1 00:00:02,080 --> 00:00:11,440 3 terms I want to clarify CHFPVD and COPD. 2 00:00:13,760 --> 00:00:18,560 Why do I want to clarify these? Because a lot of people ask me 3 00:00:18,560 --> 00:00:24,760 all the time, Doctor Z, Well, what's CHF versus the different 4 00:00:24,760 --> 00:00:28,120 types of heart failure? What's PVD? 5 00:00:28,120 --> 00:00:31,400 Is that the veins or is that like the arteries or, you know, 6 00:00:31,400 --> 00:00:34,440 how do I know the difference between PVD and PAD and venous 7 00:00:34,440 --> 00:00:38,760 insufficiency? And then COPD, which I feel like 8 00:00:38,760 --> 00:00:43,960 just kind of gets thrown out as a diagnosis of its own, when in 9 00:00:43,960 --> 00:00:47,120 fact there are things underneath it. 10 00:00:47,360 --> 00:00:50,720 All three of these are what I call umbrella terms. 11 00:00:51,880 --> 00:00:59,640 And with CHF it is congestive heart failure. 12 00:01:00,480 --> 00:01:04,360 So well which one is that? Is that left sided, right sided 13 00:01:04,760 --> 00:01:08,520 or both or biventricular or complete? 14 00:01:08,520 --> 00:01:11,520 I don't like to use the term complete heart failure anymore 15 00:01:11,520 --> 00:01:16,480 because well, obviously if you do the, the an acronym CHFCHF, 16 00:01:16,480 --> 00:01:18,480 complete heart failure and congestive heart failure gets 17 00:01:18,480 --> 00:01:20,520 confusing. So we're changing it to 18 00:01:20,680 --> 00:01:25,920 biventricular. So well, which one is congestive 19 00:01:25,920 --> 00:01:28,280 heart failure? Well, that congestion or that 20 00:01:28,280 --> 00:01:33,280 buildup of fluid happens in all three in left sided, right sided 21 00:01:33,280 --> 00:01:36,120 or biventricular where both of ventricles fail. 22 00:01:37,240 --> 00:01:41,760 So we want to see that congestive heart failure is 23 00:01:41,760 --> 00:01:46,760 actually this umbrella term that encompasses left sided, right 24 00:01:46,760 --> 00:01:48,880 sided and biventricular heart failure. 25 00:01:49,960 --> 00:01:52,680 And knowing the difference between the three is very 26 00:01:52,680 --> 00:01:58,760 important because the signs and symptoms of left versus right 27 00:01:59,320 --> 00:02:04,800 versus biventricular is a perfect, perfect case study and 28 00:02:04,800 --> 00:02:10,479 a perfect way for somebody to get confused on how the boards 29 00:02:10,479 --> 00:02:12,840 are going to ask it and or will be asked in school. 30 00:02:14,480 --> 00:02:16,880 Left sided is going to back up into the lungs, but the right's 31 00:02:16,880 --> 00:02:20,280 still working. So it only leads to the left, 32 00:02:20,480 --> 00:02:21,800 the lungs. That's it. 33 00:02:22,840 --> 00:02:24,360 So you have that congestion in the lungs. 34 00:02:24,360 --> 00:02:25,920 You have the build up of fluid in the lungs. 35 00:02:25,920 --> 00:02:28,440 Know your signs and symptoms. We talked about this heavily in 36 00:02:28,440 --> 00:02:33,160 our cardio section. Then you've got right sided. 37 00:02:33,200 --> 00:02:34,880 Well, it hasn't even made it to the lungs. 38 00:02:35,040 --> 00:02:37,640 The right side is failed. So it's going to back up into 39 00:02:37,640 --> 00:02:39,760 the body. Know your signs and symptoms, 40 00:02:40,480 --> 00:02:42,400 but that congestion, that build up of fluid is happening in the 41 00:02:42,400 --> 00:02:46,040 body. Biventricular, which typically 42 00:02:46,040 --> 00:02:49,080 happens because your left side has failed and now your right 43 00:02:49,080 --> 00:02:50,880 works, works, works, works, works, works. 44 00:02:50,880 --> 00:02:53,320 And what ultimately happens when something works, works, works, 45 00:02:53,320 --> 00:02:57,080 works, it fails. So now you've got both of them. 46 00:02:57,080 --> 00:03:01,160 Or biventricular, where the entire heart has failed and now 47 00:03:01,160 --> 00:03:04,280 the left is backing up to the lungs, the right is not working 48 00:03:04,280 --> 00:03:06,000 as well too. Now that's backing up into the 49 00:03:06,000 --> 00:03:10,000 body. So now you've got signs and 50 00:03:10,000 --> 00:03:14,400 symptoms of both. How would I ask this? 51 00:03:15,640 --> 00:03:18,560 I can guarantee you if I'm going to ask you this question and I 52 00:03:18,560 --> 00:03:22,000 write questions, I'm going to ask this as a case study. 