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:

• Paroxysmal nocturnal dyspnea
• Distention of neck veins
• Crepitations
• Cardiomegaly
• Acute pulmonary edema
• S3 gallop rhythm
• Increased venous pressure (greater than 16 cm of water)
• Positive hepatojugular reflux

The minor criteria include:

• Pedal edema
• Night cough
• Dyspnea on exertion
• Hepatomegaly
• Pleural effusion
• Tachycardia
• Vital capacity reduced by at least one third of normal

• Fatigue

  The results suggest that fatigue is a circular process in which the consequences of fatigue further exaggerate the experience. However, fatigue could be alleviated by restorative activities. [dx.doi.org]

  Forward failure also decreases the blood flow to various organs, causing weakness and fatigue. Time-dependent heart failure: Acute heart failure: This describes heart failure that occurs suddenly. [health.howstuffworks.com]

  Fatigue and weakness: Fatigue and weakness result from decreased cardiac output to the skeletal muscles and the central nervous system. [symptoma.com]

  Mental fatigue can manifest as somnolence, lethargy, or directed attention fatigue.[4] Fatigue and 'feelings of fatigue' are sometimes confused.[5] Unlike weakness, fatigue usually can be alleviated by periods of rest. [en.wikipedia.org]

  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]

• Weight Gain

  The strength of the association increased with increasing amounts of weight gain, so that a weight gain of >5 and up to 10 pounds had an adjusted, matched OR of 4.46 (95% CI 1.45 to 13.75) and a gain of >10 pounds had an adjusted, matched OR of 7.65 [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]

  At home, watch for changes in your heart rate, pulse, blood pressure, and weight. Weight gain, especially over a day or two, can be a sign that your body is holding on to extra fluid and your heart failure is getting worse. [nlm.nih.gov]

• Ascites

  Physical examination revealed S4, bilateral pretibial edema, and moderate amount of ascites. Computed tomography and X-ray of the thorax showed left-sided pleural effusion. [ncbi.nlm.nih.gov]

  Minor criteria are acceptable only if they can not be attributed to another medical condition (such as pulmonary hypertension, chronic lung disease, cirrhosis, ascites, or the nephrotic syndrome). [web.archive.org]

  In more severe cases, ascites (fluid accumulation in the abdominal cavity) and hepatomegaly (painful enlargement of the liver) may develop. [sciencedaily.com]

• Weight Loss

  […] 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) · Hepatojugular reflux · Weight [web.archive.org]

  Isa Oner Yuksel, Nihal Akar Bayram, Erkan Koklu, Cagin Mustafa Ureyen, Selcuk Kucukseymen, Sakir Arslan and Engin Bozkurt, Assessment of Impact of Weight Loss on Left and Right Ventricular Functions and Value of Tissue Doppler Echocardiography in Obese [dx.doi.org]

  Dietary Changes – If you are even slightly overweight, weight loss is imperative to prevent further damage to your heart muscle. [acls.net]

• Myxedema

  It is associated with such conditions as lymphedema, lipedema, and myxedema. [en.wikipedia.org]

  […] 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]

• Cough

  Chronic Cough & Wheezing: Just like with the shortness of breath, a chronic cough becomes more prominent in the final months and weeks of congestive heart failure. [crossroadshospice.com]

  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. [symptoma.com]

  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 and night sweats. [ncbi.nlm.nih.gov]

• 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 [web.archive.org]

  A 78-year-old woman presented with mild exertional dyspnea three weeks after starting osimertinib for the treatment of epidermal growth factor receptor (EGFR) T790M-positive non-small cell lung cancer. [ncbi.nlm.nih.gov]

  Chest x-ray is essential to evaluate dyspnea. [clinicaladvisor.com]

• Rales

  No rales were detected because of its paucity of fibrous components in the lung. [ncbi.nlm.nih.gov]

  Resulting clinical syndromes including shortness of breath, pitting edema, enlarged tender liver, engorged neck veins, and pulmonary rales in various combinations. congestive heart failure See HEART FAILURE. [medical-dictionary.thefreedictionary.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 [web.archive.org]

  […] 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]

• Pleural Effusion

  After 8 months of treatment, her symptoms improved and the pleural effusion showed significant regression. [ncbi.nlm.nih.gov]

  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. [symptoma.com]

  effusion · Decrease in vital capacity by one third from maximum recorded · Tachycardia (heart rate>120 beats/min.) [web.archive.org]

