CHF | PVD | COPD - Let's Clarify the Confusion on these terms!❤️‍🩹🫁🦵 - Episode 60
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Three terms I want to clarify: CHF, PVD, and COPD. Why do I want to clarify these? Because a lot of people ask me all the time, "Dr. 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 acronym CHF, CHF, complete heart failure and congestive heart failure, it 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 the 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 buildup of fluid in the lungs. Know your signs and symptoms. We talk 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 has failed. So it's going to back up into the body. Know your signs and symptoms.

but that congestion, that buildup 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, 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 a 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 confused. A lot of people come to me and say, Dr. Z, 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 V-A-L in it. V-A-L. 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 four eyes of structural compromise. Think about that. Another quick tip that I came up with. Any type of structural compromise, you got four eyes.

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 would 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 a 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-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 talk about that. Give them steroids. It's going to be lifelong. And we know the side effects of steroids. A big fib. We talk about this. Now we're going 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 level is being elevated because we're trying to treat that chronic bronchitis under COPD. And now we just went 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 CHF, PVD, COPD, 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 haven't amazing but um 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 pbd peripheral vascular disease is an umbrella term and so is chronic obstructive palm disease so i hope you enjoyed take care