Cardiac murmurs will be present if valvular heart disease is present, contributing to the HF such as aortic stenosis or mitral regurgitation. [healio.com]

[citation needed] Pulmonary embolism[edit] Pulmonary embolism classically presents with an acute onset of shortness of breath.[2] Other presenting symptoms include pleuritic chest pain, cough, hemoptysis, and fever.[2] Risk factors include deep vein thrombosis [en.wikipedia.org]

The presentation of a patient dyspnea carries an extensive differential diagnosis from heart failure, MI, pulmonary embolism to pneumonia, sepsis, bronchitis, asthma, chronic obstructive pulmonary disease. [epmonthly.com]

Snapshot A 60-year-old man presents to his primary care physician for several months of dyspnea on exertion, exercise intolerance, and lower-extremity swelling. He has a past medical history of sarcoidosis. [medbullets.com]

However, during the initial presentation profound hypotension and shock may be present. [escardio.org]

• Weight Gain

  Fluid retention often results in weight gain. A common symptom is fatigue, which may be related to reduced blood flow to organs and muscles. Sometimes CHF reduces blood flow to the brain and causes confusion, especially in the elderly. [sharecare.com]

  Weigh yourself daily, and record your weight. You may be told to limit the amount of fluids you drink. Call the doctor if your ankles or feet become swollen or if you gain 2-3 pounds in one day or more than 5 pounds in 5 days. Eat healthily. [columbiasurgery.org]

  Passing out during exercise Poor appetite Weight loss or lack of weight gain can be seen even in older children. [cincinnatichildrens.org]

  Swelling in your ankles, legs and abdomen; weight gain. When your kidneys do not filter enough blood, your body holds onto extra fluid and water. Extra fluid in your body causes swelling edema and weight gain. Need to urinate while resting at night. [my.clevelandclinic.org]

  Weight gain of 3 to 4 pounds in 1 or 2 days. Increased shortness of breath. Increased swelling of the ankles. Cough with sputum that is discolored or tinged with blood. Last updated 3 April 2018 [nmihi.com]

• Camping

  […] preoperatively inhaled nitric oxide 20-40ppm (good in bypass, doesn’t cause systemic hypotension as inactivated when bound to Hb) milrinone (50mcg/kg bolus -> 0.2-0.8mcg/kg/min) dipiridamole (0.2-0.6mg/kg IV over 15min bd) inhaled prostacyclin (increases cAMP [lifeinthefastlane.com]

  Milrinone, a selective PDE3 inhibitor, slows intracellular cyclic adenosine monophosphate (cAMP) metabolism and improves inotropy and facilitates pulmonary vasodilation. [escardio.org]

  Many defects in energy utilization, energy supply, electrophysiologic functions, and contractile element interaction occur, with abnormalities in intracellular calcium modulation and cAMP production. [merckmanuals.com]

  This last bit appears to reflect abnormalities in intracellular Calcium++ ion modulation and cyclic adenosine monophosphate (or cAMP) production. 6 Video licensed from Diastolic dysfunction in the left heart ventricle creates resistance to ventricular [ceufast.com]

• Pallor

  Increased adrenergic activity is manifested by tachycardia, diaphoresis, pallor, peripheral cyanosis with pallor and coldness of the extremities, and obvious distention of the peripheral veins secondary to venoconstriction. [emedicine.medscape.com]

  Pallor and diaphoresis in this medical emergency are common. The pulse may be thready and a blood pressure difficult to obtain. Respirations are labored, and rales are widely dispersed over both lung fields anteriorly and posteriorly. [ceufast.com]

• Crying

  In babies, most symptoms may occur with feeding or crying when the infant may have labored breathing and sweating. What are the symptoms of congestive heart failure? Following are the most common symptoms of congestive heart failure. [chw.org]

  Infants with heart failure often have poor weight gain, struggle to meet developmental milestones, feed poorly, and sweat excessively with crying or feeding. [aboutkidshealth.ca]

• Patient Appears Chronically Ill

  Physical examination The patient appeared chronically ill, with facial swelling, mild scleral jaundice, lip cyanosis, engorgement of the jugular vein, and a reflux-positive liver jugular vein. [omicsonline.org]

