DOCSLIB.ORG

Clinical Assessment in Acute Heart Failure

Total Page：16

File Type：pdf, Size：1020Kb

Download full-text PDF Read full-text
Clinical Assessment in Acute Heart Failure Hellenic J Cardiol 2015; 56: 285-301 Review Article Clinical Assessment in Acute Heart Failure 1 2 NIKOLAOS S. KAKOUROS , STAVROS N. KAKOUROS 1University of Massachusetts, MA, USA; 2Cardiac Department, “Amalia Fleming” General Hospital, Athens, Greece Key words: eart failure (HF) is defined as “a clear precipitant or trigger. It is very im­ Heart failure, complex clinical syn drome that portant to establish the precipitating diagnosis, physical examination, H can result from any structural or causes, which may have therapeutic and congestion. functional cardiac disorder that impairs the prognostic implications. Approximate­ ability of the ventricle to fill with, or eject ly 60% of patients with AHF have doc­ blood.” HF has an estimated overall prev­ umented CAD. Myocardial ischemia in alence of 2.6%. It is becoming more com­ the setting of acute coronary syndromes mon in adults older than 65 years, because is a precipitant or cause, particularly in of increased survival after acute myocar­ patients presenting with de novo AHF.4 dial infarction (AMI) and improved treat­ AHF is also often precipitated by medica­ ment of coronary artery disease (CAD), tion and dietary non­compliance, as well val vular heart disease and hypertension.1 as by many other conditions, which are Acute HF (AHF) is an increasingly com­ summarized in Table 1. Once the diagno­ mon cause of hospitalizations and mortality sis of AHF is confirmed, initial therapy in­ worldwide. In the majority of patients, AHF cludes removal of precipitants; if this can Manuscript received: can be attributed to worsening chronic HF, be carried out successfully, the patient’s August 25, 2014; and approximately 40­50% of this group have subsequent course may be stable. Accepted: a preserved ejection fraction. The remaining Approximately 80% of AHF admis­ November 13, 2014. cases present with de novo AHF, often sec­ sions initially present to the emergency ondary to acute coronary syndromes.2 department. Patients usually arrive with Address: Symptoms are predominantly the result the classic symptoms (e.g. dyspnea, fa­ Stavros N. Kakouros of systemic and pulmonary congestion due tigue) or signs (e.g. peripheral edema) of to elevated left ventricular (LV) filling pres­ HF. It is critical to establish the diagnosis 26, Paritsi St. sures. Signs and symptoms usually improve of AHF early, as delays in diagnosis and 15451 Athens, Greece 5 [email protected] markedly during hospitalization; however, treatment may lead to worse outcomes. mortality during that period remains high, The immediate assessment of patients ranging from 5­15%. Of those patients who presenting with AHF should include a survive to discharge, a further 10­15% will thorough history and physical examination die within 3 months. Most patients have that should be complemented by ECG, one or more serious comorbid conditions chest X­ray and the necessary initial labo­ that contribute to a poor outcome.3 ratory investigations (Table 2). Echocar­ diography is most useful in patients with 6 Initial assessment and phenotype suspected HF, when it is available. Es­ classification tablishing the HF diagnosis, according to ESC guidelines, requires the conditions In patients with AHF, there is often a shown in Table 3.2 (Hellenic Journal of Cardiology) HJC • 285 N.S. Kakouros, S.N. Kakouros Table 1. Common precipitants of hospitalization for acute heart failure. Acute coronary syndrome Cardiac tamponade Uncontrolled hypertension Acute pulmonary embolism Tachyarrhythmia / bradyarrhythmia Aortic dissection Concurrent infections Anemia Exacerbation of COPD or asthma Alcohol abuse Renal dysfunction Peripartum Thyroid dysfunction Perioperative problems Dietary and medication non­compliance Drugs (NSAID, corticosteroid, negative inotropic agents, illicit drugs) COPD – chronic obstructive pulmonary disease; NSAID – nonsteroidal anti­inflammatory drugs. Table 2. Immediate Emergency Department assessment of heart Table 3. Diagnostic requisites for heart failure (ESC HF Guide­ failure. lines 2012). History HF with reduced EF Symptoms typical of HF Clinical examination Signs typical of HF ECG Reduced EF HF with preserved EF Symptoms typical of HF Chest X­ray Signs typical of HF Initial laboratory studies: Normal or only mildly reduced Blood