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Heart Failure

HF

Heart failure occurs when the cardiovascular system is unable to meet the metabolic demands of the body, or when it can only do so at elevated filling pressures. Common causes include ischaemic heart disease, hypertension, valvular heart disease, diabetes mellitus, drugs or congenital heart disease


Presentation

Dyspnea, fatigue and swelling (in the ankles, feet, legs, abdomen) are some of the most common symptoms of heart failure [7]. The start of symptoms is heralded by feelings of tiredness or extremely short breath following any physical exertions.

The symptoms get worse as the condition continues and so the individual can begin to feel tired and short of breath after getting dressed or simply walking across the room. It will progress to a stage where the individual will be out of breath while lying flat.

Other common symtoms include continous cough, increased urinal urge especially at night, ascites, sudden weight gain, concentration difficulties, increased blood pressure and chest pain

The New York Heart Association (NYHA) classifies heart failure into classes based on functional limitations and severity: Class I (no limitation in any activities), Class II (mild observable symptoms and slight limitation during ordinary activity), Class III (marked limitation of any activity) and Class IV (severe limitations, symptoms occur at rest).

Splenomegaly
Cough
  • A 23-month-old girl visited the emergency department with high fever, cough, first wheezing episode, chest retraction and tachycardia. The chest X-ray revealed consolidation on the left lower lung field; the cardiothoracic ratio was 60%.[ncbi.nlm.nih.gov]
  • Cough Most commonly a dry cough (without phlegm) More severe heart failure can cause a wet cough-coughing up pink, frothy fluid. Some people experience wheezing, similar to that caused by asthma.[northshore.org]
  • […] failure signs and symptoms may include: Shortness of breath (dyspnea) when you exert yourself or when you lie down Fatigue and weakness Swelling (edema) in your legs, ankles and feet Rapid or irregular heartbeat Reduced ability to exercise Persistent cough[mayoclinic.org]
  • Key symptoms may include shortness of breath, a dry and hacking cough, weight gain, swelling, and fatigue. Detection and Diagnosis Detecting and diagnosing heart failure includes a complete physical exam, blood tests, and heart imaging.[intermountainhealthcare.org]
Dyspnea
  • Compared with control group, there was no effect on dyspnea improvement. Serelaxin treatment is irrelevant with the mortality, and it cannot improve dyspnea of heart failure patients.[ncbi.nlm.nih.gov]
  • A 49-year-old Japanese man with worsening dyspnea was admitted with the diagnosis of new-onset heart failure (HF). His HF symptoms improved with standard treatment, but his left ventricular ejection fraction (LVEF) 21% remained unchanged.[ncbi.nlm.nih.gov]
  • A 35-year-old Japanese man was emergently admitted to our hospital with chief complaints of palpitation and dyspnea. He has been treated for Basedow's disease.[ncbi.nlm.nih.gov]
  • Here we present an 80-year-old Asian woman complaining of progressive exertional dyspnea. She was diagnosed with acute decompensated heart failure and kidney injury due to severely calcified stenosis of the thoracoabdominal aorta, the so called AAC.[ncbi.nlm.nih.gov]
  • CASE REPORT The patient is a 46-year-old male with a history of testicular cancer that presented with dyspnea on exertion. He was found to have two large right sided intracardiac masses on echocardiography.[ncbi.nlm.nih.gov]
Orthopnea
  • Orthopnea Orthopnea is an early symptom of heart failure and may be defined as dyspnea that develops in the recumbent position and is relieved with elevation of the head with pillows.[emedicine.medscape.com]
  • Manifestations include orthopnea, paroxysmal dyspnea, pulmonary edema, cough, and cardiac asthma.[medical-dictionary.thefreedictionary.com]
  • When the legs are elevated at night, the fluid redistributes centrally, causing pulmonary edema that results in orthopnea (dyspnea while laying flat) or paroxysmal nocturnal dyspnea, or PND.[healio.com]
  • Clinical Manifestations Typical Breathlessness Ankle swelling Fatigue Orthopnea Reduced Exercise Tolerance These are the typical signs and symptoms of heart failure.[physio-pedia.com]
  • These include, among others: Dyspnea ( exertional- , dyspnea at rest , orthopnea , paroxysmal nocturnal dyspnea); Fatigue, inadequate exhaustion after stress, weakness, lethargy Fluid retention (swelling of the legs or abdomen, weight gain), nocturia[flexikon.doccheck.com]
Rales
  • It often triggers compensatory mechanisms that preserve cardiac output but produce symptoms and signs such as dyspnea, orthopnea, rales, and edema.[medical-dictionary.thefreedictionary.com]
  • Signs and symptoms include shortness of breath, pitting edema, enlarged tender liver, engorged neck veins, and pulmonary rales. Heart failure accompanied by edema, such as swelling of the legs and ankles and congestion in the lungs.[icd10data.com]
