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Congestive Heart Failure

CHF

Congestive heart failure (CHF) or congestive cardiac failure (CCF) refers to chronic, usually biventricular failure of the heart.


Presentation

The patients of congestive cardiac failure present with features of left and right heart failure. The clinical manifestations are as below.

Features due to left heart failure:

  • Dyspnea, orthopnea and paroxysmal nocturnal dyspnea: These symptoms develop due to congestion of the lungs. Sometimes chronic cough may also be seen.
  • Fatigue and weakness: Fatigue and weakness result from decreased cardiac output to the skeletal muscles and the central nervous system.
  • Nocturia: Nocturia occurs due to excretion of fluid retained during the day and increased renal perfusion in recumbent position at night.

Features due to right heart failure:

  • Headache, insomnia and restlessness: These symptoms occur because of cerebral congestion.
  • Anorexia, nausea and vomiting: Congestion of the portal system causes these symptoms.
  • Pain in the right hypochondrium: Hepatic congestion causes stretching of the hepatic capsule which causes pain in the right hypochondrium.
  • Oliguria and nocturia: These symptoms result from renal congestion.
  • Peripheral edema: Edema develops in the feet in ambulatory patients and sacral edema in bed bound patients.

On examination, the findings include raised jugular pressure and positive hepatojugular reflex, tender hepatomegaly and features of heart disease.

Framignham criteria is used for the diagnosis of congestive cardiac failure. The presence of one major and two minor criteria is the minimal requirement for establishing the diagnosis.

The major criteria include:

The minor criteria include:

