Nursing Institute at Cleveland Clinic in Cleveland, Ohio 44195, USA.
Am J Crit Care. 2010 Sep;19(5):443-52. doi: 10.4037/ajcc2009314. Epub 2009 Nov 25.
Patients may not verbalize common and atypical signs and symptoms of heart failure and may not understand their association with worsening disease and treatments.
To examine prevalence of signs and symptoms relative to demographics, care setting, and functional class.
A convenience sample of 276 patients (164 ambulatory, 112 hospitalized) with systolic heart failure completed a 1-page checklist of signs and symptoms experienced in the preceding 7 days (ambulatory) or in the 7 days before hospitalization. Demographic and medical history data were collected.
Mean age was 61.6 (SD, 14.8) years, 65% were male, 58% were white, and 45% had ischemic cardiomyopathy. Hospitalized patients reported more sudden weight gain, weight loss, severe cough, low/orthostatic blood pressure, profound fatigue, decreased exercise, restlessness/confusion, irregular pulse, and palpitations (all P < .05). Patients in functional class IV reported more atypical signs and symptoms of heart failure (severe cough, nausea/vomiting, diarrhea or loss of appetite, and restlessness, confusion, or fainting, all P <or= .001). Sudden weight gain increased from 5% in functional class I to 37.5% in functional class IV (P < .001). Dyspnea occurred in all functional classes (98%-100%) and both settings (92%-100%). Profound fatigue was associated with worsening functional class (P < .001) and hospital setting (P = .001); paroxysmal nocturnal dyspnea was associated with functional class IV (P = .02) and hospital setting (P < .001).
Profound fatigue is more reliable than dyspnea as an indicator of functional class. Nurses must recognize atypical signs and symptoms of worsening functional class to determine clinical status and facilitate patient care decisions.
患者可能无法说出心力衰竭的常见和不典型体征和症状，也可能不理解这些症状与疾病恶化和治疗的关系。
检查体征和症状与人口统计学、护理环境和功能分类的相关性。
对 276 例收缩性心力衰竭患者（164 例为门诊患者，112 例为住院患者）进行了一项便利抽样调查，他们在过去 7 天（门诊患者）或住院前 7 天内完成了一张关于经历过的体征和症状的检查表。收集了人口统计学和病史数据。
平均年龄为 61.6（SD，14.8）岁，65%为男性，58%为白人，45%为缺血性心肌病。住院患者报告了更多的突发性体重增加、体重减轻、严重咳嗽、低血压/直立性低血压、极度疲劳、运动减少、不安/意识模糊、不规则脉搏和心悸（均 P <.05）。功能分级 IV 级患者报告了更多不典型的心力衰竭体征和症状（严重咳嗽、恶心/呕吐、腹泻或食欲不振以及不安、意识模糊或晕厥，均 P <or=.001）。突发性体重增加从功能分级 I 级的 5%增加到功能分级 IV 级的 37.5%（P <.001）。呼吸困难发生在所有功能分级（98%-100%）和两种环境（92%-100%）中。极度疲劳与功能分级恶化相关（P <.001）和住院环境相关（P =.001）；阵发性夜间呼吸困难与功能分级 IV 级相关（P =.02）和住院环境相关（P <.001）。
与呼吸困难相比，极度疲劳是功能分级的更可靠指标。护士必须识别功能分级恶化的不典型体征和症状，以确定临床状况并促进患者护理决策。