  • […] artery disease possibly has to be excluded in coronary angiography. 7.3 Diagnostics of the secondary symptoms Diagnostics of an eventual Overhydration (clinical exam: Edemas up to anasarca , ascites ) Pulmonary edema (clinical exam: dispnea , bilateral rales[flexikon.doccheck.com]
  • Rales heard over the lung bases are characteristic of heart failure that is of at least moderate severity. With acute pulmonary edema, rales are frequently accompanied by wheezing and expectoration of frothy, blood-tinged sputum.[emedicine.medscape.com]
  • Limitation of excessive extracellular matrix turnover may contribute to survival benefit of spironolactone therapy in patients with congestive heart failure: insights from the randomized aldactone evaluation study (RALES). Rales Investigators.[emedicine.medscape.com]
Dyspnea at Rest
  • These include, among others: Dyspnea ( exertional- , dyspnea at rest , orthopnea , paroxysmal nocturnal dyspnea); Fatigue, inadequate exhaustion after stress, weakness, lethargy Fluid retention (swelling of the legs or abdomen, weight gain), nocturia[flexikon.doccheck.com]
  • Dyspnea at rest Dyspnea at rest in heart failure is the result of the following mechanisms: Decreased pulmonary function secondary to decreased compliance and increased airway resistance Increased ventilatory drive secondary to hypoxemia due to increased[emedicine.medscape.com]
  • When congestive heart failure worsens, fluid backs up into the lungs and interferes with oxygen getting into the blood, causing dyspnea at rest and at night (orthopnea).[emedicinehealth.com]
  • The patient will have dyspnea (shortness of breath) on exertion and in severe cases, dyspnea at rest. Increasing breathlessness on lying flat, called orthopnea , occurs.[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.medscape.com]
Fatigue
  • HF is a shared chronic phase of cardiac functional impairment secondary to many aetiologies, and patients with HF experience a range of symptoms that affect their quality of life, including dyspnoea, fatigue, poor exercise tolerance and fluid retention[radcliffecardiology.com]
  • 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]
  • Fatigue is an essential symptom of heart failure. The cause of fatigue includes low cardiac output, peripheral hypoperfusion, skeletal muscle deconditioning and is confounded by difficulties in quantifying this symptom.[physio-pedia.com]
  • Key symptoms may include shortness of breath, a dry and hacking cough, weight gain, swelling, and fatigue. Detection and Diagnosis Detecting and diagnosing heart failure includes a complete physical exam, blood tests, and heart imaging.[intermountainhealthcare.org]
  • Eventually the heart and body just can’t keep up, and the person experiences the fatigue, breathing problems or other symptoms that usually prompt a trip to the doctor.[heart.org]
Weakness
  • 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]
  • Certain conditions, such as narrowed arteries in your heart (coronary artery disease) or high blood pressure, gradually leave your heart too weak or stiff to fill and pump efficiently.[mayoclinic.org]
  • The late HMR values showed a positive weak correlation with left ventricular ejection fraction (LVEF) in CCC and non-CCC (r 0.42 and p 0.045; and r 0.49 and p 0.015, respectively).[ncbi.nlm.nih.gov]
  • When the heart muscle is weak, blood cannot be pumped efficiently enough to get oxygen to all of the cells. Sometimes the heart becomes dilated and weak. Other times it may be stiff and thickened.[medicinenet.com]
  • Heart failure develops when the contracting or the relaxing action of the heart is inadequate, typically because the heart muscle is weak, stiff, or both. As a result, blood may not flow out in adequate amounts.[msdmanuals.com]
Weight Gain
  • Key symptoms may include shortness of breath, a dry and hacking cough, weight gain, swelling, and fatigue. Detection and Diagnosis Detecting and diagnosing heart failure includes a complete physical exam, blood tests, and heart imaging.[intermountainhealthcare.org]
  • A weak heart pumps less blood to your kidneys and causes fluid and water retention, resulting in swollen ankles , legs, and abdomen (called edema ) and weight gain.[webmd.com]
  • Symptoms Abnormal Heart Rate Fatigue Fluid Retention Loss of Appetite Shortness of Breath Weight Gain Wheezing or Coughing Diagnosis Physicians can make a preliminary diagnosis by assessing medical history and a physical examination.[mercyhealth.com]
  • Fluid retention and weight gain are signals that your CHF may not be in good control. When should I call my doctor? Talk to your doctor if you have any of the following: Shortness of breath that gets worse.[familydoctor.org]
  • Symptoms of heart failure may include: Sudden, severe shortness of breath Fatigue and weakness from very little effort Swelling in your legs, ankles, feet, or abdomen Rapid weight gain from fluid retention (3 to 4 pounds in 2 days, or 2 pounds overnight[capecodhealth.org]
Fever
  • Few cases report patients with heart failure, secondary to dilated cardiomyopathy, with high fever. A 23-month-old girl visited the emergency department with high fever, cough, first wheezing episode, chest retraction and tachycardia.[ncbi.nlm.nih.gov]