biochemistry LVEF and LV not dilated Cardiac biomarkers Relevant structural heart disease Natriuretic peptides (LV hypertrophy, LA enlargement) Markers of renal impairment and/or diastolic dysfunction Oxygen saturation EF – ejection fraction; HF – heart failure; LA – left atrium; LV – left Echocardiogram (portable echo) ventricle. Once the diagnosis of AHF has been made, pa­ are predominantly the result of systemic and pulmo­ tients may be broadly categorized into phenotypes of nary congestion due to elevated LV filling pressures. hypertensive AHF, acute coronary syndrome (ACS), Patients with AHF may present insidiously or acutely, right HF, high­output HF, pulmonary edema, and with a spectrum of clinical severity ranging from in­ cardiogenic shock (Figure 1).7 The Killip classifica­ creasing dyspnea to acute pulmonary edema or car­ tion is valid in acute de novo HF after AMI, and is diogenic shock.2 Severity at presentation does not al­ used in coronary care and intensive care units. It is ways correlate well with long­term prognosis. Patients designed to provide a clinical estimate of the severity presenting with pulmonary edema due to severe hy­ of myocardial derangement in the treatment of AMI pertension and normal LV systolic function may have (Table 4).8 an excellent prognosis. In contrast, patients present­ ing with only moderate dyspnea and severe LV dys­ Clinical evaluation of severity and congestion function, may have high mortality. Overall, however, patients demonstrating clinical or hemodynamic con­ HF is characterized by dyspnea, fatigue and signs of gestion have been shown to have significantly worse volume overload, which may include peripheral ede­ rates of mortality and HF rehospitalization.9 Clinical ma and pulmonary rales. These symptoms and signs congestion in HF is defined as a high left ventricular Table 4. Killip classification. Stage I No heart failure. No clinical signs of cardiac decompensation Stage II Heart failure. Diagnostic criteria include rales, S3 gallop and pulmonary venous hypertension. Pulmonary congestion with wet rales in the lower half of the lung fields Stage III Severe heart failure. Frank pulmonary edema with rales throughout the lung fields. Stage IV Cardiogenic shock. Signs include hypotension (systolic blood pressure ≤90 mmHg) and evidence of peripheral vasoconstriction, such as oliguria, cyanosis and diaphoresis. 286 • HJC (Hellenic Journal of Cardiology) Clinical Assessment in Acute Heart Failure Pulmonary edema (chest X-ray, dyspnea and typically O2sat<90%) Cardiogenic shock Tissue hypoperfusion Hypertensive AHF 180/100 mmHg Hypotension Pulmonary congestion Tachycardia and HFPEF Reduced urine output Acute HF De Novo HF or Decompensated Chronic HF ACS High output HF Myocardial ischemia Adequate perfusion Angina Tachycardia Cardiac enzymes, MR Pulm. congestion ± reduced EF Right HF JVD, Edema, ± Signs of LHF Figure 1. Clinical phenotypes at presentation of acute heart failure (AHF). JVD – jugular vein distension; MR – mitral regurgitation; LHF – left heart failure. diastolic pressure (LVDP) associated with signs and tion, body weight, serum sodium, natriuretic peptides, symptoms of HF, such as rales, dyspnea, orthopnea, chest X­ray and others. paroxysmal nocturnal dyspnea and edema. Eleva­ Relying on a limited set of physical examination tion of LVDP in HF patients, without overt clinical findings alone is associated with low sensitivity and congestion, has been termed “hemodynamic conges­ poor predictive value in identifying hemodynamic tion”. Often, hemodynamic congestion precedes clini­ congestion. In a study of patients with chronic HF, cal congestion by days or even weeks. In chronic HF, physical signs of congestion (rales, edema, and jugu­ even severe hemodynamic congestion rarely causes lar venous distension [JVD]), were absent in 42% of rales and/or radiographic pulmonary edema.10 This patients with a measured pulmonary capillary wedge may be related to several adaptive pathophysiologi­ pressure (PCWP) ≥22 mmHg, and the combination cal changes, such as an increase in alveolar capillary of these signs showed only a 58% sensitivity in detect­ membrane thickness, increased lymphatic drainage, ing elevated PCWP.9 In another study of chronic HF and/or pulmonary hypertension. patients, the presence of JVD, when measured care­ The gold standard for evaluating hemodynamic fully, had the best combination of sensitivity (81%), congestion in HF patients