• Pleural Effusion

  Pleural effusion Pleural effusion more evident on lateral view Pleural effusion is bilateral in 70% of cases of CHF. When unilateral, it is slightly more often on the right side than on the left side. [radiologyassistant.nl]

  effusion due to another disorder Pleural effusion due to congestive heart failure Red half-moon nail in congestive heart failure Refractory heart failure Symptomatic congestive heart failure Index to Diseases and Injuries References found for the code [icdlist.com]

  effusions Sputum analysis : heart failure cells ( hemosiderin -containing cells) Thoracentesis Indicated if the etiology of the pleural effusion is unclear Pleural fluid analysis: Transudate effusions are typical of cardiogenic causes. [amboss.com]

  Chest X-ray • Size and shape of heart • Evidence of pulmonary venous congestion (dilated or upper lobe veins → perivascular edema) • Pleural effusion 29. [slideshare.net]

  effusion cardiomegaly Kerley-B lines interstitial edema Echocardiogram indication confirms the diagnosis of heart failure classifies whether heart failure is due to systolic or diastolic dysfunction findings assess for low ejection fraction systolic [medbullets.com]

• Loss of Appetite

  Edema occurs in many other areas, such as the abdominal cavity, the chest cavity, the pericardium, and in the stomach and intestines, which causes nausea and loss of appetite. Fluid retention often results in weight gain. [sharecare.com]

  The condition may also result in weight gain; chest pain; loss of appetite or a feeling of indigestion; clammy skin; a fast or irregular heartbeat; feelings of restlessness or confusion; difficulty remembering things; insomnia (trouble sleeping); a need [dartmouth-hitchcock.org]

  Signs and symptoms of heart failure include shortness of breath, fatigue, lightheadedness, exercise intolerance, coughing (or chronic cough), wheezing, pounding or racing heart, excessive tiredness, loss of appetite, nausea, confusion, problems thinking [medicinenet.com]

  A full ( bloated ) or hard stomach, loss of appetite or upset stomach ( nausea ). [my.clevelandclinic.org]

  Loss of appetite (anorexia); nausea and/or vomiting. General feeling of poor health. Anxiety; in severe cases irritability, restlessness, and mental confusion may occur. [healthcentral.com]

• Abdominal Distension

  Abdominal distension was noted; the abdominal veins; the liver was palpable 2 cm below the ribs; and the “shifting dullness” test was positive. [omicsonline.org]

• Heart Disease

  Heart failure often is the end stage of another form of heart disease. [drugs.com]

  (CHF) Hypertensive heart disease with heart failure Hypertensive heart disease, w CHF Hypertensive heart failure Hypertensive heart/kidney dis w/ congestive heart fail Hypertensive kidney and heart disease Hypertensive kidney and heart disease, on dialysis [icd9data.com]

  […] fraction due to heart valve disease Heart failure with reduced ejection fraction due to myocarditis Hypertensive heart AND chronic kidney disease with congestive heart failure Hypertensive heart and renal disease with heart failure Hypertensive heart [icdlist.com]

  […] and kidney disease Hypertensive heart and kidney disease with chf Hypertensive heart and kidney disease with congestive heart failure (chf) Hypertensive heart disease with heart failure Hypertensive heart failure Hypertensive heart/kidney dis w/ congestive [icd10data.com]

  Valvular Heart Disease Any type of valvular heart disease whose chief effect is to increase the pressure within the right side of the heart, or to obstruct the flow of blood through the right side of the heart, can produce right-sided heart failure. [verywellhealth.com]

• Tachycardia

  Electrocardiogram • Old MI or recent MI • Arrhythmia • Some forms of Cardiomyopathy are tachycardia related • LBBB→may help in management 28. [slideshare.net]

  These include atrial fibrillation and ventricular tachycardia. [healio.com]

  Other compensatory changes are increase of blood volume by retention of salt and water and tachycardia. These compensatory changes finally, become burden on cardiac function, leading to progressive CHF. Left-sided cardiac failure: Causes: 1. [histopathology-india.net]