  • A 35-year-old woman with fever, edema and rash was admitted. Pleural effusion and cardiomegaly were observed. A laboratory analysis revealed anemia with iron deficiency and elevated human parvovirus B19 (B19V) immunoglobulin M.[ncbi.nlm.nih.gov]
  • She presented with a 2 month history of fever and a 2 weeks history of rapidly worsening shortness of breath. Emergency cardiac surgery was indicated which unfortunately could not be performed leading to the death of the patient.[ncbi.nlm.nih.gov]
  • An 80-year-old Japanese man with chronic obstructive pulmonary disease and congestive heart failure visited the Kariya Toyota General Hospital, Aichi, Japan with the chief complaint of fever accompanied by chills and left leg pain.[ncbi.nlm.nih.gov]
  • A previously healthy 21 year old Sri Lankan female admitted with shortness of breath for 1 week duration with associated low grade fever and profuse sweating. She was mildly febrile and dyspnoeic with absent ankle oedema.[ncbi.nlm.nih.gov]
Weight Loss
  • Metrics of diuretic efficacy such as natriuresis, urine output, weight loss, net fluid balance, or fractional sodium excretion, differ in their risk for measurement error, convenience, and biological plausibility, which should be taken into account when[ncbi.nlm.nih.gov]
  • In people with risk of heart failure, making life style changes such as exercise, reduction of salt consumption or weight loss can lead to improvement in quality of life.[symptoma.com]
  • loss as nausea causes a loss of appetite and as the body fails to absorb food well Rapid breathing, bluish skin and feelings of restlessness, anxiety and suffocation Shortness of breath and lung congestion as the blood backs up in the lungs Tiring easily[cedars-sinai.edu]
  • Less sodium reduces fluid retention wear special elastic stockings to reduce swelling in the legs caused by fluid retention follow an appropriate weight-loss program (for those who need it) Congestive heart failure can be treated with the following medications[medbroadcast.com]
  • Weight loss or gain – heart failure causes fluid retention which may cause a sharp increase in weight. There are tools available to help you monitor your symptoms. We have a diary to help you monitor your symptoms if you have cardiomyopathy.[cardiomyopathy.org]
Nausea
  • Bloating in your stomach may cause a loss of appetite or nausea . 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.[webmd.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]
  • If you are experiencing more than one of them, you should talk with your doctor: New or worsening shortness of breath Feeling fatigued or lightheaded Build-up of fluid or edema Chronic coughing or wheezing Nausea or lack of appetite Confusion or impaired[huffingtonpost.com]
  • Stomach, which causes decreased appetite, bloating, and nausea. Intestines, which causes decreased appetite and poor absorption of medicines and food. Abdominal cavity ascites, tenderness, or fever can indicate an infection in this fluid buildup.[northshore.org]
  • Symptoms may include: Visible swelling of the legs, ankles, eyelids, face, and (occasionally) abdomen Abnormally fast breathing Shortness of breath or labored breathing Fatigue Nausea Falling asleep when feeding or becoming too tired to eat Lack of appetite[stanfordchildrens.org]
Abdominal Bloating
  • Backup of blood and fluid into the lungs Abdominal bloating Abdominal bloating can result from fluid backup in your: Liver, which makes your abdomen feel swollen or tender. Stomach, which causes decreased appetite, bloating, and nausea.[northshore.org]
  • An exacerbation of heart failure can be heralded by dyspnoea with usual daily activities, reduced exercise tolerance, abdominal bloating and poor appetite. Patients should know the weight at which their condition was previously stable.[nps.org.au]
  • These include: Abdominal bloating or discomfort Persistently pale skin Poor appetite Always take chest pain seriously. Congestive heart failure, per se, usually does not cause chest pain.[emedicinehealth.com]
Increased Abdominal Girth
  • Predominant Right-Sided Heart Failure Ascites, congestive hepatomegaly, and anasarca due to elevated right-sided heart pressures transmitted backward into the portal vein circulation may result in increased abdominal girth and epigastric and right upper[emedicine.medscape.com]
Heart Failure
  • Overview Heart failure, sometimes known as congestive heart failure, occurs when your heart muscle doesn't pump blood as well as it should.[mayoclinic.org]
  • In many cases, heart failure is caused by coronary heart disease (CHD), high blood pressure, and diabetes. Treating these problems can improve the condition of heart failure patients.[symptoma.com]
  • , heart failure/pulmonary hypertension, heart failure/diabetes, heart failure/kidney failure, etc.[en.wikipedia.org]
  • To find out more about managing the symptoms of heart failure, visit our living with heart failure page. What causes heart failure? There are lots of reasons why you may develop heart failure.[bhf.org.uk]
