CHF Assessment (OSCE)

## Inspection

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General Comfort

* SOB, Orthopnea
* Full sentences

## Vitals

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* 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)

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

## JVP

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

## Palpation

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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

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* Edema
* sacral, tibial tuberosity
* peripheral pulses

### Abdomen

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

## Auscultation

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* 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

## Other OSCE modules

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* v
* t
* e

Objective structured clinical examination

Acute Confusion \- Acute Coronary Syndrome Orders \- Anemia \- Arterial Blood Gasses \- Asthma \- Blood Pressure \- Chest pain \- Chest XRay \- CHF \- Coma \- COPD \- Cranial Nerves \- Diabetic History \- Diabetic Foot \- Dysphagia \- EKGs \- Gallbladder and Liver \- Liver Disease \- Gait and Balance \- Headache \- Hematemesis \- Hypertension \- Jugular Venous Pulses \- Knee Exam \- Lymph Nodes \- Community Acquired Pneumonia \- Parkinson Disease \- Peripheral Arterial Insufficiency \- Pneumonia Examination \- Precordial Exam \- STD's \- Spleen \- Swollen Leg Exam \- Thyroid Exam \- Upper vs Lower Motor Neuron Lesions \- Urinary Incontinence
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