How Heart Failure is Diagnosed
How Heart Failure is Diagnosed
UCSF cardiologist Dr. Munir Janmohamed discusses the signs and symptoms of heart failure. Watch the Entire Talk Here: • Examining Heart Failure: How to Recog… [2/2018] [Show ID: 33147]
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0.03 -> - So how was a heart failure diagnosed? So
first of all you you take a good medical
4.44 -> history. And what does a good medical
history? First of all you want to look, I
7.56 -> ask for questions about risk factors.
Are they diabetic? Do they have high
11.73 -> blood pressure? And you do a drug history to
kind of clue you in, what's theirs, how
16.5 -> high is your suspicion for this patient
having heart failure? And then you do an
20.64 -> exam, a physical exam. A lot of times if
and many of you know someone with heart
25.619 -> failure we always look at the neck. And
why are we doing that? So we have what's
29.189 -> called the vein here at the internal
jugular vein which is like a dipstick
32.64 -> that drains right into the heart. So you
can imagine if a patient has back up of
37.38 -> fluid it's gonna, it's gonna become
very prominent and that's what we're
41.16 -> gonna see on our exam. You can also have
swelling of the feet as well too - or the
47.91 -> abdomen, and that's what you're seeing
here. Normal and you could see swelling
50.61 -> of this leg here. There's certain labs
that we do as well too - we do a CBC or a
56.579 -> blood count. We want to see what the
hemoglobin is because if you have a high
59.399 -> hemoglobin that leads to heart failure.
The chemistry panel is gonna look at
63.12 -> your kidney function because that might
be affected by heart failure. We do a BNP
68.22 -> which is a blood test that's elevated
when you have a lot of congestion, so
71.729 -> helps clue in whether it's patients
likely to have heart failure or not. A
76.189 -> TSH which is the thyroid tests. HIV, iron
studies a patient has iron overload. Too
83.31 -> much iron in the body that can lead to
heart failure as well too. And then there's
87.33 -> some testing for specific populations.
Iron, we talked about sleep studies. Sleep
92.25 -> apnea which is increasing, is a very
common cause for heart failure and can
97.2 -> be potentially treated if you have a
patient on CPAP or certain therapy for
102.15 -> sleep apnea. There's certain proteins
that deposit in the heart. There's
106.409 -> certain testing we can do for that as
well too - and then there's some heart
110.1 -> ferrars that's genetics so that can be
genetic screen can be done as well too. So
115.28 -> BNP is actually a blood test that when
the heart is stretched or congested, it
122.159 -> will go up. So you could have a patient,
so that the troubling is when
126.84 -> your patient comes, let's say to the
emergency room and you're trying to
129.539 -> patients shortness of breath, and you're trying to
figure is it from the heart or is it from the lungs.
132.15 -> And sometimes you can use a BNP as a
134.94 -> blood test to see if it's from the heart
versus the lungs. So that kind of
138.93 -> differentiates between the two. So it's a
naturatic peptide, basically a naturatic peptide.
146.76 -> Um, so EKG is well too, can be a clue in
that there's something wrong with the
153.48 -> heart. So that could be your first sign
as well too. Chest x-ray, so this is, here's
160.38 -> your lungs basically here. And this is
the heart silhouette here.
163.349 -> You can see the lungs are clear. They're
aerated. This is a patient with heart
167.58 -> failure. I don't know if you can appreciate here,
but if you look at the size here versus
171.9 -> here. This heart is very enlarged and you
can see the lungs. This is all filled
176.79 -> with fluid. That's why it's yeah, it
doesn't has that appearance of kind of the
180.15 -> whithish appearance which is, this is all
air. This is all filled with fluid.
184.29 -> And really the gold standard is an
echocardiogram. This is an ultrasound, and
190.86 -> if you remember the Anatomy pictures we
talked about, you have the pumping
196.2 -> chambers and you have the filling
chambers. So we'll just focus on the
199.709 -> pumping chambers. Here, this is the left
side. This is the right side. You can
203.819 -> appreciate here that this this left side
here is nicely coming as pumping. Nice
208.29 -> and normal, and here's the patient with
heart failure. This is what's called
212.25 -> systolic heart failure. You can see the
chamber here is quite enlarged compared
216.389 -> to here. And you can see the function, the
matter that is coming in is reduced. So
221.76 -> this patient has systolic heart failure.
So the echo is really the gold standard.
225.03 -> Can tell us a lot information. It can
tell us the pumping ability of the heart
228.48 -> and also you can see the valves
here. We talked about those doors that
232.17 -> separate the different chambers. You can
also see if there's any leakage of this
235.41 -> valve as well too. So, so the echo is a
key indicator for diagnosing heart
242.7 -> failure. It'll tell you what's called an
ejection fraction which is the amount of
246.269 -> blood that's pumped out of your heart
with each heartbeat. It's important to
250.829 -> evaluate cardiac function. It also
reflects the strength of the ventricular
254.459 -> contraction or the left ventricle
contracting. Sometimes imaging is done as
259.979 -> well too for certain conditions. We said
heart failure there's many different causes.
263.39 -> Some causes are due to a protein deposit.
You can do a cardiac MRI to look for
268.05 -> that, and also nuclear imaging as well
too. And, and some type of workup for
273.78 -> looking for blockage of the heart has to
be done because we talked that's the
277.17 -> most common cause. So many times patients
will undergo a catheterization where we
281.46 -> actually inject dye to look at the blood
vessels and making sure there's no
285.56 -> abnormalities. Because theoretically if
there is any abnormalities they were
289.59 -> able to restore the blood flow. Now you
have more nutrients to the heart muscle
293.01 -> and the heart muscle can actually
improve. So this is a reversible cause
296.79 -> potentially of heart failure.
305.689 ->
Source: https://www.youtube.com/watch?v=LSTHZz8aB2o