is cardiac catheterization; specificity (80%), and predictive accuracy (81%) for however, its invasive nature limits its routine use in detection of an elevation in PCWP (≥18 mmHg).11 clinical practice. Numerous tools are available for the Ultrasonography of the lungs using an echocardio­ assessment of congestion, including physical examina­ graphic probe is another potentially useful way to as­ (Hellenic Journal of Cardiology) HJC • 287 N.S. Kakouros, S.N. Kakouros sess pulmonary congestion. Thoracic impedance mea­ medical history (e.g. a potential cause of cardiac dam­ surement, using external or implanted devices, has age), whereas, conversely, certain features, particu­ been investigated in recent years in assessing conges­ larly previous AMI, greatly increase the likelihood of tion.12 Measuring the lead
Load more

Recommended publications
  • International Journal of Medical and Health Sciences
    International Journal of Medical and Health Sciences Journal Home Page: http://www.ijmhs.net ISSN:2277-4505 Review article Examining the liver – Revisiting an old friend Cyriac Abby Philips1*, Apurva Pande2 1Department of Hepatology and Transplant Medicine, PVS Institute of Digestive Diseases, PVS Memorial Hospital, Kaloor, Kochi, Kerala, India, 2Department of Hepatology, Institute of Liver and Biliary Sciences, D-1, Vasant Kunj, New Delhi, India. ABSTRACT In the current era of medical practice, super saturated with investigations of choice and development of diagnostic tools, clinical examination is a lost art. In this review we briefly discuss important aspects of examination of the liver, which is much needed in decision making on investigational approach. We urge the new medical student or the newly practicing physician to develop skills in clinical examination for resourceful management of the patient. KEYWORDS: Liver, examination, clinical skills, hepatomegaly, chronic liver disease, portal hypertension, liver span INTRODUCTION respiration, the excursion of liver movement is around 2 to 3 The liver attains its adult size by the age of 15 years. The cm. Castell and Frank has elegantly described normal liver liver weighs 1.2 to 1.4 kg in women and 1.4 to 1.5 kg in span in men and women utilizing the percussion method men. The liver seldom extends more than 5 cm beyond the (Table 1). Accordingly, the mean liver span is 10.5 cm for midline towards the left costal margin. During inspiration, men and 7 cm in women. During examination, a span 2 to 3 the diaphragmatic exertion moves the liver downward with cm larger or smaller than these values is considered anterior surface rotating to the right.
    [Show full text]
  • Utility of the Digital Rectal Examination in the Emergency Department: a Review
    The Journal of Emergency Medicine, Vol. 43, No. 6, pp. 1196–1204, 2012 Published by Elsevier Inc. Printed in the USA 0736-4679/$ - see front matter http://dx.doi.org/10.1016/j.jemermed.2012.06.015 Clinical Reviews UTILITY OF THE DIGITAL RECTAL EXAMINATION IN THE EMERGENCY DEPARTMENT: A REVIEW Chad Kessler, MD, MHPE*† and Stephen J. Bauer, MD† *Department of Emergency Medicine, Jesse Brown VA Medical Center and †University of Illinois-Chicago College of Medicine, Chicago, Illinois Reprint Address: Chad Kessler, MD, MHPE, Department of Emergency Medicine, Jesse Brown Veterans Hospital, 820 S Damen Ave., M/C 111, Chicago, IL 60612 , Abstract—Background: The digital rectal examination abdominal pain and acute appendicitis. Stool obtained by (DRE) has been reflexively performed to evaluate common DRE doesn’t seem to increase the false-positive rate of chief complaints in the Emergency Department without FOBTs, and the DRE correlated moderately well with anal knowing its true utility in diagnosis. Objective: Medical lit- manometric measurements in determining anal sphincter erature databases were searched for the most relevant arti- tone. Published by Elsevier Inc. cles pertaining to: the utility of the DRE in evaluating abdominal pain and acute appendicitis, the false-positive , Keywords—digital rectal; utility; review; Emergency rate of fecal occult blood tests (FOBT) from stool obtained Department; evidence-based medicine by DRE or spontaneous passage, and the correlation be- tween DRE and anal manometry in determining anal tone. Discussion: Sixteen articles met our inclusion criteria; there INTRODUCTION were two for abdominal pain, five for appendicitis, six for anal tone, and three for fecal occult blood.