  • […] and mortality of [heart failure]." [ 3 ] Table 3, below, summarizes the development of heart failure.[emedicine.medscape.com]
Chest Pain
  • 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.org]
  • pain if your heart failure is caused by a heart attack Once referred to the Heart Failure clinic, a team of professionals, including heart failure specialist Amy French, MD, and nurse practitioner Shannon List, RN, MSN-FNP, who has completed the Heart[capecodhealth.org]
  • Other common symtoms include continous cough, increased urinal urge especially at night, ascites, sudden weight gain, concentration difficulties, increased blood pressure and chest pain.[symptoma.com]
  • Here are seven conditions that can cause chest pain—and what everyone should know about to treat them.[health.com]
Tachycardia
  • Bilateral sympathectomy can be more effective than unilateral sympathectomy or percutaneous stellate ganglion blockade in patients with refractory ventricular tachycardia.[ncbi.nlm.nih.gov]
  • An 84-year-old woman was admitted to our hospital due to acute exacerbation of chronic heart failure and marked tachycardia with atrial fibrillation.[ncbi.nlm.nih.gov]
  • A 23-month-old girl visited the emergency department with high fever, cough, first wheezing episode, chest retraction and tachycardia. The chest X-ray revealed consolidation on the left lower lung field; the cardiothoracic ratio was 60%.[ncbi.nlm.nih.gov]
  • Her ESR, Troponin I and Brain natriuretic peptide were elevated with normal CRP and electrocardiogram showed sinus tachycardia with wide spread ST depression.[ncbi.nlm.nih.gov]
  • Arrhythmias such as severe bradycardia or tachycardia can also precipitate failure. Go to Next Page Pathophysiology of Heart Failure Revised 04/23/07[cvpharmacology.com]
Palpitations
  • We report a case of heart failure in a 35-year-old man who presented with palpitations. Two-dimensional echocardiograms revealed left ventricular noncompaction, which markedly improved after standard heart failure therapy.[ncbi.nlm.nih.gov]
  • A 35-year-old Japanese man was emergently admitted to our hospital with chief complaints of palpitation and dyspnea. He has been treated for Basedow's disease.[ncbi.nlm.nih.gov]
  • However, ordinary physical activity such as walking causes some breathlessness, fatigue, or palpitations.[patient.info]
  • Ordinary physical activity results in fatigue, palpitation, dyspnea (shortness of breath). III Marked limitation of physical activity. Comfortable at rest.[physio-pedia.com]
  • Any new palpitations or dizziness should be reported. Sometimes the dizziness may be related to the tablets you are taking. However you should report any dizziness to your doctor.[irishheart.ie]
Cardiomegaly
  • Pleural effusion and cardiomegaly were observed. A laboratory analysis revealed anemia with iron deficiency and elevated human parvovirus B19 (B19V) immunoglobulin M.[ncbi.nlm.nih.gov]
  • Clinically there was no cardiomegaly and heart sounds were slightly muffled with gallop rhythm. Bilateral basal fine end inspiratory crackles and mild hepatosplenomegaly were noted.[ncbi.nlm.nih.gov]
  • […] are experts in diagnosing and treating heart failure, but also are well-versed in treating the following complex conditions: Cardiac amyloidosis Cardiomyopathy (weakened heart muscle) Advanced congenital heart disease (conditions originating at birth) Cardiomegaly[massgeneral.org]
  • Cardiomegaly is a nonspecific finding that nonetheless occurs in most patients with chronic heart failure.[emedicine.medscape.com]
  • In a person who is compensated, this may show cardiomegaly (visible enlargement of the heart), quantified as the cardiothoracic ratio (proportion of the heart size to the chest).[en.wikipedia.org]
Hepatomegaly
  • We report the case of a 41-year-old female patient admitted to the Department of Cardiology with clinical signs of right heart failure: congested jugular veins, hepatomegaly, peripheral edema, ascites associated with atrial fibrillation, low values of[ncbi.nlm.nih.gov]
  • […] possibly weight loss, memory disorders , states of confusion, cognitive impairment. 7 Diagnostics 7.1 Physical exam Increased jugular vein pressure (filling level at 45 elevated upper body and slightly reclined head) Positive hepatojugular reflux , hepatomegaly[flexikon.doccheck.com]
  • Hepatomegaly is prominent in patients with chronic right-sided heart failure, but it may occur rapidly in acute heart failure. When hepatomegaly occurs acutely, the liver is usually tender.[emedicine.medscape.com]
  • Anorexia, weight loss, nausea Exophthalmos and/or visible pulsation of eyes Distention of neck veins Weak, rapid, and thready pulse Rales, wheezing S 3 gallop and/or pulsus alternans Increased intensity of P 2 heart sound Hepatojugular reflux Ascites, hepatomegaly[emedicine.medscape.com]
  • (ii) Signs of congestion may include hepatomegaly, ascites, increased jugular venous distention or pressure, rales, peripheral edema, or rapid weight gain.[ssa.gov]
Jaundice
