Detecting and Evaluating Cognitive Impairment in Heart Failure Patients

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Physical Exam Findings

  • Mr. Reynolds appears weak.
  • He answers all questions appropriately, although he can’t recall dates and the sequence of recent events (e.g. falls and emergency room evaluations), his affect is flat and his daughter fills in some of the details.
  • Supine, his blood pressure is 160/90 mm Hg and his heart rate is 75; immediately after standing up he feels dizzy and his blood pressure drops to 120/60 mm Hg with a heart rate of 110.
  • Three months ago he weighed 155 pounds (70.3 kg); today he weighs 145 pounds (65.9 kg).
  • His neck veins are not distended. On chest auscultation, bibasilar coarse crackles are heard, as well as a systolic murmur (grade 2 on a scale of 6), loudest in the second intercostal space at the right parasternal border.
  • No peripheral edema is detected.