53 00:03:22,000 --> 00:03:25,000 And I'm going to make it into a matrix or grid and column one, 54 00:03:25,000 --> 00:03:27,280 right side, column two, left side, column three, 55 00:03:27,280 --> 00:03:29,080 biventricular. And I'm going to give you signs 56 00:03:29,080 --> 00:03:31,840 and symptoms for each one. And I'm going to want you to 57 00:03:31,840 --> 00:03:34,280 know it. So those of you that are 58 00:03:34,280 --> 00:03:36,000 students of mine, look at your notes. 59 00:03:37,840 --> 00:03:46,080 Then we go into PVD and again, the question is, well, we're so 60 00:03:46,080 --> 00:03:48,320 like confused. A lot of people come to me and 61 00:03:48,320 --> 00:03:51,520 Doctor Z, you know, I was taught this or I saw this or I read 62 00:03:51,520 --> 00:03:52,680 this. No, no, no. 63 00:03:52,960 --> 00:03:58,400 Let me make it very clear. PVD means peripheral vascular 64 00:03:58,680 --> 00:04:01,800 disease. Well, what is a vasculature? 65 00:04:01,880 --> 00:04:04,480 It's one of those quick tips in our quick tip book, right? 66 00:04:05,400 --> 00:04:10,440 The way that I came up with this quick tip was vasculature has 67 00:04:10,480 --> 00:04:18,160 the letters Val in it, Val, veins, arteries and lymphs. 68 00:04:18,360 --> 00:04:21,680 So our vasculature can include any of them. 69 00:04:22,480 --> 00:04:26,320 So if I have a peripheral vascular disease, am I telling 70 00:04:26,320 --> 00:04:31,600 you that it's one of the three? I'm not saying veins, am I? 71 00:04:32,080 --> 00:04:36,920 I'm saying there's any of these three or a combination of these 72 00:04:36,920 --> 00:04:40,120 three could be affected by this disease process. 73 00:04:40,320 --> 00:04:42,480 And where is that disease process happening in any of 74 00:04:42,480 --> 00:04:45,480 these three or combination of these three in the periphery? 75 00:04:47,600 --> 00:04:52,040 So it could be infectious, it could be ischemic, it could be 76 00:04:52,200 --> 00:04:56,520 inflammatory. The three or the 4I S of 77 00:04:56,520 --> 00:04:58,920 structural compromise, think about that. 78 00:04:58,920 --> 00:05:02,280 Another quick tip that I came up with, any type of structural 79 00:05:02,280 --> 00:05:08,080 compromise you've got 4I S ischemia, infarction, infection 80 00:05:08,160 --> 00:05:12,040 and inflammation will all affect the structural integrity. 81 00:05:12,280 --> 00:05:14,840 Something is going to happen in that process. 82 00:05:15,240 --> 00:05:19,000 So again, look at that as an umbrella term. 83 00:05:19,680 --> 00:05:24,280 PVD can include PAD, sure, because in PAD it's peripheral 84 00:05:24,280 --> 00:05:26,480 arterial disease. I'm telling you that it's 85 00:05:26,480 --> 00:05:30,200 specifically the arteries in venous insufficiency. 86 00:05:30,440 --> 00:05:33,840 I'm telling you that the veins are insufficient or in chronic 87 00:05:34,080 --> 00:05:38,520 venous insufficiency where the valves are not working. 88 00:05:39,040 --> 00:05:42,240 So again, we must understand the difference. 89 00:05:42,240 --> 00:05:46,560 Now how would I ask PAD versus chronic venous insufficiency or 90 00:05:46,560 --> 00:05:49,800 venous insufficiency 100%. I wouldn't go with the matrix or 91 00:05:49,800 --> 00:05:53,880 grid because think I'm going to compare the signs and symptoms, 92 00:05:54,240 --> 00:05:58,280 right? Ulcers towards the most distal 93 00:05:58,280 --> 00:06:02,240 part versus around the ankle swelling, compression versus no 94 00:06:02,240 --> 00:06:06,720 compression, dangling versus not dangling or elevating. 95 00:06:07,680 --> 00:06:09,520 These are all comparisons between the two. 96 00:06:09,520 --> 00:06:12,640 So I would definitely put this as a matrix or grid and I'd put, 97 00:06:13,160 --> 00:06:16,040 you know, maybe the intervention education, select all that 98 00:06:16,040 --> 00:06:17,240 apply. It's still the same type of 99 00:06:17,240 --> 00:06:18,960 question. What am I going to do? 100 00:06:18,960 --> 00:06:25,120 Education, right? So again, PVD is an umbrella 101 00:06:25,120 --> 00:06:28,200 term. Please do not mix up PVD to be 102 00:06:28,200 --> 00:06:31,840 specific to veins. It's a peripheral vascular 103 00:06:31,960 --> 00:06:34,800 disease, peripheral vascular disease. 