  • Significant liver congestion may result in impaired liver function ( congestive hepatopathy ), and jaundice and even coagulopathy (problems of decreased or increased blood clotting) may occur.[en.wikipedia.org]
Flushing
  • […] feeding, playing, or exercising Breathing difficulty with activity, especially while feeding, walking, or climbing stairs Loss of muscle mass Failure to gain weight Change in skin temperature and color (tendency to become cold and clammy, or sweaty, flushed[stanfordchildrens.org]
  • Safety Side effects caused by Bidil include flushing, headache, upset stomach, vomiting, loss of appetite, diarrhea, constipation, tearing, stuffy nose, and rash.[consumerreports.org]
  • Central cyanosis, icterus, and malar flush may be evident in patients with severe heart failure.[emedicine.medscape.com]
Oliguria
  • […] year-old female patient admitted to the Department of Cardiology with clinical signs of right heart failure: congested jugular veins, hepatomegaly, peripheral edema, ascites associated with atrial fibrillation, low values of arterial blood pressure and oliguria[ncbi.nlm.nih.gov]
  • 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]
  • 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.medscape.com]
Nocturia
  • These include, among others: Dyspnea ( exertional- , dyspnea at rest , orthopnea , paroxysmal nocturnal dyspnea); Fatigue, inadequate exhaustion after stress, weakness, lethargy Fluid retention (swelling of the legs or abdomen, weight gain), nocturia[flexikon.doccheck.com]
  • Nocturia and oliguria Nocturia may occur relatively early in the course of heart failure. Recumbency reduces the deficit in cardiac output in relation to oxygen demand, renal vasoconstriction diminishes, and urine formation increases.[emedicine.medscape.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.medscape.com]
Dizziness
  • 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]
  • Any new palpitations or dizziness should be reported. Sometimes the dizziness may be related to the tablets you are taking. However you should report any dizziness to your doctor.[irishheart.ie]
  • 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]
  • Safety Digoxin can cause several side effects, including dizziness, drowsiness, vision changes (vision may become blurred or things may seem yellow), rash, and irregular heartbeat.[consumerreports.org]
  • Possible side effects include dizziness, blurred vision, feeling and being sick, diarrhoea , and an irregular heartbeat .[nhsdirect.wales.nhs.uk]
Confusion
  • In addition, the confusion of similar terms with HFpEF, such as diastolic heart failure, and diastolic dysfunction (DD), has led to a misunderstanding of the true scope of HFpEF.[ncbi.nlm.nih.gov]
  • 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]
  • Less blood to the brain can cause dizziness or confusion. Rapid or irregular heartbeats. The heart beats faster to pump enough blood to the body. This can cause a fast or irregular heartbeat .[webmd.com]
  • […] including: Shortness of breath Swelling of the feet and legs Lack of energy, feeling tired Difficulty sleeping at night due to breathing problems Swollen or tender abdomen, loss of appetite Cough with "frothy" mucus or phlegm Increased urination at night Confusion[medtronic.com]
  • If you are experiencing more than one of them, you should talk with your doctor: New or worsening shortness of breath Feeling fatigued or lightheaded Build-up of fluid or edema Chronic coughing or wheezing Nausea or lack of appetite Confusion or impaired[huffingtonpost.com]
Headache
  • Safety Side effects caused by Bidil include flushing, headache, upset stomach, vomiting, loss of appetite, diarrhea, constipation, tearing, stuffy nose, and rash.[consumerreports.org]
  • Side effects can include headaches , a fast heartbeat and a pounding, fluttering or irregular heartbeat (palpitations) .[nhsdirect.wales.nhs.uk]
  • A sudden, severe headache that is different from past headaches. Call your doctor right away if you have a pacemaker or ICD and think you have an infection near the device.[healthlinkbc.ca]
  • This may manifest as temporary numbness or weakness on one side of the body, loss of balance, confusion, blindness in one or both eyes, double vision, difficulty speaking, or a severe headache.[world-heart-federation.org]
  • Cerebral symptoms The following may occur in elderly patients with advanced heart failure, particularly in those with cerebrovascular atherosclerosis: Confusion Memory impairment Anxiety Headaches Insomnia Bad dreams or nightmares Rarely, psychosis with[emedicine.medscape.com]
Insomnia
  • Cerebral symptoms The following may occur in elderly patients with advanced heart failure, particularly in those with cerebrovascular atherosclerosis: Confusion Memory impairment Anxiety Headaches Insomnia Bad dreams or nightmares Rarely, psychosis with[emedicine.medscape.com]
Memory Impairment
  • Common noncardiac signs and symptoms of heart failure include anorexia, nausea, weight loss, bloating, fatigue, weakness, oliguria, nocturia, and cerebral symptoms of varying severity, ranging from anxiety to memory impairment and confusion.[emedicine.medscape.com]