Fatigue
  • A 60-year-old man presented with exertional dyspnea, fatigue, and chest discomfort of 18-month history. Physical examination revealed S4, bilateral pretibial edema, and moderate amount of ascites.[ncbi.nlm.nih.gov]
  • A 4-L decrease in lower extremity edema volume was noted, but fatigue and shortness of breath increased markedly. Treatment was discontinued and the patient was referred back to her physician for cardiac evaluation and treatment.[ncbi.nlm.nih.gov]
  • MIP, maximal expiratory pressure, spirometry, resting oxyhemoglobin saturation, modified Borg Scale, Fatigue Assessment Scale, and Barthel Index were assessed in each patient.[ncbi.nlm.nih.gov]
  • A 22-year-old man with a 2-month history of fatigue was admitted to our hospital because of chest discomfort, dyspnea, and pitting edema of the lower limbs experienced over a 1-month period.[ncbi.nlm.nih.gov]
  • Right-side and left-side heart failure also cause shortness of breath and fatigue (tiredness). The leading causes of heart failure are diseases that damage the heart. These include coronary artery disease (CAD), high blood pressure, and diabetes.[womenheart.org]
Coronary Artery Disease
  • In recent studies, coronary artery disease (CAD) is accepted as the most important cause of CHF. This study focuses on the diagnosis of both the CHF and the CAD.[ncbi.nlm.nih.gov]
  • Comorbidities examined were acute or decompensated CHF, along with coronary artery disease, chronic obstructive pulmonary disease, diabetes, dyspnea, obesity, and smoking status.[ncbi.nlm.nih.gov]
  • These include coronary artery disease (CAD), high blood pressure, and diabetes. "Heart failure” doesn’t mean that your heart has stopped or is about to stop working. However, it’s a serious condition that requires medical care.[womenheart.org]
  • It is used to monitor changes in your heart’s function when it’s under stress that may indicate coronary artery disease. Echocardiogram An ultrasound probe is moved over the surface of your chest to capture moving images of your heart.[dukehealth.org]
  • This invasive procedure helps determine whether coronary artery disease is a cause of congestive heart failure. Stress Test. Noninvasive stress tests provide information about the likelihood of coronary artery disease.[webmd.com]
Weight Gain
  • Passing out during exercise Poor appetite Weight loss or lack of weight gain can be seen even in older children.[cincinnatichildrens.org]
  • . — Korin Miller, SELF , "13 Surprising Medical Conditions That Can Cause Weight Gain or Loss (and When to Go to the Doctor)," 12 Nov. 2018 The cause was congestive heart failure , said a daughter, Nancy Becker. — Washington Post , "Community deaths,"[merriam-webster.com]
  • Another symptom is weight gain (when fluid builds up).[cheyenneregional.org]
  • These data demonstrate that, on average, weight gain begins in a gradual fashion at least 1 week before heart failure hospitalization, but the present findings do not indicate that all admissions are preceded by weight gain.[dx.doi.org]
  • Signs & Symptoms Shortness of breath, especially when lying down Swelling (edema) in your legs, feet, ankles or abdomen Fatigue and weakness Increased cough Weight gain from fluid buildup (especially 2 pounds overnight or 3-4 pounds in a week) Managing[lourdes.com]
Weight Loss
  • loss 4.5 kg in 5 days in response to treatment Minor criteria: · Bilateral ankle edema · Nocturnal cough · Dyspnea on ordinary exertion · Hepatomegaly · Pleural effusion · Decrease in vital capacity by one third from maximum recorded · Tachycardia (heart[medicalcriteria.com]
  • Dietary Changes – If you are even slightly overweight, weight loss is imperative to prevent further damage to your heart muscle.[acls.net]
  • Alpert, Jad Omran, Ankit Mehra and Sivakumar Ardhanari , Impact of Obesity and Weight Loss on Cardiac Performance and Morphology in Adults , Progress in Cardiovascular Diseases , 56 , 4 , (391) , (2014) . Carlos D. Libhaber, Angela J.[dx.doi.org]
  • Passing out during exercise Poor appetite Weight loss or lack of weight gain can be seen even in older children.[cincinnatichildrens.org]
Myxedema
  • […] independent of other risk factors. [25, 26] Because of increased myocardial oxygen consumption and demand beyond a critical level, the following high-output states can precipitate the clinical presentation of heart failure: Profound anemia Thyrotoxicosis Myxedema[emedicine.com]
Dyspnea
  • Dyspnea occurs because of the damming of blood in the lungs resulting in pulmonary venous congestion. Initially dyspnea occurs only at exertion. Later on orthopnea and paroxysmal nocturnal dyspnea also develop. Later on dyspnea occurs even at rest.[symptoma.com]
  • Major criteria: · Paroxysmal nocturnal dyspnea · Neck vein distention · Rales · Radiographic cardiomegaly (increasing heart size on chest radiography) · Acute pulmonary edema · S3 gallop · Increased central venous pressure ( 16 cm H2O at right atrium)[medicalcriteria.com]
