Now, signs and symptoms of dysfunction. If
your left ventricle is not working properly,
then what kind of issues as your patient coming
in with please? Pulmonary. What does that
mean? Pulmonary edema, orthopnea. What does
that mean? "Hey doc, when I go to bed, I have
this beautiful beautiful bed that I bought,
nice foam bed and you know which is fantastic,
but I never get a chance to use it. And whenever
that I do it at night, I feel like I cannot
breathe. So after placed four pillows underneath
my bed, now at this point, I have to sleep on my
recliner. Can’t even use my bed. You know
how bad I feel." Welcome to orthopnea. Or "Hey
doc, I sleep at night and I can’t breathe.
I have to run out to the window, open it and
I have to take a breath of air." This is PND,
paroxysmal nocturnal dyspnea. This then to
you signifies failure of what side of the
heart? Left side of the heart, backup into
lungs. Welcome to transudate pulmonary edema.
Worst case scenario. You have blood that is
now escaping into the lung in parenchyma. These are
called heart failure cells or hemosiderin-laden
macrophages. All the macrophages do is they
come in and they are going to
gobble anything that is in that particular
environment, maybe it is coal. Later on we
will talk about coal workers pneumoconiosis,
those macrophages will gobble up coal. And here it
is blood in hemosiderin. So different places
in which macrophages, atherosclerosis.
Forgot about that one, almost. Macrophages
come in and they gobble up LDL or cholesterol.
Welcome to foam cells. So in general, just
understand the concept. What if it is right
ventricular dysfunction? Now I get into circulatory
issues on the systemic side. So we have positive
JVD. You might have pitting edema before we
get into anything further and it is important
that you pay attention to the official
New York Heart Association Classification.
Now class I. Symptoms only with maximal exertion.
So we're the process of congestive heart failure,
but we were going through different classes and
in your mind, you might want to bring that
graph that we just reviewed in great detail
to then help you explain the different classes.
So imagine now you are moving clockwise. Why
did the performance decrease? Because of decreased
contractility. At some point, the contractility
may then be improved. That is so much of contractility,
but the performance might be improved because
of an increase in volume due to compensation.
We will talk about aldosterone. Symptoms with
moderate exertion class II, moderate. Minimal.
Now we're getting worse. Even minimal exertion
is then going to exacerbate the issues of
heart failure. And then symptoms at rest.
Where are you? Pay attention to class III
and class IV. Ladies and gentleman, the parallel
that I wish to bring here as well is that
there will be particular WHO classifications
that is imperative for you to keep in mind
when dealing with what is known as pulmonary
arterial hypertension. And the reason I say
that is because when it comes to pharmacology
management, they will then ask you and all
they put in there is "Your patient has
congestive heart failure showing symptoms
of class III and class IV." Or "Hey, I have a
patient and the patient is now exhibiting
symptoms of class II, class III of pulmonary
arterial hypertension." So it is important
that you pay attention to some of these guidelines.
They are created on purpose and you must understand
the clinical significance of it. You begin
here with NYHA.
Physical examination. Left sided everything
is pulmonary. Crackles.