  […] symptoms during less than ordinary physical activity, marked limitation (patients generally only comfortable at rest) NYHA IV: symptoms even when at rest, severe limitation Patients with end-stage CCF may have Cheyne-Stokes respiration, hypotension, tachycardia [radiopaedia.org]

  (PSVT)発作性上室性頻拍 paroxysmal ventricular tachycardia (PVT)発作性心室頻拍 patent ductus arteriosus (PDA) 動脈管開存［症］ percardial friction rub心膜摩擦音 percussion 打診［法］、叩打法〈マッサージの一法〉 percutaneous transluminal coronaryangioplasty (PTCA)経皮的冠［状］［動脈］形成［術］ percutaneous transluminal [tokyo-med.ac.jp]

• Cyanosis

  Physical examination The patient appeared chronically ill, with facial swelling, mild scleral jaundice, lip cyanosis, engorgement of the jugular vein, and a reflux-positive liver jugular vein. [omicsonline.org]

  Extremities : Check for peripheral cyanosis – its caused when a lot of the hemoglobin in the blood isn’t carrying oxygen. Clubbing of the fingers is caused by chronic hypoxemia. [medictests.com]

  History : Symptoms include shortness of breath with exercise, chronic cough that produces sputum, blue tinge around the mouth and fingernails (cyanosis), wheezing, weakness, tiring easily, and swelling of the lower extremities (edema). [nmihi.com]

  […] paroxysmal nocturnal dyspnea: dyspnea that awakens the patient from sleep, usually only after 1-2 hours, and may have a chronic nocturnal cough and cardiac asthma 1,2 bendopnoea: dyspnea while bending forward 3 angina 1,2 syncope and cerebral dysfunction 1,2 cyanosis [radiopaedia.org]

  If vigorous massage improves nail bed color, cyanosis may be peripheral; increasing local blood flow does not improve color if cyanosis is central. [merckmanuals.com]

• Palpitations

  Symptoms may include the following (in no particular order of progression or presentation): Cough (typically non-productive) with or without wheezing Fatigue Shortness of breath at rest or worse on exertion Palpitations Sudden weight gain Edema (may see [sharecare.com]

  He denied other gastrointestinal symptoms, fever, night sweats, cough, palpitations, chest and low back pain or even genitourinary symptoms. On general examination, he had a body mass index of 18 kg/ m² and at rest he did not have dyspnea. [austinpublishinggroup.com]

  Class III: Patients with marked limitation of physical activity in which minimal ordinary activity results in fatigue, palpitation, dyspnea, or angina pain ; they are comfortable at rest. [medicinenet.com]

  […] causing a puffy appearance Extra sound when listening to the heart (called a gallop) Enlargement of the liver due to congestion on the right side of the heart, and it may be more easily felt Eyes or feet may be puffy as the right heart fails Chest pain Palpitations [cincinnatichildrens.org]

  Rapid or irregular heartbeats ( palpitations ): When your heart muscle does not pump with enough force, your heart may beat faster to try to get enough oxygen-rich blood to major organs and muscles. [my.clevelandclinic.org]

• Cardiomegaly

  On the left a patient with cardiomegaly and redistribution. The upper lobe vessels have a diameter > 3 mm (normal 1-2 mm). Notice the increased artery-to-bronchus ratio at hilar level (arrows). LEFT: normal. [radiologyassistant.nl]

  Chest x-ray did not show additional changes besides those previously known such as cardiomegaly. Electrocardiogram showed atrial fibrillation with a normal heart rate. Brain natriuretic peptide was 690 ng/L. [austinpublishinggroup.com]

  […] liquid accumulates in alveoli due to left heart pressure overload alveoli pop open during inhalation, causing rales on exam abdominal exam ascites hepatojugular reflex Imaging Chest radiograph findings pulmonary vascular congestion pleural effusion cardiomegaly [medbullets.com]

  With left-sided congestive cardiac failure, the features are that of pulmonary edema which includes 1,2,4-8 : central pulmonary venous congestion cephalisation of pulmonary veins pulmonary interstitial edema pulmonary alveolar edema cardiomegaly (may [radiopaedia.org]