  • We present a case of a 70 year-old male presented with exertional dyspnea for 2 months and found to have giant LV pseudo aneurysm on transthoracic echocardiogram, cardiac MRI and angiogram.[ncbi.nlm.nih.gov]
  • Treatment with tolvaptan increased the urine volume, improved the dyspnea and decreased the edema. However, the patient's renal function and hyperkalemia worsened, and the blood eosinophil count increased without signs of dehydration or hypotension.[ncbi.nlm.nih.gov]
Cough
  • […] information 1 Department of Respiratory Medicine, Kyorin University, Mitaka, Japan. [email protected] Abstract A 66-year-old woman with a history of myocardial infarction 2 months prior presented to our respiratory department with several days of dry cough[ncbi.nlm.nih.gov]
  • There was partial response to Captopril and Frusemide therapy, with development of a progressive cough.[ncbi.nlm.nih.gov]
  • CASE REPORT: A middle-aged man having past history of treated pulmonary tuberculosis and obstructive uropathy presented with 2-weeks of progressive cough with scanty purulent sputum and breathlessness without any fever, chest pain, or pedal edema.[ncbi.nlm.nih.gov]
  • Medicine, University of Missouri, Columbia, Missouri 65212, USA. [email protected] Abstract A 70-year-old Caucasian male presented 8 months postcadaveric renal transplant with slowly progressive shortness of breath, abdominal distention, and cough[ncbi.nlm.nih.gov]
  • […] chest radiography) · Acute pulmonary edema · S3 gallop · Increased central venous pressure ( 16 cm H2O at right atrium) · Hepatojugular reflux · Weight loss 4.5 kg in 5 days in response to treatment Minor criteria: · Bilateral ankle edema · Nocturnal cough[medicalcriteria.com]
Rales
  • No rales were detected because of its paucity of fibrous components in the lung.[ncbi.nlm.nih.gov]
  • Major criteria: · Paroxysmal nocturnal dyspnea · Neck vein distention · Rales · Radiographic cardiomegaly (increasing heart size on chest radiography) · Acute pulmonary edema · S3 gallop · Increased central venous pressure ( 16 cm H2O at right atrium)[medicalcriteria.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]
  • Clinical symptoms of heart failure include: unusual dyspnea on light exertion, recurrent dyspnea occurring in the supine position, fluid retention; or rales, jugular venous distension, pulmonary edema on physical exam, or pulmonary edema on chest x-ray[fpnotebook.com]
Pleural Effusion
  • After 8 months of treatment, her symptoms improved and the pleural effusion showed significant regression.[ncbi.nlm.nih.gov]
  • Computed tomography and X-ray of the thorax showed left-sided pleural effusion. Abdominal imaging showed normal liver and spleen structure with intraperitoneal effusion and periportal edema.[ncbi.nlm.nih.gov]
  • effusion · Decrease in vital capacity by one third from maximum recorded · Tachycardia (heart rate 120 beats/min.)[medicalcriteria.com]
  • Chest radiographs in patients with CHF showed cardiomegaly, pulmonary edema, and pleural effusions. Patients with CHF were discharged with suboptimal medication regimens. Referral to outpatient rehabilitation programs was low in both groups.[ncbi.nlm.nih.gov]
Orthopnea
  • CASE REPORT: A 35-year-old woman presented to the ED with a 2-month history of shortness of breath, dyspnea on exertion, decreased exercise tolerance, and orthopnea. The physical examination revealed a 4/6 continuous machine-like murmur.[ncbi.nlm.nih.gov]
  • Abstract A 31-year-old woman complained of dyspnea and orthopnea at 38 weeks of gestation.[ncbi.nlm.nih.gov]
  • Later on orthopnea and paroxysmal nocturnal dyspnea also develop. Later on dyspnea occurs even at rest. Orthopnea refers to breathlessness on lying flat. It occurs because of the following two circulating changes when the person lies flat.[symptoma.com]
  • […] failure high cardiac output and systemic vascular resistance often occurs in the setting of existing systolic or diastolic dysfunction Associated conditions obstructive sleep apnea major depression disorder Presentation Symptoms dyspnea on exertion orthopnea[medbullets.com]
  • Orthopnea and paroxysmal nocturnal dyspnea are related to congestion of the pulmonary blood vessels and edema of the lung tissues.[medical-dictionary.thefreedictionary.com]
Nausea
  • Anorexia, nausea and vomiting: Congestion of the portal system causes these symptoms. Pain in the right hypochondrium: Hepatic congestion causes stretching of the hepatic capsule which causes pain in the right hypochondrium.[symptoma.com]
  • You’re sick to your stomach iStock/elenaleonova Some people notice decreased appetite or nausea due to the fact that the digestive system is getting less blood, which could lead to an upset stomach, says the AHA.[rd.com]
  • […] palpitations Chronic cough or wheezing Decreased urine production Difficulty sleeping Fatigue or fainting spells Feeling of fullness, loss of appetite, or abdominal pain Fluid retention, which causes swollen extremities or abdomen (edema) Loss of muscle mass Nausea[utswmedicine.org]