• Orthopnea

  The patient's orthopnea was slightly ameliorated, and he was able to sleep at night. The technique of inserting a PICC in the sitting position is simple and feasible. [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]

  In right-sided heart failure, fluid backs up into the body causing peripheral edema, JVD, and hepatomegaly, while in left-sided heart failure, fluid builds up in the lungs causing dyspnea, crackles, orthopnea, and paroxysmal nocturnal dyspnea. [youtube.com]

• Nausea

  Dizziness or nausea Irregular heartbeat. A heart attack is a medical emergency. If someone appears to be having a heart attack, call 911 or your local medical emergency number. [aurorahealthcare.org]

  Symptoms of CHF may include: Shortness of breath when lying down Fatigue Weakness Lack of appetite Nausea Abdominal swelling Irregular heartbeat Wheezing If not treated, CHF may lead to kidney or liver damage, heart valve problems, and heart attack or [dmc.org]

  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]

  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 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]

• Loss of Appetite

  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]

  […] of appetite constipation. [betterhealth.vic.gov.au]

  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]

• 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]

  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]

  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]

• 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]

  (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]

  Angiography Cardiac catheterization and coronary angiography have a useful role in patients with congestive heart failure, those with valvular heart disease, and those with congenial heart disease, as well as patients with other conditions. [14] CHF For [emedicine.com]

  Prognosis is poor when the underlying heart disease is not treatable. [symptoma.com]

• Chest Pain

  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]

  pains congestive heart failure coronary coronary infarction coronary thrombosis myocardial infarction tachycardia heart disease noun disease of the heart angina cardiac infarction congenital heart disease congestive heart failure coronary thrombosis [thesaurus.com]

  Seek emergency treatment if you experience any of the following: Chest pain Fainting or severe weakness Rapid or irregular heartbeat associated with shortness of breath, chest pain or fainting Sudden, severe shortness of breath and coughing up pink, foamy [mayoclinic.com]

  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]

  Seek emergency medical treatment for sudden or unexplained symptoms like chest pain, which may be a sign of a severe heart condition. [modernheartandvascular.com]

• 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]

  SEE DEFINITION OF congestive heart failure as in coronary infarction as in heart disease as in cardiac arrest as in heart attack Synonyms for congestive heart failure cardiac arrest heart failure myocardial infarction tachycardia MOST RELEVANT Roget's [thesaurus.com]

  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]

• Palpitations

  A 56-year-old man was admitted because of palpitations and dyspnea. A 12-lead electrocardiogram showed irregular wide QRS complex tachycardia with a slur at the initial portion of the QRS complex. [ncbi.nlm.nih.gov]

  However, ordinary physical activity such as walking causes some breathlessness, fatigue, or palpitations. [patient.info]

  […] of breath during physical activity Difficulty breathing when lying in a flat position Waking at night feeling short of breath Swollen neck ( jugular ) veins Abdominal swelling ( ascites ) from excess fluid Lower leg or foot swelling ( pedal edema ) Palpitations [jama.ama-assn.org]

  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]

• Hypotension

  Therefore, ASV may be effective for treating CHF in HD patients with LV dysfunction and chronic hypotension. [ncbi.nlm.nih.gov]

  In patients with hypotension, therapy should be started without a bolus. [doi.org]

• Hepatomegaly

  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]

  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]

  · 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 [web.archive.org]

• Periorbital Edema

  Edema surrounding the eyes is called periorbital edema or eye puffiness. The periorbital tissues are most noticeably swollen immediately after waking, perhaps as a result of the gravitational redistribution of fluid in the horizontal position. [en.wikipedia.org]

• Neck Swelling

  The symptoms include high fever, muffled voice, difficulty opening the mouth, increased salivation and drooling and neck swelling. See a doctor if these symptoms occur. [aboutkidshealth.ca]

• 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]

  Similarly, patients with sleep apnea without heart failure have frequent awakenings, nocturia and may wake up short of breath due to the apnea. [web.archive.org]

  […] exercise Accumulation of fluid, usually in the lower legs (peripheral edema) or lower back (sacral edema) A distended jugular vein in the neck Rapid heart rate (tachycardia) Chest pain or pressure Dizziness Chronic coughing Frequent nighttime urination (nocturia [verywellhealth.com]

  Also common are nocturia, paroxysmal nocturnal dyspnea, orthopnea, anorexia, right upper quadrant abdominal discomfort due to hepatic congestion. At times, patients can present with altered mental status due to cerebral hypoperfusion. [clinicaladvisor.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]

