectic. Fever may be present in severe decompensated heart failure because of cutaneous vasoconstriction and impairment of heat loss.

Rales heard over the lung bases are characteristic of heart failure of at least moderate severity. With acute pulmonary edema, rales are frequently accompanied by wheezing and expectoration of frothy, blood-tinged sputum. The absence of rales certainly does not exclude elevation of pulmonary capillary pressure due to left ventricular (LV) failure.

For more on the presentation of heart failure, read here.

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