  • , abdominal swelling, tenderness or pain (may result from the buildup of fluid in the body and the backup of blood in the liver) Weight gain (due to fluid buildup) Weight loss as nausea causes a loss of appetite and as the body fails to absorb food well[cedars-sinai.edu]
  • Lack of appetite, nausea ...a feeling of being full or sick to your stomach. The digestive system receives less blood, causing problems with digestion. Confusion, impaired thinking ...memory loss and feelings of disorientation.[heart.org]
Loss of Appetite
  • […] of appetite constipation.[betterhealth.vic.gov.au]
  • Heart Failure Symptoms Shortness of breath Weight gain Swelling of the lower extremities Fatigue Exercise intolerance Palpitations Loss of appetite Congestive Heart Failure Causes Many conditions that cause your heart to fail result in irreversible damage[wexnermedical.osu.edu]
  • Heart failure symptoms can include: Abnormal heart rhythm or palpitations Chronic cough or wheezing Decreased urine production Difficulty sleeping Fatigue or fainting spells Feeling of fullness, loss of appetite, or abdominal pain Fluid retention, which[utswmedicine.org]
  • Common symptoms are: Cough Fatigue, weakness, faintness Loss of appetite Need to urinate at night Pulse that feels fast or irregular, or a sensation of feeling the heartbeat (palpitations) Shortness of breath when you are active or after you lie down[nlm.nih.gov]
Vomiting
  • Anorexia, nausea and vomiting: Congestion of the portal system causes these symptoms. Pain in the right hypochondrium: Hepatic congestion causes stretching of the hepatic capsule which causes pain in the right hypochondrium.[symptoma.com]
  • Chronic cough or wheezing Decreased urine production Difficulty sleeping Fatigue or fainting spells Feeling of fullness, loss of appetite, or abdominal pain Fluid retention, which causes swollen extremities or abdomen (edema) Loss of muscle mass Nausea or vomiting[utswmedicine.org]
  • Main side effects are taste disturbances, while less common side effects are nausea, vomiting, abdominal pain, diarrhoea, flushing, bronchospasm, fever, myalgia and injection site reactions.[web.archive.org]
  • 847,073 209,017 24.7 12 Personality disorders 5,436 1,316 24.2 13 Nutritional deficiencies 9,845 2,355 23.9 14 Coagulation and hemorrhagic disorders 33,397 7,920 23.7 15 Respiratory failure, insufficiency, arrest (adult) 260,781 59,842 22.9 16 Nausea and vomiting[hcup-us.ahrq.gov]
Polydipsia
  • […] develops, it requires continuous therapy to M&M–ie, 1. non-pharmacologic maneuvers–eg, salt restriction in the form of a 'no salt added' regimen, reduction of alcohol intake, exercise as tolerated and, for Pts with impaired renal function or psychogenic polydipsia[medical-dictionary.thefreedictionary.com]
Heart Disease
  • In some people, heart disease and heart failure symptoms persist even after revascularisation.[doi.org]
  • A promising approach to the treatment of chronic ischaemic heart disease and congestive heart failure is the use of stem cells.[ncbi.nlm.nih.gov]
  • Related Criteria: Estimate of 10-Year Risk for Coronary Heart Disease for Men (Framingham Point Scores) Estimate of 10-Year Risk for Coronary Heart Disease for Women (Framingham Point Scores) NYHA Functional Classification for Congestive Heart Failure[medicalcriteria.com]
  • After the analysis had been adjusted for confounders, the leading comorbidities associated with PCHF were structural heart diseases (adjusted odds ratio [aOR]: 67.21; 95% confidence interval [CI]: 54.29-83.22), pulmonary diseases (aOR: 13.12; 95% CI:[ncbi.nlm.nih.gov]
Tachycardia
  • Renal failure may also occur following heart transplantation as a result of long-term immunosuppression. [3] Cardiac rhythm disorders may be caused by the following: Complete heart block Supraventricular tachycardia Ventricular tachycardia Sinus node[emedicine.com]
  • A 12-lead electrocardiogram showed irregular wide QRS complex tachycardia with a slur at the initial portion of the QRS complex. He had preexisting long-standing persistent atrial fibrillation, but early excitation syndrome had never been noted.[ncbi.nlm.nih.gov]
  • ECG and telemetry revealed relatively slow supraventricular tachycardia, which did not trigger the alert, and catheter ablation successfully controlled the heart failure.[ncbi.nlm.nih.gov]
  • With an increase in creatinine, he experienced 3 episodes of ventricular tachycardia and ventricular fibrillation. Withdrawal of the phosphodiesterase (PDE) inhibitor resulted in no further episodes of dysrhythmias.[ncbi.nlm.nih.gov]
Chest Pain
  • CASE REPORT: A middle-aged man having past history of treated pulmonary tuberculosis and obstructive uropathy presented with 2-weeks of progressive cough with scanty purulent sputum and breathlessness without any fever, chest pain, or pedal edema.[ncbi.nlm.nih.gov]
  • Symptoms of heart failure Some of the most common symptoms you may experience are reduced energy, confusion, chest pain, shortness of breath and swelling in the legs.[novanthealth.org]
