Fast Five Quiz: Test Your Knowledge on Key Aspects of Heart Failure

Yasmine S. Ali, MD, MSCI

Disclosures

February 08, 2021

Systemic venous hypertension is manifested by jugular venous distention. Normally, jugular venous pressure declines with respiration; however, it increases in patients with HF, a finding known as the Kussmaul sign (also found in constrictive pericarditis). This reflects an increase in right atrial pressure and, therefore, right-sided HF. In general, elevated jugular venous pressure is the most reliable indicator of fluid volume overload in older patients, and thorough evaluation is needed.

Fundamental causes include biochemical and physiologic mechanisms, through which myocardial contraction is impaired by either an increased hemodynamic burden or a reduction in oxygen delivery to the myocardium.

Protodiastolic (S3) gallop is the earliest cardiac physical finding in decompensated HF in the absence of severe mitral or tricuspid regurgitation or left-to-right shunts. The presence of an S3 gallop in adults is important, pathologic, and often the most apparent finding on cardiac auscultation in patients with significant HF.

The following may occur in elderly patients with advanced HF, particularly in those with cerebrovascular atherosclerosis:

  • Confusion

  • Memory impairment

  • Anxiety

  • Headaches

  • Insomnia

  • Bad dreams or nightmares

  • Rarely, psychosis with disorientation, delirium, or hallucinations

Nocturia may occur relatively early in the course of HF. Recumbency reduces the deficit in cardiac output in relation to oxygen demand, renal vasoconstriction diminishes, and urine formation increases. Nocturia may be troublesome for patients with HF because it may prevent them from obtaining much-needed rest. Oliguria is a late finding in HF, and it is found in patients with markedly reduced cardiac output from severely reduced left ventricular (LV) function.

Learn more about the presentation and physical examination of patients with HF.

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