Master Right Heart Failure Assessment with Picmonic for Medicine

Peripheral edema is secondary to gravitational stasis in dependent regions in the pressure poor venous circulatory system. Common sites of peripheral edema including the lower legs, ankles and feet for ambulatory patients or the sacrum and groin in patients confined to beds.

Hepatosplenomegaly, an enlarged liver and spleen, can occur in right-sided heart failure from building peripheral edema and engorgement in the highly vascularized organs.

Individuals with decreased cardiac output with impaired renal perfusion leads to a decreased urine output (oliguria) during the day. With positional changes, such as lying down at night, dependent venous fluid is more evenly distributed and increases cardiac preload and potentially cardiac output. If cardiac output improves, or there is more renal perfusion from increased intravascular flow, this increases urinary filtration and output, but at a very unconvenient time during a patient’s slumber.

Progressive weight gain may occur due to fluid retention. Patient education on taking a daily weight at the same time each morning, upon waking, remains a reliable indicator of fluid gain or loss. A gain of 2 pounds in one day or 5 pounds in one week is clinically significant and warrants further evaluation.

Ascites is the increase of intraabdominal fluid from failing vascular flow in the liver (e.g. portal hypertension), progressive renal failure and other factors. Abdominal fullness from ascites frequently causes anorexia and nausea due to uncomfortable abdominal distension.

Fatigue is one of the earliest symptoms of heart failure. It occurs due to decreased cardiac output, impaired perfusion to vital organs, and decreased oxygenation to tissues. Energy management should be implemented when providing care, which includes organizing care to allow for rest periods throughout the day.