  • […] simmering discontents, dies at 85," 22 May 2018 Other symptoms of congestive heart failure include a rapid or irregular heartbeat, a persistent cough or wheezing with white or pink phlegm, an increased need to pee at night, difficulty concentrating, and chest[merriam-webster.com]
  • Some people may chest pain, which may range from excruciating, to a mild discomfort. The severity of pain does not indicate how severe the damage to the heart muscle may be.[chemocare.com]
  • pain or discomfort in parts of the upper body unexplained coughing and wheezing loss of appetite constipation.[betterhealth.vic.gov.au]
Hypotension
  • After cardioversion, refractory hypotension and cardiopulmonary arrest occurred. An arterial blood gas analysis showed marked lactic acidosis.[ncbi.nlm.nih.gov]
  • However, the patient's renal function and hyperkalemia worsened, and the blood eosinophil count increased without signs of dehydration or hypotension.[ncbi.nlm.nih.gov]
  • LESSONS: TLV has side effect of severe hypotension that is consistent with its physiological activity. The dose should be increased gradually to achieve the desired effect, while attention should be paid to potential drug interactions.[ncbi.nlm.nih.gov]
  • Exclusion criteria included recent myocardial infarction in the preceeding 2 months, ventricular or atrioventricular pacing for 40% of the day, atrial fibrillation or flutter, and symptomatic hypotension.[2minutemedicine.com]
  • Hypotensive patients : Avoid nitrates and morphine, as they will drop the blood pressure even loser. Instead, increase myocardial contractility with dopamine, dobutamine, norepinephrine, amrinone or milrinone.[saem.org]
Palpitations
  • Author information 1 Division of Cardiology, Department of Internal Medicine, Nippon Medical School Chiba Hokusoh Hospital, Japan. [email protected] Abstract A 56-year-old man was admitted because of palpitations and dyspnea.[ncbi.nlm.nih.gov]
  • You may experience palpitations. Some people may chest pain, which may range from excruciating, to a mild discomfort. The severity of pain does not indicate how severe the damage to the heart muscle may be.[chemocare.com]
  • […] failure Symptoms of heart failure include: new or worsening shortness of breath (particularly during physical activity or waking you up at night) weight gain muscular fatigue, tiredness swelling of ankles or legs swelling of abdomen dizziness heart palpitations[betterhealth.vic.gov.au]
  • Your ticker is working overtime Tyler Olson/Shutterstock “If some people were to check their heart rate, they would see it’s actually increased, and some might experience palpitations,” says Dr. Fonarow.[rd.com]
  • Heart Failure Symptoms Shortness of breath Weight gain Swelling of the lower extremities Fatigue Exercise intolerance Palpitations Loss of appetite Congestive Heart Failure Causes Many conditions that cause your heart to fail result in irreversible damage[wexnermedical.osu.edu]
Hepatomegaly
  • Cardiac examination at the age of 6 years revealed constrictive pericarditis with significant elevation of atrial filling pressures, consecutive hepatomegaly, and protein loosing enteropathy.[ncbi.nlm.nih.gov]
  • Right upper quadrant sonogram revealed hepatomegaly of 15 cm, trace amount of perihepatic ascites, pericholecystic fluid, and also thickened edematous gallbladder wall with no stones, no common bile duct stones, and no portal vein thrombosis.[ncbi.nlm.nih.gov]
  • […] edema · S3 gallop · Increased central venous pressure ( 16 cm H2O at right atrium) · Hepatojugular reflux · Weight loss 4.5 kg in 5 days in response to treatment Minor criteria: · Bilateral ankle edema · Nocturnal cough · Dyspnea on ordinary exertion · Hepatomegaly[medicalcriteria.com]
  • On examination, the findings include raised jugular pressure and positive hepatojugular reflex, tender hepatomegaly and features of heart disease. Framignham criteria is used for the diagnosis of congestive cardiac failure.[symptoma.com]
Oliguria
  • Oliguria and nocturia: These symptoms result from renal congestion. Peripheral edema: Edema develops in the feet in ambulatory patients and sacral edema in bed bound patients.[symptoma.com]
  • These mechanisms are responsible for the symptoms of diaphoresis, cool skin, tachycardia, cardiac arrhythmias, and oliguria.[medical-dictionary.thefreedictionary.com]
  • The full-blown syndrome includes anasarca with liver dysfunction and oliguria.[doi.org]
  • Signs and symptoms Signs and symptoms of heart failure include the following: Exertional dyspnea and/or dyspnea at rest Orthopnea Acute pulmonary edema Chest pain/pressure and palpitations Tachycardia Fatigue and weakness Nocturia and oliguria Anorexia[emedicine.com]
Nocturia
  • Nocturia: Nocturia occurs due to excretion of fluid retained during the day and increased renal perfusion in recumbent position at night.[symptoma.com]
  • This may lead to peripheral edema or anasarca and nocturia (frequent nighttime urination when the fluid from the legs is returned to the bloodstream).[sciencedaily.com]
  • Nocturia (frequent nighttime urination) may occur when fluid from the legs is returned to the bloodstream while lying down at night.[en.wikipedia.org]
