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1.1.5: Obtain, interpret, assess, and/or evaluate signs and symptoms associated with diseases and medical conditions

CU is a 52-year-old man with cardiomyopathy (left ventricular ejection fraction 31%) following an acute myocardial infarction (MI). After his MI, he developed signs and symptoms of heart failure (HF) including shortness of breath (SOB) at rest. Which of the following characterizes CU's current American College of Cardiology (ACC)/American Heart Association (AHA) HF stage and New York Heart Association (NYHA) class?

(A) Stage A, NYHA class not applicable

(B) Stage B, NYHA class I

(C) Stage C, NYHA class II

(D) Stage C, NYHA class IV

The Correct Answer is: D

CU meets the criteria for Stage C. Patients such as CU who are Stage C have developed signs and/or symptoms of heart failure. The NYHA classification system categorizes patients as class I if they are relatively asymptomatic and physical activity is not limited by the heart failure disease process. Patients who are NYHA class II and III are symptomatic with moderate and minimal physical activity, respectively. Finally, patients such as CU who have symptoms at rest are classified as NYHA class IV (D).

Patients who are Stage A (A) are at risk for developing left ventricular dysfunction and heart failure (e.g., hypertension, coronary artery disease). Patients who are Stage B (B) have developed structural heart disease but have not developed signs and symptoms of heart failure. CU meets the criteria for Stage C. Patients such as CU who are Stage C have developed signs and/or symptoms of heart failure. However, patients who are NYHA class II (C) and III are symptomatic with moderate and minimal physical activity. CU is symptomatic at rest.

Which of the following is the best predictor of fluid status and should be monitored daily by all heart failure patients?

(A) Fatigue

(B) Shortness of breath

(C) Weight change

(D) Lower extremity edema

The Correct Answer is: C

Weight gain (C) is the best predictor of fluid status since weight change often precedes overt HF signs and symptoms. Signs and symptoms of low cardiac output are less readily identified and subjective.

Vague symptoms of fatigue (A) are common and can be related to other disease states. Patients with fluid overload may present with signs and symptoms of pulmonary congestion such as shortness of breath (B), or peripheral congestion such as lower extremity edema (D). Therefore, shortness of breath is not the best predictor of fluid status because the patient is having symptoms and likely already fluid overloaded.

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