CHF Assessment (OSCE)

Inspection
General Comfort
 * SOB, Orthopnea
 * Full sentences

Vitals

 * 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)

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

JVP

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

Palpation
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

 * Edema
 * sacral, tibial tuberosity
 * peripheral pulses

Abdomen

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

Auscultation

 * 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