  • Signs and symptoms Signs and symptoms of heart failure include the following: Exertional dyspnea and/or dyspnea at rest Orthopnea Acute pulmonary edema Chest pain/pressure and palpitations Tachycardia Fatigue and weakness Nocturia and oliguria Anorexia[emedicine.com]
Confusion
  • Depressive symptoms, however, sometimes are confused with the physical repercussions of heart failure. This article highlights different screening assessments for major depression and recommends treatment for this population.[ncbi.nlm.nih.gov]
  • Symptoms of heart failure Some of the most common symptoms you may experience are reduced energy, confusion, chest pain, shortness of breath and swelling in the legs.[novanthealth.org]
  • The term ‘failure’ can be confusing – the heart does not actually stop pumping. However, the heart is less effective at both delivering oxygen and nutrients to the rest of the body and carrying waste products away.[gosh.nhs.uk]
  • Without enough blood, the brain does not function well, resulting in lightheadedness and/or mental confusion. Lightheadedness is a sensation of dizziness or mild disorientation.[northshore.org]
  • It is not to be confused with "cessation of heartbeat", which is known as asystole, or with cardiac arrest, which is the cessation of normal cardiac function in the face of heart disease.[sciencedaily.com]
Dizziness
  • While symptoms of heart failure vary by person, swelling of the legs, irregular heartbeats or other unexplained symptoms like shortness of breath or dizziness could be early signs of heart failure.[novanthealth.org]
  • Symptoms of heart failure Symptoms of heart failure include: new or worsening shortness of breath (particularly during physical activity or waking you up at night) weight gain muscular fatigue, tiredness swelling of ankles or legs swelling of abdomen dizziness[betterhealth.vic.gov.au]
  • Dizziness , fatigue , and weakness . Less blood to your major organs and muscles makes you feel tired and weak. Less blood to the brain can cause dizziness or confusion. Rapid or irregular heartbeats.[webmd.com]
  • […] 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 (irregular heartbeat) Dizziness[cincinnatichildrens.org]
  • Lightheadedness is a sensation of dizziness or mild disorientation. People with heart failure may also experience lightheadedness as a side effect of certain medications.[northshore.org]
Headache
  • Features due to right heart failure: Headache, insomnia and restlessness: These symptoms occur because of cerebral congestion. Anorexia, nausea and vomiting: Congestion of the portal system causes these symptoms.[symptoma.com]
  • No serious adverse events occurred in either group; however, constipation, headaches, and hypotension were more frequent in the conivaptan arms.[uscjournal.com]
  • Symptoms include fever, chills, rigors, dyspnea, wheezing, chest pain or tightness, headache, nausea, vomiting, and diarrhea.[doi.org]
  • Tolerance on continuous use Isosorbide dinitrate Acute heart failure, when blood pressure is adequate Start with 1 mg/h, increase to 10 mg/h Hypotension, headache Tolerance on continuous use Nitroprusside Hypertensive crisis, cardiogenic shock combined[doi.org]
  • Nervous System and Sense Organs 76 Meningitis 32,909 2,565 7.8 77 Encephalitis 8,487 1,219 14.4 79 Parkinson's disease 13,089 2,118 16.2 80 Multiple sclerosis 21,708 2,529 11.6 82 Paralysis 7,394 987 13.3 83 Epilepsy, convulsions 252,200 31,965 12.7 84 Headache[hcup-us.ahrq.gov]
Insomnia
  • Features due to right heart failure: Headache, insomnia and restlessness: These symptoms occur because of cerebral congestion. Anorexia, nausea and vomiting: Congestion of the portal system causes these symptoms.[symptoma.com]
  • […] strengthening of relationships with loved ones. 10 Although heart failure patients are often assumed principally to suffer from fatigue and dyspnea, a majority have pain, and depression is extremely common. 11 Other sources of suffering include edema, insomnia[doi.org]
  • Side effects of amiodarone have included thyroid abnormalities, pulmonary toxicity, hepatotoxicity, neuropathy, insomnia, and numerous other reactions.[content.onlinejacc.org]
  • Janszky , Insomnia and the risk of incident heart failure: a population study , European Heart Journal , 35 , 21 , (1382) , (2014) .[dx.doi.org]
Sleep Disturbance
  • Screening for hemochromatosis, sleep-disturbed breathing, or human immunodeficiency virus is reasonable in selected patients who present with HF. (Level of Evidence: C) 6.[doi.org]
  • Screening for hemochromatosis, sleep-disturbed breathing, or human immunodeficiency virus is reasonable in selected patients who present with HF. ( Level of Evidence: C ) 7.[content.onlinejacc.org]
  • Peter Johansson, Barbara Riegel, Erland Svensson, Anders Broström, Urban Alehagen, Ulf Dahlström and Tiny Jaarsma , The Contribution of Heart Failure to Sleep Disturbances and Depressive Symptoms in Older Adults , Journal of Geriatric Psychiatry and Neurology[dx.doi.org]