Workup

Proper evaluation of the patient’s history as well as physical checks for signs of congestion such as jugular venous distention can bring about the underlying cardiac abnormality in heart failure [8]. It may however, be needful to subject the individual to other tests and studies to pinpoint conditions or systemic abnormalities that may either lead to or exacerbate heart failure.

Diagnostic procedures for clearer diagnosis include:

  • Blood tests
  • Chest X-ray
  • Electrocardiogram (ECG)
  • Echocardiogram
  • Ejection fraction.
  • Stress test
  • Cardiac computerized tomography (CT) scan or magnetic resonance imaging (MRI)
  • Coronary catheterization (Angiogram)
  • Myocardial biopsy
Pericardial Effusion
  • Heart failure was evident on chest X-ray and 2D-echocardiogram showed global left ventricular hypokinesia with 40% ejection fraction and a thin layer of pericardial effusion.[ncbi.nlm.nih.gov]
  • Pericardial disease The sac that encases the heart is called the pericardium and it can be affected by a variety of conditions such as inflammation (pericarditis), fluid accumulation (pericardial effusion) and stiffness (constrictive pericarditis).[world-heart-federation.org]

Treatment

Treatment of heart failure is focused on improving symptoms and also interfering with the pathophysiology of the condition [9]. Reversible causes of the condition, such as infection, alcohol ingestion, anemia or hypertension need to be addressed.

