Author + information
- Thach Nguyen1,2,3,
- Luong Thanh Phuoc2,
- Tran Ngoc Minh Chau2,
- Khanh Duong3,
- Nguyen Khanh Duy4 and
- Nguyen Phuc Hieu5
It is difficult to diagnose fluid overload in asymptomatic heart failure (HF) patients especially if these patients have concomitant severe chronic obstructive pulmonary disease (COPD), cirrhosis or chronic kidney disease (CKD) or while on respirator. If the patient is asymptomatic, where is the fluid accumulated?
Patients with HF were enrolled. Many of these patient had severe comorbidities (chronic obstructive lung disease, cirrhosis, chronic kidney disease) were enrolled. The control group included symptomatic patients and the study group included asymptomatic HF patients (which had prior history of HF confirmed). Both groups underwent detailed physical exam (PE), Chest XR PLUS an ultrasound study checking the size and expansion of the FV (SEFV). The physical examination included edema in the leg, in the buttocks, signs of fluid infiltration in the abdominal wall, jugular venous distension. Liver fluid congestion was evidenced by pain secondary to a small punch in the right lower rib cage. Detailed exam of the face, the areas around the eyes was done in order to find the sign of fluid overload in the cutaneous vein. The ultrasound of the FV showed the size of the FV on a coronal plane proximal to the bifurcation of the superficial (SFA) and deep femoral artery (PFA). The principle of this test is that the volume of blood going through the FA and returning through the common FV should be the same. In normal condition, the FV is a little larger than the FA. If the size of the FV at baseline is 2 times larger than the FA, the patient has significant fluid overload. If the FV can expand >1.5 times during cough, the test showed that the venous system can accommodate more fluid if needed. In patients with HF, the FV does not expand with cough. The diagnosis of asymptomatic heart failure was made when the asymptomatic patients had enlarged FV. Both groups underwent detailed physical examination for fluid overload in six areas: the ankle, buttock, abdominal wall, liver, jugular vein and cutaneous veins. The physical findings of both groups were compared.
For symptomatic HF, the majority of patients had fluid overload in all 6 areas of interest including the enlarged FV. For asymptomatic HF, the majority of patients had fluid overload only in the cutaneous veins and enlarged FV. After 6 months of good treatment, the asymptomatic patients had no enlarged FV and minimal fluid in the cutaneous veins.
Fluid overload in the cutaneous vein was usually overlooked and neglected. However, this is the main area to be focused in order to keep the HF asymptomatic and in recovery.