104 00:06:36,600 --> 00:06:45,080 And the last one is COPD, chronic obstructive pulmonary 105 00:06:45,600 --> 00:06:49,080 disease, again chronic. This is not something that's 106 00:06:49,080 --> 00:06:51,080 acute. This is happening long term 107 00:06:51,920 --> 00:06:53,840 obstruction. There's some sort of obstruction 108 00:06:53,840 --> 00:06:57,080 in our respiratory system, pulmonary disease. 109 00:06:58,520 --> 00:07:02,200 So why is this an umbrella term? I thought COPD was its own 110 00:07:02,200 --> 00:07:03,880 diagnosis. Isn't that just with smokers? 111 00:07:03,960 --> 00:07:06,400 No, that's where a lot of people kind of get wrong. 112 00:07:06,560 --> 00:07:10,920 COPD smokers. Can it be a smoker 100% That's 113 00:07:10,920 --> 00:07:15,000 why it's an umbrella term. So COPD doesn't equal smokers. 114 00:07:15,120 --> 00:07:20,240 Smokers fall under COPD. Chronic obstructive pulmonary 115 00:07:20,240 --> 00:07:24,800 disease can entail chronic bronchitis, which is an 116 00:07:24,800 --> 00:07:26,720 inflammatory process, but it's chronic. 117 00:07:27,920 --> 00:07:33,240 Or it can entail emphysema, and emphysema can be caused by 118 00:07:33,240 --> 00:07:38,080 smoking and something that's not really too high yield, but alpha 119 00:07:38,080 --> 00:07:42,240 and alpha antitrypsin, which I don't really talk about too, too 120 00:07:42,240 --> 00:07:44,120 much. I kind of brush over it in our 121 00:07:44,120 --> 00:07:46,920 respiratory system, but the smoking part is super high 122 00:07:46,920 --> 00:07:48,920 yield, but that's causing emphysema. 123 00:07:48,920 --> 00:07:51,600 Emphysema is under chronic obstructive pulmonary disease. 124 00:07:52,040 --> 00:07:57,120 So you see a lot of people tend to say, hey, COPD equals 125 00:07:57,120 --> 00:07:58,560 smoking. That's not true. 126 00:07:58,840 --> 00:08:03,000 Chronic bronchitis falls right under COPD, but that's a chronic 127 00:08:03,000 --> 00:08:05,520 inflammatory process. So what are we going to do about 128 00:08:05,520 --> 00:08:07,040 that? Well, if it's chronic 129 00:08:07,040 --> 00:08:09,680 inflammation, what do we do for inflammation? 130 00:08:09,840 --> 00:08:12,240 Steroids, and we talked about that. 131 00:08:12,480 --> 00:08:14,280 Give them steroids. It's going to be lifelong. 132 00:08:15,160 --> 00:08:17,440 And we know the side effects of steroids. 133 00:08:17,960 --> 00:08:19,600 A big fib. We talked about this. 134 00:08:19,600 --> 00:08:20,920 Now we're going back, back to endocrine. 135 00:08:20,920 --> 00:08:23,520 We went from respiratory to endocrine real quick and now 136 00:08:23,520 --> 00:08:25,120 we're going right into a big fib. 137 00:08:26,720 --> 00:08:30,600 So we know the chronic cortisol levels being elevated because 138 00:08:30,600 --> 00:08:33,159 we're trying to treat that chronic bronchitis under COPD. 139 00:08:33,280 --> 00:08:37,000 And now we just want to endocrine because we're giving 140 00:08:37,000 --> 00:08:40,799 them exogenous cortisol and we're giving them a big fib, 141 00:08:41,240 --> 00:08:45,160 that quick tip. So again, very important to 142 00:08:45,160 --> 00:08:52,320 understand the difference between CHFPVDCOPD all being 143 00:08:52,320 --> 00:08:55,160 umbrella terms and what falls underneath them, what falls 144 00:08:55,160 --> 00:09:01,240 underneath them, and the common mistakes that we all fall for or 145 00:09:01,240 --> 00:09:03,600 we have fallen for or we may fall for. 146 00:09:03,800 --> 00:09:08,240 And if you have it, amazing. But I was guilty of it. 147 00:09:08,240 --> 00:09:10,000 I had to go back and clarify everything in my head. 148 00:09:10,480 --> 00:09:12,760 So I just want to make sure that everyone understood that 149 00:09:12,760 --> 00:09:14,520 congestive heart failure is an umbrella term. 150 00:09:14,840 --> 00:09:18,440 PVD, peripheral vascular disease is an umbrella term, and so is 151 00:09:18,440 --> 00:09:21,440 chronic obstructive palm disease. 152 00:09:21,920 --> 00:09:24,240 So I hope you enjoy it. Take care.