Fast Five Quiz: Test Your Knowledge on Key Aspects of Heart Failure

Yasmine S. Ali, MD, MSCI

Disclosures

December 22, 2021

Systemic venous hypertension is manifested by jugular venous distention. In general, elevated jugular venous pressure is the most reliable indicator of fluid volume overload in older patients, and thorough evaluation is needed. Fundamental causes include biochemical and physiologic mechanisms, through which myocardial contraction is impaired by either an increased hemodynamic burden or a reduction in oxygen delivery to the myocardium.

The third heart sound (S3) is the initial clue indicating left heart failure and is associated with severe mitral regurgitation, a low ejection fraction, restrictive diastolic filling, functionally severe heart failure, and cardiovascular mortality. Recognition of the third heart sound is consequently critical for prompt treatment.

Rarely, elderly patients with advanced HF may present with psychosis with disorientation, delirium, or hallucinations. Dementia, depression, and stroke are common in the setting of HF and can create a particularly challenging series of clinical problems to manage.

Nocturia may occur relatively early in the course of HF. Recumbency reduces the deficit in cardiac output in relation to oxygen demand, renal vasoconstriction diminishes, and urine formation increases. Nocturia may be troublesome for patients because it may prevent them from obtaining much-needed rest.

Learn more about the presentation and physical examination of patients with HF.

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