3 terms I want to clarify CHFPVD and COPD.
Why do I want to clarify these? Because a lot of people ask me
all the time, Doctor Z, Well, what's CHF versus the different
types of heart failure? What's PVD?
Is that the veins or is that like the arteries or, you know,
how do I know the difference between PVD and PAD and venous
insufficiency? And then COPD, which I feel like
just kind of gets thrown out as a diagnosis of its own, when in
fact there are things underneath it.
All three of these are what I call umbrella terms.
And with CHF it is congestive heart failure.
So well which one is that? Is that left sided, right sided
or both or biventricular or complete?
I don't like to use the term complete heart failure anymore
because well, obviously if you do the, the an acronym CHFCHF,
complete heart failure and congestive heart failure gets
confusing. So we're changing it to
biventricular. So well, which one is congestive
heart failure? Well, that congestion or that
buildup of fluid happens in all three in left sided, right sided
or biventricular where both of ventricles fail.
So we want to see that congestive heart failure is
actually this umbrella term that encompasses left sided, right
sided and biventricular heart failure.
And knowing the difference between the three is very
important because the signs and symptoms of left versus right
versus biventricular is a perfect, perfect case study and
a perfect way for somebody to get confused on how the boards
are going to ask it and or will be asked in school.
Left sided is going to back up into the lungs, but the right's
still working. So it only leads to the left,
the lungs. That's it.
So you have that congestion in the lungs.
You have the build up of fluid in the lungs.
Know your signs and symptoms. We talked about this heavily in
our cardio section. Then you've got right sided.
Well, it hasn't even made it to the lungs.
The right side is failed. So it's going to back up into
the body. Know your signs and symptoms,
but that congestion, that build up of fluid is happening in the
body. Biventricular, which typically
happens because your left side has failed and now your right
works, works, works, works, works, works.
And what ultimately happens when something works, works, works,
works, it fails. So now you've got both of them.
Or biventricular, where the entire heart has failed and now
the left is backing up to the lungs, the right is not working
as well too. Now that's backing up into the
body. So now you've got signs and
symptoms of both. How would I ask this?
I can guarantee you if I'm going to ask you this question and I
write questions, I'm going to ask this as a case study.
And I'm going to make it into a matrix or grid and column one,
right side, column two, left side, column three,
biventricular. And I'm going to give you signs
and symptoms for each one. And I'm going to want you to
know it. So those of you that are
students of mine, look at your notes.
Then we go into PVD and again, the question is, well, we're so
like confused. A lot of people come to me and
Doctor Z, you know, I was taught this or I saw this or I read
this. No, no, no.
Let me make it very clear. PVD means peripheral vascular
disease. Well, what is a vasculature?
It's one of those quick tips in our quick tip book, right?
The way that I came up with this quick tip was vasculature has
the letters Val in it, Val, veins, arteries and lymphs.
So our vasculature can include any of them.
So if I have a peripheral vascular disease, am I telling
you that it's one of the three? I'm not saying veins, am I?
I'm saying there's any of these three or a combination of these
three could be affected by this disease process.
And where is that disease process happening in any of
these three or combination of these three in the periphery?
So it could be infectious, it could be ischemic, it could be
inflammatory. The three or the 4I S of
structural compromise, think about that.
Another quick tip that I came up with, any type of structural
compromise you've got 4I S ischemia, infarction, infection
and inflammation will all affect the structural integrity.
Something is going to happen in that process.
So again, look at that as an umbrella term.
PVD can include PAD, sure, because in PAD it's peripheral
arterial disease. I'm telling you that it's
specifically the arteries in venous insufficiency.
I'm telling you that the veins are insufficient or in chronic
venous insufficiency where the valves are not working.
So again, we must understand the difference.
Now how would I ask PAD versus chronic venous insufficiency or
venous insufficiency 100%. I wouldn't go with the matrix or
grid because think I'm going to compare the signs and symptoms,
right? Ulcers towards the most distal
part versus around the ankle swelling, compression versus no
compression, dangling versus not dangling or elevating.
These are all comparisons between the two.
So I would definitely put this as a matrix or grid and I'd put,
you know, maybe the intervention education, select all that
apply. It's still the same type of
question. What am I going to do?
Education, right? So again, PVD is an umbrella
term. Please do not mix up PVD to be
specific to veins. It's a peripheral vascular
disease, peripheral vascular disease.
And the last one is COPD, chronic obstructive pulmonary
disease, again chronic. This is not something that's
acute. This is happening long term
obstruction. There's some sort of obstruction
in our respiratory system, pulmonary disease.
So why is this an umbrella term? I thought COPD was its own
diagnosis. Isn't that just with smokers?
No, that's where a lot of people kind of get wrong.
COPD smokers. Can it be a smoker 100% That's
why it's an umbrella term. So COPD doesn't equal smokers.
Smokers fall under COPD. Chronic obstructive pulmonary
disease can entail chronic bronchitis, which is an
inflammatory process, but it's chronic.
Or it can entail emphysema, and emphysema can be caused by
smoking and something that's not really too high yield, but alpha
and alpha antitrypsin, which I don't really talk about too, too
much. I kind of brush over it in our
respiratory system, but the smoking part is super high
yield, but that's causing emphysema.
Emphysema is under chronic obstructive pulmonary disease.
So you see a lot of people tend to say, hey, COPD equals
smoking. That's not true.
Chronic bronchitis falls right under COPD, but that's a chronic
inflammatory process. So what are we going to do about
that? Well, if it's chronic
inflammation, what do we do for inflammation?
Steroids, and we talked about that.
Give them steroids. It's going to be lifelong.
And we know the side effects of steroids.
A big fib. We talked about this.
Now we're going back, back to endocrine.
We went from respiratory to endocrine real quick and now
we're going right into a big fib.
So we know the chronic cortisol levels being elevated because
we're trying to treat that chronic bronchitis under COPD.
And now we just want to endocrine because we're giving
them exogenous cortisol and we're giving them a big fib,
that quick tip. So again, very important to
understand the difference between CHFPVDCOPD all being
umbrella terms and what falls underneath them, what falls
underneath them, and the common mistakes that we all fall for or
we have fallen for or we may fall for.
And if you have it, amazing. But I was guilty of it.
I had to go back and clarify everything in my head.
So I just want to make sure that everyone understood that
congestive heart failure is an umbrella term.
PVD, peripheral vascular disease is an umbrella term, and so is
chronic obstructive palm disease.
So I hope you enjoy it. Take care.