Workup

The main investigations in the diagnosis of congestive cardiac failure include the following.

  • Electrocardiography (ECG): ECG may show signs of right and left ventricular enlargement, myocardial infarction and arrhythmias.
  • X-ray of the chest: Possible findings include hilar congestion and bat wings appearance in the lungs, cardiomegaly, pleural effusion and evidence of pulmonary hypertension.
  • Echocardiography: Echocardiography may demonstrate systolic or diastolic impairment of the left or right ventricle, valve diseases, motion abnormalities of the heart walls, cardiomyopathies, reduced ejection fraction and intracardiac thrombus.
Pericardial Effusion
  • Patients were excluded if they met any of the following conditions: chronic primary pulmonary diseases, unstable angina, Q-wave myocardial infarction within the last 3 weeks, cardiac surgery within the previous 3 months, pericardial effusion or cachexia[doi.org]
  • The clinical presentation, with a pericardial effusion of 1 cm depth, and echo densities in the effusion, confirms the diagnosis. 200 Temporary haemodynamic stabilization can be obtained by pericardiocentesis, fluids, and positive inotropes.[doi.org]
  • Rheumatological/Connective Tissue Disorders Along with a number of cardiac abnormalities (eg, pericarditis, pericardial effusion, conduction system abnormalities, including complete atrioventricular heart block), DCM can be a rare manifestation of systemic[doi.org]
Kerley B Lines
  • […] 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 Kerley-B[medbullets.com]
  • Kerley B lines – Dilated lymphatic channels. Typically 2 cm in length and horizontal, peripherally located perpendicular to pleura. Black arrowheads in following image are kerley b lines, white arrows are septal lines.[saem.org]
  • The interlobular septal thickening is referred to as Kerley B lines. Early blunting of the lateral and posterior costophrenic angles may occur; such blunting indicates the presence of pleural fluid.[emedicine.com]
  • Kerley B lines. Apart from pulmonary congestion, CXR findings are only predictive of heart failure where there are co-existing typical signs and symptoms. Urinalysis. Lung function tests (peak flow or spirometry).[patient.info]
Kerley Lines
Pulmonary Edema on Chest X-Ray
  • Clinical symptoms of heart failure include: unusual dyspnea on light exertion, recurrent dyspnea occurring in the supine position, fluid retention; or rales, jugular venous distension, pulmonary edema on physical exam, or pulmonary edema on chest x-ray[fpnotebook.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]
Echocardiogram Abnormal
  • Objective evidence of a structural or functional abnormality of the heart at rest: cardiomegaly, third heart sound, cardiac murmurs, echocardiogram abnormalities, raised natriuretic peptide concentration.[patient.info]
Hyponatremia
  • Conivaptan therapy was administered for 48 hours, after which the patient recovered from her hyponatremia without untoward effects.[ncbi.nlm.nih.gov]
  • It seems that icodextrin may contribute to clinically relevant hyponatremia if the hyponatremia is compounded by other factors. Patients with extremely severe congestive heart failure are susceptible to this complication.[ncbi.nlm.nih.gov]
  • Abstract Tolvaptan is an oral vasopressin type 2 receptor antagonist that can be used for heart failure patients with hyponatremia or symptomatic congestion.[ncbi.nlm.nih.gov]
  • Classification of Hyponatremia The definition of hyponatremia is serum sodium concentration 4,5 Depletional hyponatremia is caused by certain disorders or drugs that produce a decrease in extracellular fluid, leading to an excessive loss of renal salts[uscjournal.com]
  • Other poor prognostic factors include left ventricular dysfunction with ejection fraction less than 20%, secondary renal insufficiency, hyponatremia and hypokalemia (with potassium less than 3 mEq/l).[symptoma.com]
Hypercapnia
  • Respiratory muscle fatigue may be diagnosed by a decrease in respiratory rate, associated with hypercapnia and confused state of mind.[doi.org]
Pleural Effusion
  • After 8 months of treatment, her symptoms improved and the pleural effusion showed significant regression.[ncbi.nlm.nih.gov]
  • Computed tomography and X-ray of the thorax showed left-sided pleural effusion. Abdominal imaging showed normal liver and spleen structure with intraperitoneal effusion and periportal edema.[ncbi.nlm.nih.gov]
  • effusion · Decrease in vital capacity by one third from maximum recorded · Tachycardia (heart rate 120 beats/min.)[medicalcriteria.com]
  • Chest radiographs in patients with CHF showed cardiomegaly, pulmonary edema, and pleural effusions. Patients with CHF were discharged with suboptimal medication regimens. Referral to outpatient rehabilitation programs was low in both groups.[ncbi.nlm.nih.gov]

Treatment

The treatment strategy for congestive cardiac failure has three components; namely correction of the underlying cause(s), removal of the precipitating cause(s) and control of congestive cardiac failure.

The general measures for controlling the congestive cardiac failure include the following.

  • Bed rest: Bed rest reduces the demands of the heart. Propping up of the head of the patient should be proposed to reduce lung congestion. 
  • Diet: Diet low in salt, general good nutrition and weight reduction should be advised.
  • Smoking: Complete cessation of smoking has to be ensured.
  • Exercise: Adequate exercise within the limits of the symptoms is beneficial.

Medical therapy

Initially, angiotensin converting enzyme (ACE) inhibitors are given to the patient which reduce cardiac workload by causing vasodilation [3]. Captopril and lisinopril are the commonly used agents [4].

If ACE inhibitors alone are not effective, a combination of other vasodilators (such as nitrates, hydralazine and neseritide) and diuretics (such as loop diuretics, thiazide diuretics and potassium sparing diuretics) may be used [5] [6].

If adequate control is still not achieved, positive ionotropic agents such as digoxin and digitalis are useful [7] [8].

Cardiac transplantation

Cardiac transplantation is indicated in end stage cardiac disease that is refractory to other kinds of therapy. Ideal candidates should have age less than 60 years, adequate renal function and pulmonary vascular resistance less than 3 RU [9] [10].

Prognosis

The prognosis depends upon the extent of cardiac failure and the type of treatment given. Prognosis is poor when the underlying heart disease is not treatable. Other poor prognostic factors include left ventricular dysfunction with ejection fraction less than 20%, secondary renal insufficiency, hyponatremia and hypokalemia (with potassium less than 3 mEq/l).

Ventricular arrhythmias and pump failure are the leading causes of death in these patients.

Etiology

Congestive cardiac failure results from the following types of conditions related to the heart.

Volume overload

Pressure overload

Myocardial diseases

Epidemiology

Heart failure is a relatively common outcome of various cardiac diseases. Approximately 0.67 million people are affected in the United States each year [1]. Out of these, 0.27 million die from it.

