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CARDIAC SYSTEM

47

Table 1-16. Signs and Symptoms of Pericardial Hearr Diseases

Disease

Symptoms

Signs

Acute peri

Retrosternal chest pain

Pericardial friction rub; difcarditis

(worsened by supine

fuse ST segmem elevaand/or deep inspiration; decreased QRS

tion), dyspnea, cough,

volrage in all ECG leads if

hoarseness, dysphagia,

pericardial effusion also

fever, chilJs, and weakpresent

ness may occur.

Constrictive

Abdominal swelling,

Jugular venous distention;

pericarditis

peripheral edema,

QRS volrage diminished

fatigue, dyspnea, dizzion ECGj occasionally

ness and/or syncope,

atrial fibrillation

signs of pulmonary

venous congestion,

vague non-specific retrosternal chest pain.

Chronic peri

May have vague fullness in

Muffled heart sounds; may

cardial effuanterior chesr, cough,

have pericardial friction

sion (without

hoarseness, dysphagia.

rub; QRS voltage dimintamp

ished on ECG; chest x-ray

with cardiomegaly without pulmonary congestion

Pericardial

Symptoms of low cardiac

Jugular venous distention,

tamponade

output (dyspnea, fatigue,

cardiomegaly, diminished

dizziness, syncope); may

QRS volrage on ECG;

have retrosrcrnal chest

becomes tamponade from

pain; may have cough,

effusion when right heart

hiccoughs, hoarseness.

catheterization shows

equal pressures in right

atrium, ventricle, and capillary wedge (signifies lefr

atria pressure), and left

heart catheterization

would show equal pressure on left side of heart to

right side

ECG = electrocardiogram.

Sources: Data from Sl Woods, ES Sivarajian-Froclicher, S Underhill-Morzer (cds). Cardiac Nursing (4th ed). Philadelphia: Lippincotf, 2000; and MD Cheidin, M Sokolow, MB Mcilroy. Clinical Cardiology (6th cd). Norwalk, CT: Appleton & lange, 1993.

48

AClfT'f. CARE HANDBOOK FOR PHYSICAL THERAPISTS

most common pathologic etiology of CHF is some type of cardiomyopathy (see Table 1 - 1 5).

The following terms are used to classify the types of cardiac

impairment in CHF42:

Left-sided heart failure refers to failure of the left ventricle, resulting

in back flow into the lungs.

Right-sided failure refers to failure of the right side of the heart,

resulting in back flow into the systemic venous system.

High-output failure refers to heart failure that is secondary to renal

system failure to filter off excess fluid. The renal system failure

places a higher load on the heart that cannot be maintained.

Low-output failure refers to the condition in which the heart is not

able to pump the minimal amount of blood to suppOrt circulation.

Systolic dysfunction refers to a problem with systole or the actual

strength of myocardial contraction.

Diastolic dysfunction refers to a problem during diastOle or the ability

of the ventricle to allow the filling of blood.

Possible signs and symptoms of CHF arc described in Table 1 - 1 7.

The American Heart Association revised the New York Heart Association

Table 1-17. Signs and Symproms of Congesrive Hearr Failure

Syrnproms

Signs

Dyspnea

Cold, pale possibly cyanmic extremities

Tachypnea

\'(i'eight gain

Paroxysmal nocrurnal dyspnea

Peripheral edema

Onhopnea

Heparomegaly

Cough

Jugular venous distention

Fatigue

Crackles (rales)

Tubular breath sounds and consolidation

S3 hear[ sound

Sinus tachycardia

Decreased exercise rolerancc and physical

work capacity

Source: Adapced from LP Cahalin. Hcar{ failurc Pl1ys

.

Ther 1 996;76:520.