    [Show full text]
  • General Signs and Symptoms of Abdominal Diseases
    General signs and symptoms of abdominal diseases Dr. Förhécz Zsolt Semmelweis University 3rd Department of Internal Medicine Faculty of Medicine, 3rd Year 2018/2019 1st Semester • For descriptive purposes, the abdomen is divided by imaginary lines crossing at the umbilicus, forming the right upper, right lower, left upper, and left lower quadrants. • Another system divides the abdomen into nine sections. Terms for three of them are commonly used: epigastric, umbilical, and hypogastric, or suprapubic Common or Concerning Symptoms • Indigestion or anorexia • Nausea, vomiting, or hematemesis • Abdominal pain • Dysphagia and/or odynophagia • Change in bowel function • Constipation or diarrhea • Jaundice “How is your appetite?” • Anorexia, nausea, vomiting in many gastrointestinal disorders; and – also in pregnancy, – diabetic ketoacidosis, – adrenal insufficiency, – hypercalcemia, – uremia, – liver disease, – emotional states, – adverse drug reactions – Induced but without nausea in anorexia/ bulimia. • Anorexia is a loss or lack of appetite. • Some patients may not actually vomit but raise esophageal or gastric contents in the absence of nausea or retching, called regurgitation. – in esophageal narrowing from stricture or cancer; also with incompetent gastroesophageal sphincter • Ask about any vomitus or regurgitated material and inspect it yourself if possible!!!! – What color is it? – What does the vomitus smell like? – How much has there been? – Ask specifically if it contains any blood and try to determine how much? • Fecal odor – in small bowel obstruction – or gastrocolic fistula • Gastric juice is clear or mucoid. Small amounts of yellowish or greenish bile are common and have no special significance. • Brownish or blackish vomitus with a “coffee- grounds” appearance suggests blood altered by gastric acid.
    [Show full text]
  • Heart Failure
    Heart Failure Sandra Keavey, DHSc, PAC, DFAAPA Defined Heart failure (HF) is a common clinical syndrome resulting from any structural or functional cardiac disorder that impairs the ability of the ventricle to fill with or eject blood. HF may be caused by disease of the myocardium, pericardium, endocardium, heart valves, vessels, or by metabolic disorders Epidemiology-Magnitude Heart failure disproportionately affects the older population. Approximately 80% of all cases of heart failure in the United States occur in persons aged 65 years and older. In the older population, heart failure accounts for more hospital admissions than any other single condition. Following hospitalization for heart failure, nearly half are readmitted within 6 months. Epidemiology-Prevalence Prevalence. About 5.1 million people in the United States have heart failure. One in 9 deaths in 2009 included heart failure as contributing cause. About half of people who develop heart failure die within 5 years of diagnosis. 25% of all heart failure patients are re-admitted to the hospital within 30 days. 50% of all heart failure patients are re-admitted to the hospital within 6 months. Systolic vs Diastolic There are two common types of heart failure Systolic HF Systolic HF is the most common type of HF Now referred to as HFrEF Heart Failure reduced Ejection Fraction The heart is weak and enlarged. The muscle of the left ventricle loses some of its ability to contract or shorten. Diastolic HF Diastolic HF is not an isolated disorder of diastole; there are widespread abnormalities of both systolic and diastolic function that become more apparent with exercise.
    [Show full text]
  • Central Venous Pressure Venous Examination but Underestimates Ultrasound Accurately Reflects the Jugular
    Ultrasound Accurately Reflects the Jugular Venous Examination but Underestimates Central Venous Pressure Gur Raj Deol, Nicole Collett, Andrew Ashby and Gregory A. Schmidt Chest 2011;139;95-100; Prepublished online August 26, 2010; DOI 10.1378/chest.10-1301 The online version of this article, along with updated information and services can be found online on the World Wide Web at: http://chestjournal.chestpubs.org/content/139/1/95.full.html Chest is the official journal of the American College of Chest Physicians. It has been published monthly since 1935. Copyright2011by the American College of Chest Physicians, 3300 Dundee Road, Northbrook, IL 60062. All rights reserved. No part of this article or PDF may be reproduced or distributed without the prior written permission of the copyright holder. (http://chestjournal.chestpubs.org/site/misc/reprints.xhtml) ISSN:0012-3692 Downloaded from chestjournal.chestpubs.org at UCSF Library & CKM on January 21, 2011 © 2011 American College of Chest Physicians CHEST Original Research CRITICAL CARE Ultrasound Accurately Refl ects the Jugular Venous Examination but Underestimates Central Venous Pressure Gur Raj Deol , MD ; Nicole Collett , MD ; Andrew Ashby , MD ; and Gregory A. Schmidt , MD , FCCP Background: Bedside ultrasound examination could be used to assess jugular venous pressure (JVP), and thus central venous pressure (CVP), more reliably than clinical examination. Methods: The study was a prospective, blinded evaluation comparing physical examination of external jugular venous pressure (JVPEXT), internal jugular venous pressure (JVPINT), and ultrasound collapse pressure (UCP) with CVP measured using an indwelling catheter. We com- pared the examination of the external and internal JVP with each other and with the UCP and CVP.
