1. Demographics
   1. 59 years old
   2. married
   3. mother of three
   4. BMI = 31.7
      1. Obese
2. Diagnosis
   1. Heart Failure
      1. Definition
         1. Syndrome caused by myocardial dysfunction
      2. Types
         1. Right-sided Failure
            1. Causes
            2. Left-ventricular failure
            3. intrinsic disease of the lung parenchyma or vasculature
            4. primary pulmonic or tricuspid valve disease
            5. follows congenital diseases with right-to-left shunt
            6. morphological characteristics
            7. Liver and portal system congestion (congestive hepatosplenomegaly)
            8. Chronic edema of bowel wall
            9. Transudate in peritoneal cavity
            10. Heart Failure cells in the lungs
            11. Clinical Features
            12. Systemic and portal venous congestion
            13. Hepatosplenomegaly
            14. Peripheral Edema esp. ankles and pretibial
            15. Pleural Effusion and Ascites
            16. Anasarca
         2. Left-sided Failure
            1. Types
            2. Diastolic
            3. Systolic
            4. Causes
            5. IHD
            6. HTN
            7. valvular disease
            8. myocardium primary disease
            9. morphological characteristics
            10. LV hypertrophy
            11. LV dilatation
            12. myocardium fibrosis
            13. Pulmonary congestion
            14. Clinical Features
            15. Dyspnea
            16. orthopnea
            17. Paroxysmal nuctornal dyspnea
            18. Cardiomegaly
            19. Mitral regurgitation
         3. other classification
            1. Acute
            2. Chronic
      3. Risk factors
         1. Hypertension
         2. Obesity
         3. smoking
         4. alcohol consumption
         5. CAD
         6. diabetes
      4. Causes
         1. Coronary artery disease and heart attack.
         2. Hypertension
         3. Faulty heart valves
         4. Cardiomyopathy
         5. Myocarditis
         6. Congenital heart defects
         7. Heart arrhythmias
      5. S&S
         1. Hyperdynamic apical impulse
            1. Definition
            2. normal situation
            3. thin chest
            4. depressed sternum
            5. lying on side
            6. Abnormalities indicated
            7. LV hypertrophy
            8. LV dilatation
            9. mitral/aortic regurgitation
         2. Decreased alertness
         3. Elevated blood pressure
         4. decreased appetite
         5. Chest pain
         6. Increased urination at night
         7. tachycardia
         8. Fatigue & weakness
      6. Compensatory mechanisms
         1. The Frank-Starling mechanism
         2. Activation of neurohumoral systems
         3. Myocardial structural changes
      7. Investigations
         1. Echocardiograph
         2. Chest X-ray
         3. Blood test
         4. ECG
      8. Physical examination
         1. JVP measurement
         2. vital signs
         3. Pulmonary examination
         4. cardiac examination
         5. abdomen & extremities
         6. cardiac cachexia
      9. Management
         1. Pharmacological
            1. ACE inhibitors
            2. Beta-blockers
            3. Diuretics
            4. Direct vasodilators
            5. Intropic agents
            6. Aldosterone antagonists
      10. Prognosis
          1. Decreased life expectancy
             1. 5 years survival
          2. affected by
             1. Stress
3. Health status
   1. Diabetic
   2. hypertensive
   3. heavy smoker
4. S & S
   1. SOB
   2. edema
      1. Causes
         1. Increased Hydrostatic Pressure
         2. Reduced Plasma Osmotic Pressure
         3. Lymphatic Obstruction
         4. Sodium/Water Retention
         5. Inflammation
   3. dyspnea
      1. Causes
         1. Cardiac
            1. CHF
            2. MI
            3. cardiac tamponade
         2. Respiratory
            1. COPD
            2. asthma
            3. pneumothorax
            4. pulmonary edema
         3. Others
            1. Anemia
            2. multiple sclerosis
            3. muscular dystrophy
            4. obesity
            5. CO poisoning
   4. orthopnea
      1. Definition
         1. dyspnea with supine position
      2. Causes
         1. MV disease
         2. LV failure
         3. obstructive lung disease
         4. increase in hydrostatic pressure in the lungs