The increasing use of refined diets and higher incidence of hypertension and diabetes in developing countries is also causing a rise in the international incidence of cardiac failure [2].

Sex distribution
Age distribution

Pathophysiology

Congestive cardiac failure usually involves failure of both the left and right side of the heart. The features of left sided heart cardiac failure are mainly due to congestion of the lungs. Dyspnea occurs because of the damming of blood in the lungs resulting in pulmonary venous congestion. Initially dyspnea occurs only at exertion. Later on orthopnea and paroxysmal nocturnal dyspnea also develop. Later on dyspnea occurs even at rest. Orthopnea refers to breathlessness on lying flat. It occurs because of the following two circulating changes when the person lies flat.

  • There is redistribution of blood from the tissues into the plasma. Approximately half a liter of blood pooled in the leg veins during standing is returned to the heart increasing the venous return.
  • In upright position, hydrostatic pressure helps in draining the upper lung zones into the left atrium. Respiration can continue in the upper zones even if the lower zones are congested. Upon lying flat, this hydrostatic effect is lost and the whole lung becomes congested causing severe breathlessness.

Paroxysmal nocturnal dyspnea results from the same two mechanisms above along with the following:

  • Depression of the nervous system during sleep leads to reduced awareness of pulmonary congestion. The patient wakes up when extreme congestion and breathlessness have developed.
  • The sympathetic system is also depressed during sleep which causes reduction in the heart rate causing further pooling of the blood in the pulmonary vessels. 

Later on, pulmonary edema also develops and causes persistent breathlessness.

Right sided heart failure mainly causes tissue congestion because of the inability of the heart to empty properly. Many organs including the brain, liver and kidneys are affected. In addition, generalized congestion develops which manifests as peripheral edema.

Prevention

The causes that predispose to the development of myocardial or valvular diseases should be avoided. In case of active disease, early diagnosis and prompt treatment is necessary to reduce mortality.

Summary

Cardiac failure refers to the inability of the heart to maintain adequate cardiac output to meet the demands of the body. Depending upon the cause, there may be a failure of the left side or the right side of the heart; known as left and right sided cardiac failure respectively. The salient features are also different.

Biventricular cardiac failure is the condition in there is chronic failure of both the left and right sides of the heart. In most of the cases, right sided cardiac failure is a result of preexisting left sided cardiac failure.

Patient Information

Congestive cardiac failure refers to the failure of both sides of the heart. The blood is not adequately pumped by the heart. As a result, the organs of the body do not get sufficient amount of blood and damming of blood in the vessels also takes place. A healthy lifestyle and proper treatment prevents mortality from congestive cardiac failure.

References

Article

  1. Roger VL, Go AS, Lloyd-Jones DM, et al. Heart disease and stroke statistics--2011 update: a report from the American Heart Association. Circulation. Feb 1 2011;123(4):e18-e209
  2. Stewart S, Wilkinson D, Hansen C, et al. Predominance of heart failure in the Heart of Soweto Study cohort: emerging challenges for urban African communities. Circulation. Dec 2 2008;118(23):2360-2367.
  3. Cayley WE, Jr. Therapy with ACE inhibitors and ARBs in heart failure. American family physician. Jul 15 2004;70(2):261.
  4. Ball SG, Julian DG. ACE inhibitors and heart failure. Lancet. Mar 14 1992;339(8794):687-688.
  5. Jentzer JC, DeWald TA, Hernandez AF. Combination of loop diuretics with thiazide-type diuretics in heart failure. Journal of the American College of Cardiology. Nov 2 2010;56(19):1527-1534.
  6. Miraglia G, Nava A, Dalla Volta S. [Clinical amd metabolic results of a particular combination thiazide-antialdosterone in heart failure]. La Clinica terapeutica. Mar 15 1974;68(5):445-451.
  7. Batterman RC, De Graff AC. Comparative study on the use of the purified digitalis glycosides, digoxin, digitoxin, and lanatoside C, for the management of ambulatory patients with congestive heart failure. American heart journal. Nov 1947;34(5):663-673
  8. Digitalis Investigation G, Ahmed A, Waagstein F, et al. Effectiveness of digoxin in reducing one-year mortality in chronic heart failure in the Digitalis Investigation Group trial. The American journal of cardiology. Jan 1 2009;103(1):82-87.
  9. Villar E, Boissonnat P, Sebbag L, et al. Poor prognosis of heart transplant patients with end-stage renal failure. Nephrology, dialysis, transplantation : official publication of the European Dialysis and Transplant Association - European Renal Association. May 2007;22(5):1383-1389.
  10. Hori M, Koretsune Y, Takemura K, et al. Prognosis of patients with severe congestive heart failure referred to the cardiac transplant program. Osaka University Cardiac Transplant Program. Japanese circulation journal. Jun 1994;58(6):395-402.

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Last updated: 2018-06-21 22:48