    [Show full text]
  • Medical Terminology Abbreviations Medical Terminology Abbreviations
    34 MEDICAL TERMINOLOGY ABBREVIATIONS MEDICAL TERMINOLOGY ABBREVIATIONS The following list contains some of the most common abbreviations found in medical records. Please note that in medical terminology, the capitalization of letters bears significance as to the meaning of certain terms, and is often used to distinguish terms with similar acronyms. @—at A & P—anatomy and physiology ab—abortion abd—abdominal ABG—arterial blood gas a.c.—before meals ac & cl—acetest and clinitest ACLS—advanced cardiac life support AD—right ear ADL—activities of daily living ad lib—as desired adm—admission afeb—afebrile, no fever AFB—acid-fast bacillus AKA—above the knee alb—albumin alt dieb—alternate days (every other day) am—morning AMA—against medical advice amal—amalgam amb—ambulate, walk AMI—acute myocardial infarction amt—amount ANS—automatic nervous system ant—anterior AOx3—alert and oriented to person, time, and place Ap—apical AP—apical pulse approx—approximately aq—aqueous ARDS—acute respiratory distress syndrome AS—left ear ASA—aspirin asap (ASAP)—as soon as possible as tol—as tolerated ATD—admission, transfer, discharge AU—both ears Ax—axillary BE—barium enema bid—twice a day bil, bilateral—both sides BK—below knee BKA—below the knee amputation bl—blood bl wk—blood work BLS—basic life support BM—bowel movement BOW—bag of waters B/P—blood pressure bpm—beats per minute BR—bed rest MEDICAL TERMINOLOGY ABBREVIATIONS 35 BRP—bathroom privileges BS—breath sounds BSI—body substance isolation BSO—bilateral salpingo-oophorectomy BUN—blood, urea, nitrogen
    [Show full text]
  • Study Guide Medical Terminology by Thea Liza Batan About the Author
    Study Guide Medical Terminology By Thea Liza Batan About the Author Thea Liza Batan earned a Master of Science in Nursing Administration in 2007 from Xavier University in Cincinnati, Ohio. She has worked as a staff nurse, nurse instructor, and level department head. She currently works as a simulation coordinator and a free- lance writer specializing in nursing and healthcare. All terms mentioned in this text that are known to be trademarks or service marks have been appropriately capitalized. Use of a term in this text shouldn’t be regarded as affecting the validity of any trademark or service mark. Copyright © 2017 by Penn Foster, Inc. All rights reserved. No part of the material protected by this copyright may be reproduced or utilized in any form or by any means, electronic or mechanical, including photocopying, recording, or by any information storage and retrieval system, without permission in writing from the copyright owner. Requests for permission to make copies of any part of the work should be mailed to Copyright Permissions, Penn Foster, 925 Oak Street, Scranton, Pennsylvania 18515. Printed in the United States of America CONTENTS INSTRUCTIONS 1 READING ASSIGNMENTS 3 LESSON 1: THE FUNDAMENTALS OF MEDICAL TERMINOLOGY 5 LESSON 2: DIAGNOSIS, INTERVENTION, AND HUMAN BODY TERMS 28 LESSON 3: MUSCULOSKELETAL, CIRCULATORY, AND RESPIRATORY SYSTEM TERMS 44 LESSON 4: DIGESTIVE, URINARY, AND REPRODUCTIVE SYSTEM TERMS 69 LESSON 5: INTEGUMENTARY, NERVOUS, AND ENDOCRINE S YSTEM TERMS 96 SELF-CHECK ANSWERS 134 © PENN FOSTER, INC. 2017 MEDICAL TERMINOLOGY PAGE III Contents INSTRUCTIONS INTRODUCTION Welcome to your course on medical terminology. You’re taking this course because you’re most likely interested in pursuing a health and science career, which entails ­proficiency­in­communicating­with­healthcare­professionals­such­as­physicians,­nurses,­ or dentists.
