Core IM | Internal Medicine Podcast #69 Inpatient Heart Failure: 5 Pearls Segment
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Jun 24, 2020 Delve into the essentials of managing decompensated heart failure on general medicine floors. Discover key clinical assessments and relevant lab findings. Explore guideline-directed therapy with a focus on beta-blockers and ACE inhibitors. Learn effective diuretic dosing strategies and how to monitor volume removal safely. Understand the implications of diuretic-induced metabolic alkalosis and methods to address it. Gain insights into the role of brain natriuretic peptide in patient care and the importance of thorough documentation in clinical practice.
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Initial Clinical Assessment
- Assess patient vitals, especially blood pressure and pulse pressure, to determine perfusion status.
- Document medications affecting heart rate (e.g., "Heart rate 80s on metoprolol").
JVD Importance
- Jugular venous distension (JVD) is a crucial physical exam finding in heart failure.
- JVD provides a direct indication of right atrial pressure, offering insights into intracardiac filling pressures.
Measuring JVD
- To find JVP, sit the patient at 90 degrees and check for venous pressure above the clavicle.
- Alternatively, position at 45-60 degrees and check for pulsation near the ear, comparing with carotid pulse.