  Framingham Criteria for Dx of Heart Failure • Major Criteria: – PND – JVD – Rales – Cardiomegaly – Acute Pulmonary Edema – S3 Gallop – Positive hepatic Jugular reflex – ↑ venous pressure > 16 cm H2O 22. [slideshare.net]

• Hepatomegaly

  Venous congestion in the systemic circulation results in jugular venous distention, hepatomegaly, splenomegaly, vascular congestion of the gastrointestinal tract, and peripheral edema. [quizlet.com]

  Abdominal examination elicited pain during superficial palpation on the right upper quadrant with hepatomegaly identification, with no signs of ascites. [austinpublishinggroup.com]

  Hepatomegaly - Centrilobular congestion and atrophy of central hepatocytes (nutmeg liver). [histopathology-india.net]

  Symptoms1 Failure of the Right Ventricle results in systemic venous hypertension, and can lead to the following signs/symptoms: Peripheral edema Anorexia, nausea, and abdominal pain related to congestion hepatomegaly Fatigue, dypnea (related to inadequate [openanesthesia.org]

  Fluid can also accumulate within the liver causing it to swell (hepatomegaly) and within the abdominal cavity ( ascites ). Ascites and hepatomegaly may make the patient feel bloated, nauseated, and have abdominal pain with the feeling of distension. [medicinenet.com]

• Pulsatile Liver

  Signs of RV failure include nontender peripheral pitting edema (digital pressure leaves visible and palpable imprints, sometimes quite deep) in the feet and ankles; an enlarged and sometimes pulsatile liver palpable below the right costal margin; abdominal [merckmanuals.com]

• Dermatitis

  It can be caused by systemic diseases, pregnancy in some women, either directly or as a result of heart failure, or local conditions such as varicose veins, thrombophlebitis, insect bites, and dermatitis. [en.wikipedia.org]

• Nocturia

  O2 exchange), Crackles, pulmonary edema Left sided heart failure Symptoms Weakness, fatigue, anxiety, depression, dyspnea, shallow respirations up to 32-40 min, Paroxysymal Nocturnal Dyspnea, Orthopnea (SOB in recumbent position, dry hacking cough, nocturia [quizlet.com]

  It can also cause nocturia, when the body fluid returns to the blood stream after lying down. Ascites will be caused in severe cases, which will further lead to liver enlargement and impaired liver functioning. [newhealthadvisor.com]

  D: Nocturia is not present in heart failure. 4. Answer: A. Stage I A: Stage I refer to a patient who reports no symptoms of heart failure at rest but becomes symptomatic with increased physical activity. [nurseslabs.com]

  […] around in a large dilated ventricle) 1,2 S4 ‘atrial gallop’ (occurs before S1 and is due to blood entering the ventricle during atrial systole hitting the stiff hypertrophied ventricular wall 1,2 pulsus alternans 1,2 right-predominant symptoms and signs nocturia [radiopaedia.org]

  Biventricular (global) HF presents with clinical features of both left-sided and right-sided failure, as well as general symptoms such as tachycardia, fatigue, and nocturia. [amboss.com]

• Oliguria

  These mechanisms are responsible for the symptoms of diaphoresis, cool skin, tachycardia, cardiac arrhythmias, and oliguria. [medical-dictionary.thefreedictionary.com]

  Oliguria is a late finding in heart failure, and it is found in patients with markedly reduced cardiac output from severely reduced LV function. [emedicine.medscape.com]

The diagnosis of CHF is based on clinical presentation and requires an initial workup to assess disease severity and possible causes. The initial workup includes measurement of brain natriuretic peptide levels, chest x-ray, and ECG. [amboss.com]

This is just one example of why it is so important that a complete diagnostic workup is made routinely. [ceufast.com]

• Pericardial Effusion

  On the left another patient with a large cardiac silhouette on the chest x-ray due to pericardial effusion. Pericardial effusion is demonstrated on the coronal CT-reconstruction. [radiologyassistant.nl]

  effusion ( Figure 4 ). [omicsonline.org]

  effusion心膜液 pericarditis 心膜炎 pericardium 心膜 peripheral 末梢［性］　【形】 permeability透過性、浸透性 phonocardiogram (PCG)心音図 plateau phaceプラトー相 positron emission tomography (PET)ポジトロン放射計断層撮影[法] potential（１）潜在性　【形】　（２）電位 precordial pain前胸[部]痛 preload前負荷 premature beat [tokyo-med.ac.jp]

