all edema is not heart failure - arcard.orguserfiles/editor/docs/2018/all edema is not heart... ·...
TRANSCRIPT
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ALL EDEMA IS NOT HEART FAILURE
Joseph Hackler, DO
Disclosures: None
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Objectives
1. Discuss the different etiologies/pathophysiology of edema
2. Discuss the manifestations and diagnostic approach to edema
3. Discuss who to refer for further testing
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What Is It and How Does It Get There?
• Palpable swelling caused by expansion of interstitial fluid volume
– Increased capillary hydraulic pressure
• Increased plasma volume from renal sodium retention
• Venous obstruction or insufficiency
– Hypoalbuminemia
– Lymphatic obstruction
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Most Common Etiologies
• Heart Failure
• Cirrhosis
• Nephrotic Syndrome/Other Renal Disease
• Other
– Drugs
– Lymphedema
– Venous insufficiency
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H&P
• Is the edema unilateral or bilateral?
• Ask about disorders that can cause cardiac, hepatic, or renal disease
– CAD
– HTN
– EtOH
• Survey the drug list
• Is there history consistent with sleep apnea?
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H&P
• Location of edema
• Pitting vs non‐pitting
• Ascites
• Estimation of CVP
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Heart Failure
• Things that impair LV function tend to cause pulmonary edema– CAD– HTN heart disease– AV/MV disorders
• Things that impair RV function tend to cause peripheral edema– Cor pulmonale– TV disorders
• Cardiomyopathies usually involve both the LV and RV, thus present with both pulmonary and peripheral edema
Cardiac PE
• Murmur
• Rales
• S3/S4
• JVP
• Edema
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Left vs Right Heart Failure
Pulmonary Edema
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Elevated JVP
Cirrhosis
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Cirrhosis PE
• Ascites first
• Peripheral edema next
• No elevations in JVP given elevations of pressure are below the liver
Renal Disease PE
• PE similar to biventricular failure– Pulmonary and peripheral edema– Elevated JVP– Clues
• Abnormal UA• Elevated BUN/Cr
• Nephrotic syndrome often has periorbital and peripheral edema– Clues
• Nephrotic range proteinuria • Low albumin
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Other Causes PE
• Mostly normal PE
– No rales, S3/4, or elevation in JVP
• Edema can be unilateral
– DVT
– Venous insufficiency
• Non‐pitting when related to lymphedema
CHRONIC VENOUS INSUFFICIENCY(CVI)
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Thank You