    [Show full text]
  • Bitemedicine.Com/Watch
    Aims and Objectives • Requires some basic knowledge of clinical examinations • Clinical examination station (OSCE) • Abdominal examination: 4 cases • Duration: 70 mins • Slides and recordings: www.bitemedicine.com/watch • Other common OSCE cases available in previous and upcoming webinars • Aim of the week is to cover most of the common scenarios 2 Abdominal examination: OSCE Cases list What cases could come up? 1. Renal transplantation (+ AV fistula) 2. Stoma 3. Chronic liver disease 4. Hepatosplenomegaly 5. Cushing’s syndrome This is not an exhaustive list • But by preparing for these you will be better at: • Your exam routine • Looking out for important signs • Formulating your findings systematically • Tackling the VIVA 3 How to present your findings? I performed an abdominal examination on this patient If you have an idea, then • Who has signs suggestive of XXX back yourself from the start. It gets the examiner listening My main positive findings are: 1. XXX 2. YYY My relevant negative findings are: RELEVANT negatives 1. XXX (Risk factors) 2. YYY (Signs of decompensation) 3. ZZZ (POSSIBLE associated features) Overall, this points towards a diagnosis of XXX with no signs of decompensation 4 Abdominal examination: Case 1 Background 65M Central (1) (2) • Palpable mass in the left iliac fossa Bedside/peripheral Tacrolimus 5 Question 1 Q1 Q2 What is the most likely diagnosis? Chronic kidney disease Diabetic nephropathy resulting in renal transplantation Tacrolimus-induced nephropathy resulting in renal transplantation Hypertensive nephropathy
    [Show full text]
  • Myocarditis in Acute Infective Diseases a Review of 200 Cases by C
    Arch Dis Child: first published as 10.1136/adc.19.100.178 on 1 December 1944. Downloaded from MYOCARDITIS IN ACUTE INFECTIVE DISEASES A REVIEW OF 200 CASES BY C. NEUBAUER, M.D. Resident Medical Officer, City Hospital for Infectious Diseases, Newcastle upon Tyne The acute infective diseases constitute the most voltage in all three limb leads together. This sign important cause of myocarditis, the commonest occurs especially in cases of severe myocarditis. heart disease in childhood. Increasing amount of Pathological anatomy. Whenever possible the evidence from electrocardiographic investigations heart of a fatal case was examined in the Patho- of the heart in acute infective diseases shows that logical Department (Prof. B. Shaw) ofKing's College, there can be a myocarditis when clinical signs and Newcastle upon Tyne. Two illustrative cases are symptoms are slight, doubtful or completely absent. given: These investigations further revealed that many 1. convalescent cases whose unsatisfactory condition Sheila F., ten years, died on the eleventh day of diphtheria. Immediately beneath the ven- was accounted for by post-infective or secondary tricular anaemia were endocardium and also in the inner third of actually suffering from myocarditis. the wall are some scattered small foci of lymphoid Therefore, since this involvement of the myocardium and histiocytic cells. These foci sometimes occur is so common an event and liable to be missed or in association with shrunken muscle fibres and what misdiagnosed, it seems justifiable to give an account appear to be small delicate recent scars. of 200 cases of myocarditis occuring in acute 2. Iris N., eight years old,'died on the fourth day infectious diseases.