  Echocardiography can help evaluate chamber dimensions, valve function, LVEF, wall motion abnormalities, LV hypertrophy, diastolic function, pulmonary artery pressure, LV and RV filling pressures, RV function, and pericardial effusion. [merckmanuals.com]

• Cardiac Output Decreased

  CHF occurs when the flow of blood from the heart ( cardiac output ) decreases, or fluid backs-up behind the failing ventricle, or both. [health.howstuffworks.com]

  Blood flow through the Left Heart chambers and vessels In left ventricular failure, cardiac output decreases and pulmonary venous pressures increase. [ceufast.com]

• Hyponatremia

  "Tolvaptan (samsca) for hyponatremia: is it worth its salt?". Pharmacy and Therapeutics. 34 (10): 543–547. [en.wikipedia.org]

  Specifically, tolvaptan is approved by the FDA for the treatment of euvolemic hyponatremia and hypervolemic hyponatremia. [healio.com]

  Monitor for hyponatremia. For pulmonary edema, an extreme of CHF, morphine and IV nitrates are adjuncts. Within the first twelve hours of presentation in the ED, ACE-inhibitors can be initiated as second-line therapy. [epmonthly.com]

  Benefits I II III IV First-line drugs Diuretics ( loop diuretics and thiazide diuretics ) (✓) (✓) ✓ ✓ Begin treatment with loop diuretics ( furosemide ) to treat volume overload Thiazides may be added for a synergistic effect Monitor for hypokalemia and hyponatremia [amboss.com]

• P Pulmonale

  Electrocardiography in patients with pulmonary hypertension shows signs of RV hypertrophy in the form of right axis deviation, dominant R in V1 and dominant S in V5 or 6 + P pulmonale. [escardio.org]

• Pleural Effusion

  Pleural effusion Pleural effusion more evident on lateral view Pleural effusion is bilateral in 70% of cases of CHF. When unilateral, it is slightly more often on the right side than on the left side. [radiologyassistant.nl]

  effusion due to another disorder Pleural effusion due to congestive heart failure Red half-moon nail in congestive heart failure Refractory heart failure Symptomatic congestive heart failure Index to Diseases and Injuries References found for the code [icdlist.com]

  effusions Sputum analysis : heart failure cells ( hemosiderin -containing cells) Thoracentesis Indicated if the etiology of the pleural effusion is unclear Pleural fluid analysis: Transudate effusions are typical of cardiogenic causes. [amboss.com]

  Chest X-ray • Size and shape of heart • Evidence of pulmonary venous congestion (dilated or upper lobe veins → perivascular edema) • Pleural effusion 29. [slideshare.net]

  effusion cardiomegaly Kerley-B lines interstitial edema Echocardiogram indication confirms the diagnosis of heart failure classifies whether heart failure is due to systolic or diastolic dysfunction findings assess for low ejection fraction systolic [medbullets.com]

The Content is not intended to be a substitute for professional medical advice, diagnosis, or treatment. [heartfailurecenter.com]

Treatment and Recovery Treatment for left-sided heart failure focuses on managing symptoms and treating underlying causes of the condition. [baptisthealth.com]

Treatment The treatment of heart failure focuses on: Lessening symptoms Decreasing hospitalizations Improving life expectancy To accomplish these goals, your doctor will advise a low-salt diet and medication. [drugs.com]

When the cause of right-sided heart failure is a pulmonary disorder (that is, if cor pulmonale is present), then the treatment relies on optimizing the treatment of the underlying lung problem. [verywellhealth.com]

The cause of your acute heart failure will determine your treatment plan. Treatment for acute heart failure and chronic heart failure is often the same. Treatment typically includes a combination of medication, surgery, and medical devices. [healthline.com]

References: [35] [36] [37] Prognosis [amboss.com]

