CARDIACHeart Sounds: S1- tricuspid and mitral valve close S2- pulmonary and aortic valve close S3- ventricular filling complete S4-elevated atrial pressure (atrial kick)Right Sided Heart FailureLeft Sided Heart Failure

Right Upper Quadrant Pain Right Ventricular Heave Tricuspid Murmur Weight gain Nausea Elevated Right Atrial Pressure Elevated Central Venous Pressure Peripheral Edema Ascites Anorexia Hepatomegaly Left Ventricular Heave Confusion Paroxysmal Nocturnal Dyspnea DOE Fatigue S3 Gallop Crackles Tachycardia Cough Mitral Murmur Diaphoresis Orthopnea

CONGESTIVE HEART FAILUREClass I describes a patient who is not limited with normal physical activity by symptoms. Class II occurs when ordinary physical activity results in fatigue, dyspnea, or other symptoms. Class III is characterized by a marked limitation in normal physical activity. Class IV is defined by symptoms at rest or with any physical activity.Causes: CAD, Valvular heart disease, Cardiomyopathies, Endocarditis, Extracardiac infection, Pulmonary embolusSymptoms: Skin cold or cyanotic, Wheezing, Mitral valvular deficits, Lower extremity edema, Pulsus alternans, Hypertension, Tachypnea