    [Show full text]
  • Abdominal Palpation/Auscultation of Fetal Heart Rate
    Shared Maternity Care Program Guidelines Abdominal Palpation/Auscultation of Fetal Heart Rate Introduction Abdominal palpation and auscultation of the fetal heart rate is recommended as part of routine examination in pregnancy to assist in assessing fetal wellbeing. Requirements Sonicaid to identify the fetal heart rate. Aqueous gel Tape measure Recommendations for Abdominal Palpation Palpation is not performed during a contraction Only perform a GENTLE abdominal palpation for any woman with: History of ante partum hemorrhage Premature labour Severe (acute) abdominal pain Documentation of fundal height is advised from 24/40 A clinical estimate followed by a symphyso-fundal height using a tape measure should also be used A consistent approach to measurement increases accuracy Palpate the fundus first to identify the upper limit . Measure from the top of the fundus to the top of the pubic symphysis . The tape measure should stay in contact with the skin. It is not recommended to repeat the measurement. If the fundal height is more than 2cm below or above expected height, an obstetric opinion advised. Refer Antenatal Clinic 9784 2626 or if unavailable contact the obstetric registrar via switchboard 9784 7777 Fundal height measurement is of little value in a twin pregnancy. Recommendations for Intermittent Auscultation of fetal Heart Rate Is recommended from 20 weeks gestation It is important to identify maternal pulse before locating the fetal heart. Using intermittent auscultation the normal heart rate range is >110bpm and < 160bpm If fetal heart rate or fetal movements are not present after 24 weeks gestation immediately, contact the Women’s Health Unit on 9784 7959 SMCP GPLU 2018 Shared Maternity Care Program Guidelines Abdominal Palpation/Auscultation of Fetal Heart Rate Leopold’s manoeuvres:[1] a) Fundal palpation- to locate the upper pole of the fetus and note if cephalic or breech b) Lateral palpation- to locate the fetal back, anterior shoulder and limbs c) Pawlick’s grip- to assess the presentation and station.
    [Show full text]
  • Effects of Vasodilation and Arterial Resistance on Cardiac Output Aliya Siddiqui Department of Biotechnology, Chaitanya P.G
    & Experim l e ca n i t in a l l C Aliya, J Clinic Experiment Cardiol 2011, 2:11 C f a Journal of Clinical & Experimental o r d l DOI: 10.4172/2155-9880.1000170 i a o n l o r g u y o J Cardiology ISSN: 2155-9880 Review Article Open Access Effects of Vasodilation and Arterial Resistance on Cardiac Output Aliya Siddiqui Department of Biotechnology, Chaitanya P.G. College, Kakatiya University, Warangal, India Abstract Heart is one of the most important organs present in human body which pumps blood throughout the body using blood vessels. With each heartbeat, blood is sent throughout the body, carrying oxygen and nutrients to all the cells in body. The cardiac cycle is the sequence of events that occurs when the heart beats. Blood pressure is maximum during systole, when the heart is pushing and minimum during diastole, when the heart is relaxed. Vasodilation caused by relaxation of smooth muscle cells in arteries causes an increase in blood flow. When blood vessels dilate, the blood flow is increased due to a decrease in vascular resistance. Therefore, dilation of arteries and arterioles leads to an immediate decrease in arterial blood pressure and heart rate. Cardiac output is the amount of blood ejected by the left ventricle in one minute. Cardiac output (CO) is the volume of blood being pumped by the heart, by left ventricle in the time interval of one minute. The effects of vasodilation, how the blood quantity increases and decreases along with the blood flow and the arterial blood flow and resistance on cardiac output is discussed in this reviewArticle.
    [Show full text]
  • Jugular Venous Pressure
    NURSING Jugular Venous Pressure: Measuring PRACTICE & SKILL What is Measuring Jugular Venous Pressure? Measuring jugular venous pressure (JVP) is a noninvasive physical examination technique used to indirectly measure central venous pressure(i.e., the pressure of the blood in the superior and inferior vena cava close to the right atrium). It is a part of a complete cardiovascular assessment. (For more information on cardiovascular assessment in adults, see Nursing Practice & Skill ... Physical Assessment: Performing a Cardiovascular Assessment in Adults ) › What: Measuring JVP is a screening mechanism to identify abnormalities in venous return, blood volume, and right heart hemodynamics › How: JVP is determined by measuring the vertical distance between the sternal angle and the highest point of the visible venous pulsation in the internal jugular vein orthe height of the column of blood in the external jugular vein › Where: JVP can be measured in inpatient, outpatient, and residential settings › Who: Nurses, nurse practitioners, physician assistants, and treating clinicians can measure JVP as part of a complete cardiovascular assessment What is the Desired Outcome of Measuring Jugular Venous Pressure? › The desired outcome of measuring JVP is to establish the patient’s JVP within the normal range or for abnormal JVP to be identified so that appropriate treatment may be initiated. Patients’ level of activity should not be affected by having had the JVP measured ICD-9 Why is Measuring Jugular Venous Pressure Important? 89.62 › The JVP is
    [Show full text]