- So how was a heart failure diagnosed? So first of all you you take a good medical
history. And what does a good medical history? First of all you want to look, I
ask for questions about risk factors. Are they diabetic? Do they have high
blood pressure? And you do a drug history to kind of clue you in, what's theirs, how
high is your suspicion for this patient having heart failure? And then you do an
exam, a physical exam. A lot of times if and many of you know someone with heart
failure we always look at the neck. And why are we doing that? So we have what's
called the vein here at the internal jugular vein which is like a dipstick
that drains right into the heart. So you can imagine if a patient has back up of
fluid it's gonna, it's gonna become very prominent and that's what we're
gonna see on our exam. You can also have swelling of the feet as well too - or the
abdomen, and that's what you're seeing here. Normal and you could see swelling
of this leg here. There's certain labs that we do as well too - we do a CBC or a
blood count. We want to see what the hemoglobin is because if you have a high
hemoglobin that leads to heart failure. The chemistry panel is gonna look at
your kidney function because that might be affected by heart failure. We do a BNP
which is a blood test that's elevated when you have a lot of congestion, so
helps clue in whether it's patients likely to have heart failure or not. A
TSH which is the thyroid tests. HIV, iron studies a patient has iron overload. Too
much iron in the body that can lead to heart failure as well too. And then there's
some testing for specific populations. Iron, we talked about sleep studies. Sleep
apnea which is increasing, is a very common cause for heart failure and can
be potentially treated if you have a patient on CPAP or certain therapy for
sleep apnea. There's certain proteins that deposit in the heart. There's
certain testing we can do for that as well too - and then there's some heart
ferrars that's genetics so that can be genetic screen can be done as well too. So
BNP is actually a blood test that when the heart is stretched or congested, it
will go up. So you could have a patient, so that the troubling is when
your patient comes, let's say to the emergency room and you're trying to
patients shortness of breath, and you're trying to figure is it from the heart or is it from the lungs.
And sometimes you can use a BNP as a
blood test to see if it's from the heart versus the lungs. So that kind of
differentiates between the two. So it's a naturatic peptide, basically a naturatic peptide.
Um, so EKG is well too, can be a clue in that there's something wrong with the
heart. So that could be your first sign as well too. Chest x-ray, so this is, here's
your lungs basically here. And this is the heart silhouette here.
You can see the lungs are clear. They're aerated. This is a patient with heart
failure. I don't know if you can appreciate here, but if you look at the size here versus
here. This heart is very enlarged and you can see the lungs. This is all filled
with fluid. That's why it's yeah, it doesn't has that appearance of kind of the
whithish appearance which is, this is all air. This is all filled with fluid.
And really the gold standard is an echocardiogram. This is an ultrasound, and
if you remember the Anatomy pictures we talked about, you have the pumping
chambers and you have the filling chambers. So we'll just focus on the
pumping chambers. Here, this is the left side. This is the right side. You can
appreciate here that this this left side here is nicely coming as pumping. Nice
and normal, and here's the patient with heart failure. This is what's called
systolic heart failure. You can see the chamber here is quite enlarged compared
to here. And you can see the function, the matter that is coming in is reduced. So
this patient has systolic heart failure. So the echo is really the gold standard.
Can tell us a lot information. It can tell us the pumping ability of the heart
and also you can see the valves here. We talked about those doors that
separate the different chambers. You can also see if there's any leakage of this
valve as well too. So, so the echo is a key indicator for diagnosing heart
failure. It'll tell you what's called an ejection fraction which is the amount of
blood that's pumped out of your heart with each heartbeat. It's important to
evaluate cardiac function. It also reflects the strength of the ventricular
contraction or the left ventricle contracting. Sometimes imaging is done as
well too for certain conditions. We said heart failure there's many different causes.
Some causes are due to a protein deposit. You can do a cardiac MRI to look for
that, and also nuclear imaging as well too. And, and some type of workup for
looking for blockage of the heart has to be done because we talked that's the
most common cause. So many times patients will undergo a catheterization where we
actually inject dye to look at the blood vessels and making sure there's no
abnormalities. Because theoretically if there is any abnormalities they were
able to restore the blood flow. Now you have more nutrients to the heart muscle
and the heart muscle can actually improve. So this is a reversible cause
potentially of heart failure.