Heart Failure 6: Clinical Manifestations

Failed heart is divided into 3 parts based on the failure of the heart pumping:
1. Failed left heart
Symptoms and signs: dyspneu d'effort, ortopnea, dispnea nocturnal paroxysmal, fatiq, cough, heart enlargement, clop rhythm, ventricular heaving, clip-clop sound of S3 and S4, respiratory Cheyne Stokes, tankard, pulses alternans, ronki and congestive vena pulmonalis.
2. Failed right heart
Symptoms and signs: fatigue, edema, hepatomegali, and anorexia, hypertrophy ventricle right, right atrium clop rhythm, murmur, signs of disease tuberculosis chronicles, vena jugularis increased pressure, heart sounds 2 indurate, asites, hidrotoraks, edema pitting.
3. Failed heart congestive
Symptoms and signs: a combination of right heart failure and left.

New York Heart Association (NYHA) functional classification created in 4 classes:
- Class 1. When the patient can perform the activity without weight concerns.
- Class 2. When the patient can not weight more activity from the day-to-day activities without complaint.
- Class 3. When the patient can not perform daily activities without complaint.
- Class 4. When the patient is unable to perform any activity, and must lie. (Mansjoer, et al, 2000).

According Isselbacher et al. (2000):
Dispnea: serious respiratory happens as a result of increased respiratory effort. Dispnea heart most often experienced in patients with increased pulmonalis vein and capillary pressure. Patients usually experience obstacles vein pulmo interstitial and edema, which reduces flexible tuberculosis and therefore increase workplace respiratory musculature needed to develop tuberculosis. Activation receptor cause respiratory tuberculosis in a fast and in a typical dispnea from the heart. Respiratory oxygen needs increased by excessive labor of respiratory musculature. This is double folded with a reduction in oxygen delivery to the musculature, which occur as a consequence the reduced rainfall and the heart may cause muscle fatigue, muscle respiratory sensation and shortness of breath.

Ortopnea: Dispnea lie in the position is usually the final manifestation of heart failure. Ortopnea occurred because the fluid redistribute extremity of the abdomen and chest down to cause an increase in the diaphragm. Patients with elevated ortopnea should head with several pillows at night and often awakened as cough or shortness of breath (so called cough at night).

Dispnea paroxysmal (nocturnal): attacks of shortness of breath and cough that generally occur at night, often making the patients bed. Central respiratory depression during sleep may reduce the ventilation is sufficient to decrease arterial oxygen tension, especially in patients with interstitial edema and less
flexible of pulmo. Ventricle function may be more disturbed at night because of the reduced stimulus adrenergik on miokard function.

Cheyne-Stokes respiratory: respiratory is also known as respiratory or periodic siklik. Cheyne-Stokes respiratory marked also by the reduced sensitivity of the respiratory center PCO2. There is a phase during which apneu phase is ¬ arterial PO2 and PCO2 down ¬ arterial rise. This change in arterial blood stimulate respiratory centers of emphasis, the hyperventilate and hipokapnia, then followed by apnea.
Fatigue, weakness, and reduced exercise capacity: Symptoms are not specific but the general failure of the heart is, associated with reduced muscle perfused order. Reduced exercise capacity with the limited ability of the heart that failed to improve after load and deliver oxygen to the muscles being exercise.

Cerebral Symptoms: In the failing heart weight, especially in patients with old age comes arteriosclerosis serebralis, reduced perfused cerebral, and hipoksemia arterial, there may be changes in mental condition marked by confusion (confused).
Difficulty concentrating, remembering disturbances, headache, insomnia, and fear. At the heart fails, the patient does not seem to suffer when the rest do not feel comfortable but if lie supine for more than a few minutes. Failed on a heavy heart, pulse pressure may be reduced, indicating a decrease in volume one load and sometimes, diastolic increased arterial pressure due vasokonstriksi comprehensive. In the acute heart failure, hipotensi may be prominent. Perhaps there is sianosis on the lips and nails cushion, sinus tachycardia and force the patient to sit upright. Vena systemic pressure is often abnormal increase in heart failure and can be identified with the size of the distends vena jugulars.

Beep third and fourth heart sounds are often but not specific for heart failure, and may be pulses alternates, regular rhythm that is caused by the changes there is a strong contraction and the heart is weak and therefore the change in the strength of pulse perifer. Beep third and fourth heart is a sign of heart failure and is caused by a reduction in the number of units during contraction contractile the weak and / or by changes in the volume diastolic end ventricle.
Ronki (abnormal sound in tuberculosis): In heart failure patients with increased capillary pressure and vena pulmonalis general ronki found wet, crepitation when the inspiration auskultasi and deaf to the noise in the base perkusi tuberculosis. Edema in the patients with tuberculosis, ronki may be knowledge able in the field of tuberculosis, often rough and fizz and may be accompanied by wheezing during ekspirasi. Some patients with heart failure who have not have lasted long because of the increased ronki drainage limfatik liquid alveolaris.

Edema: Edema usually happens in areas that depend on, going down the leg on the symmetrical, especially in the area pretibia eyes and feet in the outpatient, most clearly in the night and in the region sakrum in patients lie. Edema pitting on the arm and face, and only rarely arise in the journey failed to slow the heart.

Asites and Hidrotoraks: Efusi pleura occur in heart failure due to increased capillary pressure and pleura fluid transudasi into pleura. Because the vena pleura into the vena pulmonalis and vena systemic, hidrotoraks most commonly occur with increasing pressure is evident both vena this system, but can also be seen with a significant increase in pressure in one of the veins. More often in cavitas pleural right than left. Asites also occur as a consequence and transudasi and arise due to increased pressure in the vein hepatika and vein who drainase peritonium

Hepatomegali: Be the belly, soft, is also attached to the vein systemic hypertension and can be observed not only in the same situation appears when asites but also in the form of a mild heart fail because of any kind.