CHF and Coloring

Congestive heart failure (CHF) is a two-part disease: “congestive” and “heart failure.” By definition, heart failure means that the heart is unable to pump sufficient quantities of blood to the rest of the body. “Congestive” refers to the vasculature being engorged with fluid causing it to essentially back up in circulation.

CHF can be precipitated by things like myocardial ischemia, smoking, hypertension, obesity, and valvular heart diseases. The physical findings of CHF provide insight as to whether the patient has right-sided or left-sided heart failure. A general understanding of the circulatory system is necessary to explain said findings.

Blood flow to body -> blood returns to right side of heart -> blood flow to lungs -> blood returns to left side of heart -> blood flow to body… and the cycle repeats roughly 100,000 times a day.

If the patient has right-sided heart failure, blood will pool in the body and lead to findings like lower extremity edema, ascites, and jugular venous distention. If the heart failure is left-sided, fluid will accumulate in the lungs and lead to shortness of breath (especially when laying flat). Because of all this fluid excess, one of the major modes of controlling patients with an exacerbation of their CHF is using diuretics like Lasix. This basically makes patients “pee out” additional volume to reduce congestion and restore normal flow.

Bilateral basal pulmonary congestion


So now you’re probably wondering what the “and Coloring” in the title of this post is referring to. After morning report, the medical students had an informal meeting discussing the doctor-patient relationship in the context of what we, as unique individuals, bring to the “doctor” end of the interaction. We used different colors and shapes to diagram our interests, positive/negative reinforcers, and where medical school falls in the grand scheme of things. We then deliberated the rules of “rock-paper-scissors” before eventually being allowed to return to our teams. All in all, I felt comfortably back in kindergarten. 😀

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