The prognosis of heart failure patients is very closely associated with the functional class. An important issue in congestive heart failure is the risk of heart rhythm disturbances (arrhythmias). [medicinenet.com]

Prognosis The prognosis for left-sided heart failure varies, depending on the cause of the condition and severity of the symptoms. Some will improve with treatment and lifestyle changes. For others, left-sided heart failure can be life-threatening. [baptisthealth.com]

Treatment and prognosis Treatment involves a multidisciplinary team and incorporates lifestyle, allied health, pharmacological, and even surgical therapies, often specific to the underlying etiology 1,2. [radiopaedia.org]

Clinical presentation varies considerably depending on the severity and etiology of CCF 1,2. [radiopaedia.org]

Etiology ADHF typically occurs in patients who have a history of chronic HF or other cardiac conditions in which an acute cause precipitates the deterioration of cardiac function. [amboss.com]

Pathophysiology | Etiology | Symptoms | Diagnosis | Treatment | Special Situations Introduction Congestive heart failure occurs when the cardiac output is not adequate enough to meet the demands of the body. [healio.com]

[…] the diet (post-holiday heart) uncontrolled hypertension thyrotoxicosis myocardial infarction Epidemiology risk factors coronary artery disease viral infection alcohol abuse hypertension arrhythmias metabolic syndrome drugs ( e.g., doxorubicin) smoking Etiology [medbullets.com]

Other studies should be individualized depending upon the suspected etiology of RHF. [revespcardiol.org]

[…] metabolic demand decompensated heart failure occurs when symptoms are worsened or exacerbated precipitating factors include infections arrhythmias excessive salt in the diet (post-holiday heart) uncontrolled hypertension thyrotoxicosis myocardial infarction Epidemiology [medbullets.com]

References: [2] [3] Epidemiological data refers to the US, unless otherwise specified. Etiology The three major causes of heart failure are coronary artery disease, hypertension, and diabetes mellitus. [amboss.com]

Epidemiology There are few reliable figures for prevalence of cor pulmonale in the population at large, as the condition is difficult to diagnose reliably on the basis of clinical symptoms and signs alone. [patient.info]

"The epidemiology of heart failure: the Framingham Study." Journal of the American College of Cardiology 22.4 Suppl A (1993): 6A-13A. CONTINUE SCROLLING FOR RELATED SLIDESHOW [medicinenet.com]

EPIDEMIOLOGY Heart failure is an ongoing public health challenge in the United States. In the adult population over age 20, the prevalence of heart failure is 2.6 percent. It is generally higher in men than in women but highest in black women. [nap.edu]

Right Sided heart failure Pathophysiology Right sided heart failure occurs when the right ventricle fails to contract effectively. right sided heart failure causes a backup of blood into the right atrium and venous circulation. [quizlet.com]

Can J Anaesth: 2012, 59(6);586-603 [PubMed:22528163] [WorldCat.org] [DOI] (I p) François Haddad, Ramona Doyle, Daniel J Murphy, Sharon A Hunt Right ventricular function in cardiovascular disease, part II: pathophysiology, clinical importance, and management [openanesthesia.org]

Pathophysiology To make intelligent management decisions, you must first understand several key pathologic pathways in RV failure: RV response to increased PVR (i.e. [nuemblog.com]

Sun XG, Hansen JE, Oudiz RJ, Wasserman K: Exercise pathophysiology in patients with primary pulmonary hypertension. Circulation 2001, 104: 429–435. CrossRef PubMed Google Scholar 20. [link.springer.com]

Lilly, Pathophysiology of Heart Disease, 2007 Predominantly systolic dysfunction is seen in a majority of patients, while others exhibit mainly diastolic dysfunction. Components of both can also be found. [pathophys.org]

Prevention While you cannot prevent all risks factors associated with left-sided heart failure, you can take steps to lower, or in some cases even reverse, your risks of diseases or conditions that can cause or complicate left-sided heart failure. [baptisthealth.com]

Because of this, treatment is centered on managing symptoms and preventing future heart failure. In some cases, acute heart failure can be caused by undiagnosed chronic heart failure. [healthline.com]

Prevention The key to preventing heart failure is to reduce your risk factors. [mayoclinic.org]