Treatments include lifestyle and pharmacological modalities. Device therapy is used in some cases and on rare occasions, cardiac transplantation may be needful.

Prognosis

Generally, mortality as a result of hospitalization in patients with heart failure is 10.4% at 30 days, 22% at 1 year and 42.3% at 5 years [6]. This is regardless of the sharp improvement in medical solutions. When there is a rehospitalisation, the chances of mortality increases by a further 20 to 22%.

Etiology

In many cases, heart failure is caused by coronary heart disease (CHD), high blood pressure, and diabetes. Treating these problems can improve the condition of heart failure patients. Other possible etiologic factors include: 

Epidemiology

Heart failure is a condition that occurs worldwide [4]. In the United States, heart failure affects around 5.7 million Americans of all ages and sexes. It is also responsible for more hospitalisations than all forms of cancer.

In industrialised countries the common cause of heart failure is ischemic cardiomyopathy. In developing countries, Chagas disease and valvular cardiomyopathy are the most common causes.

Data in developing nations are not as complete as what is obtainable in the Western world.

Sex distribution
Age distribution

Pathophysiology

Heart failure refers to any condition that reduces the efficiency of the myocardium through damage or overloading [5]. It can be caused by a wide range of conditions. These etiologic factors affect the heart in various ways and cause an increase in workload which ends up producing changes to the heart. 

All of these lead to the general effect of reduced cardiac output, causing an increased strain on the heart. It increases the risk of cardiac arrest especially as a result of ventricular dysrhythmias and brings about a reduction in blood supply to other areas of the body.

Prevention

The major key to the prevention of heart failure is reduction of the risk factors. The risk factors of heart failure can be eliminated by making lifestyle changes and with the help of relevant medications. Lifestyle changes that can help in prevention of heart failure include [10]:

  • Cessation of smoking 
  • Adherence to treatment of high cholesterol, diabetes or high blood pressure
  • Remaining physically active
  • Consumption of healthy foods
  • Maintenance of a healthy weight
  • Reduction and management of stress

Summary

Heart failure is a condition in which the heart is unable to meet the metabolic of the body, or when it can only do so at elevated filling pressures. [1].

Heart failure develops over time as the pumping action of the heart grows weaker. The condition can affect the right side of the heart only or the left side only. In majority of cases however, both sides of the heart are affected [2].

Right-side heart failure happens when the heart can’t pump enough blood to the lungs to gather oxygen. Left-side heart failure occurs when the heart is unable to pump oxygen rich blood to other parts of the body.

Patient Information

Heart failure happens, when the heart muscle is unable to pump enough blood as is supposed. Conditions like thinned down arteries in the heart or high blood pressure end up leaving the heart too weak or stiff to fill and pump efficiently.

Only some of the conditions that lead to heart failure can be reversed but treatments can improve the signs and symptoms of heart failure allowing most people to it to live much longer. In people with risk of heart failure, making life style changes such as exercise, reduction of salt consumption or weight loss can lead to improvement in quality of life.

Preventing heart failure depends on the control of conditions that lead to it such as coronary artery disease, high blood pressure, obesity and diabetes.

References

Article

  1. Braunwald E. The pathogenesis of heart failure: Then and now. Medicine. 1991;70:68.
  2. Braunwald E, Ross J Jr, Sonnenblick EH. 2 ed. Mechanisms of Contraction of the Normal and Failing Heart. Boston: Little Brown & Co; 1976:417.
  3. Clifford R Greyson, MD. Pathophysiology of right ventricular failure. Crit Care Med. 2008;36(suppl):S57-65.
  4. Haddad F, Doyle R, Murphy DJ, Hunt SA. Right ventricular function in cardiovascular disease, part II: pathophysiology, clinical importance, and management of right ventricular failure. Circulation. Apr 1 2008;117(13):1717-31.
  5. Onwuanyi A, Taylor M. Acute decompensated heart failure: pathophysiology and treatment. Am J Cardiol. Mar 26 2007;99(6B):25D-30D.
  6. Ho KK, Pinsky JL, Kannel WB, Levy D. The epidemiology of heart failure: the Framingham Study. J Am Coll Cardiol 1993; 22:6A.
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Last updated: 2018-06-22 11:51