• Confusion

  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]

  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]

  Confusion & Delirium: As with any chronic, life-threatening illness, some confusion and delirium can be expected. CHF patients often times experience disorientation due to changing sodium levels in the blood. [crossroadshospice.com]

  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]

  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]

• Dizziness

  Poor circulation to the body leads to dizziness, confusion and diaphoresis and cool extremities at rest. The right side of the heart pumps blood returned from the tissues to the lungs to exchange carbon dioxide for oxygen. [sciencedaily.com]

  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]

  Fatigue and dizziness – because less blood is reaching the organs of the body, it can cause feelings of weakness. Because less blood is reaching the brain is can also cause dizziness and confusion. [medicalnewstoday.com]

  Here are some of the most common signs: - Shortness of breath, wheezing or coughing - Dizziness, fatigue and weakness - Swelling, especially in the ankles - Rapid or irregular heart rate Always tell your doctor or health care provider about new and worsening [modernheartandvascular.com]

  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]

  […] failure symptoms poster PDF" src="https://assets.aboutkidshealth.ca/akhassets/congestive_heart_failure_PDFdownload.jpg" /> </figure> </a> <p>Symptoms of heart failure can affect different areas of the body:</p><h3>Brain</h3><ul><li>Irritability</li><li>Headaches [aboutkidshealth.ca]

  No serious adverse events occurred in either group; however, constipation, headaches, and hypotension were more frequent in the conivaptan arms. [uscjournal.com]

  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]

• 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

  In older people, presenting complaints may be atypical, such as confusion, delirium, falls, sudden functional decline, nocturnal urinary incontinence, or sleep disturbance. [msdmanuals.com]

  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]

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.

• Kerley B Lines

  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]

  […] 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. 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]

  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]

• Pericardial Effusion

  (in pneumothorax), water-bottle heart (in pericardial effusion), and hyperinflation (in chronic obstructive pulmonary disease (COPD) and asthma) can all give clues to diagnosis. [clinicaladvisor.com]

  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]

  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. [msdmanuals.com]

• 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]

• Kerley Lines

  Ultrasound of the lung may also be able to detect Kerley lines.[37] Congestive heart failure with small bilateral effusions. Kerley b lines. [en.wikipedia.org]

• 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]

• 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]

• Hyponatremia

  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]

  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]

  […] explained clearly including: Asthma, COPD, Acute Renal Failure, Mechanical Ventilation, Coronary Artery Disease, Cardiomyopathy, Oxygen Hemoglobin Dissociation Curve, Hypertension, Shock, Diabetic Ketoacidosis (DKA), Medical Acid Base, VQ Mismatch, Hyponatremia [youtube.com]

• Hypercapnia

  These SRDB cause arousals, hypoxemia-reoxygenation, hypercapnia-hypocapnia, and changes in intrathoracic pressure. [web.archive.org]

  Thus, poor ventilation leading to hypercapnia, left heart failure leading to interstitial edema (impairing gas exchange), asthma causing bronchoconstriction (limiting airflow) and muscle fatigue leading to ineffective respiratory muscle action could all [en.wikipedia.org]

  Respiratory muscle fatigue may be diagnosed by a decrease in respiratory rate, associated with hypercapnia and confused state of mind. [doi.org]

• Hypoglycemia

  […] reducing the risk of respiratory disorders most likely reflects its reduction of the rate of recurrent heart failure, whereas its benefit in reducing the risk of metabolic and nutritional disorders largely reflects a reduced incidence of hypokalemia and hypoglycemia [doi.org]

• Pleural Effusion

  After 8 months of treatment, her symptoms improved and the pleural effusion showed significant regression. [ncbi.nlm.nih.gov]

  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. [symptoma.com]

  effusion · Decrease in vital capacity by one third from maximum recorded · Tachycardia (heart rate>120 beats/min.) [web.archive.org]

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].

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.

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

Volume overload

• Aortic regurgitation
• Mitral regurgitation
• Atrial septal defect
• Tricuspid regurgitation

Pressure overload

• Systemic hypertension
• Aortic stenosis
• Pulmonary hypertension
• Pulmonary stenosis

Myocardial diseases

• Ischemic heart disease
• Cardiomyopathies
• Myocarditis
• Diabetes mellitus
• Alcohol toxicity
• Sarcoidosis

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].

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.

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.

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.

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.

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