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

  Some of the extracardiac signs of heart failure are ascites, bronchial wheezing, hydrothorax, edema, liver enlargement, moist rales, and splenomegaly. [medical-dictionary.thefreedictionary.com]

• 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]

  New York Heart Association (NYHA) Classification of Heart Failure New York Heart Association (NYHA) Classification of Heart Failure NYHA Class Definition Limitation Example I Ordinary physical activity does not cause undue fatigue, dyspnea, or palpitations [msdmanuals.com]

  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]

  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]

• Weakness

  There are many causes of congestive heart failure including: (1) coronary artery disease leading to heart attacks and heart muscle weakness, (2) primary heart muscle weakness from viral infections or toxins such as prolonged alcohol exposure, (3) heart [medterms.com]

  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.com]

  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]

• 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]

  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]

  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]

• 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 [medicalcriteria.com]

  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]

  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]

• 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]

  Framingham Point Scores) NYHA Functional Classification for Congestive Heart Failure Cardiovascular Major Risk Factors Braunwald Classification of Unstable Angina (UA) Duke Criteria for Infective Endocarditis (IE) Revised Jones Criteria for Acute Rheumatic Fever [medicalcriteria.com]

• 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]

  […] 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]

  […] 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.com]

• Dyspnea

  We introduced oxycodone for medically refractory dyspnea instead of morphine because of the patient's renal insufficiency. [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]

  New York Heart Association (NYHA) Classification of Heart Failure New York Heart Association (NYHA) Classification of Heart Failure NYHA Class Definition Limitation Example I Ordinary physical activity does not cause undue fatigue, dyspnea, or palpitations [msdmanuals.com]

• Rales

  Excerpt: " Heart failure (HF) is a clinical syndrome that occurs in patients who, because of an inherited or acquired abnormality of cardiac structure and/or function, develop a constellation of clinical symptoms (dyspnea and fatigue) and signs (edema and rales [web.archive.org]

  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]

  Two of these studies were the large EPHESUS and RALES trials ( EPHESUS 2003 ; RALES 1999 ). [doi.org]

• Pleural Effusion

  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]

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

  Typical signs: tachycardia, tachypnoea, pulmonary rales, pleural effusion, raised jugular venous pressure (JVP), peripheral oedema, hepatomegaly. [patient.info]

• 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]

  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]

  Manifestations include orthopnea, paroxysmal dyspnea, pulmonary edema, cough, and cardiac asthma. [medical-dictionary.thefreedictionary.com]

  Heart failure patients without sleep apnea have difficulty maintaining sleep, which may be fragmented by nocturia, orthopnea and paroxysmal nocturnal dyspnea, waking up the patient with shortness of breath. [web.archive.org]

  Clinical Manifestations Typical Breathlessness Ankle swelling Fatigue Orthopnea Reduced Exercise Tolerance These are the typical signs and symptoms of heart failure. [physio-pedia.com]

• Nausea

  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]

  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]

  Other signs and symptoms of heart attack may include: indigestion, jaw ache, pain only in the shoulders or arms, shortness of breath, or nausea and vomiting. [emedicinehealth.com]

  Lack of Appetite or Nausea — When the liver and digestive system become congested they fail to receive a normal supply of blood. This can make you feel nauseous or full, even if you haven't eaten. [ucsfhealth.org]

• Abdominal Pain

  Subsequently, 3 attempts at hepatic arterial embolization were performed; however, her abdominal pain aggravated and her heart discomfort could not be relieved eventually. [ncbi.nlm.nih.gov]

  Hepatic congestion can occur, causing right upper quadrant abdominal pain. Symptoms related to low cardiac output include fatigue and weakness. In extreme cases, cardiac cachexia can occur. [healio.com]

  The most common symptoms of CHF include: breathing difficulties during the night or when lying down coughing and wheezing fatigue and weakness shortness of breath swollen ankles Other symptoms of CHF include: abdominal pain, bloating, or loss of appetite [medbroadcast.com]

  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]

  pain, 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 [flexikon.doccheck.com]

• 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]

  Hepatic congestion can cause right upper quadrant abdominal discomfort, and stomach and intestinal congestion can cause early satiety, anorexia, and abdominal bloating. [msdmanuals.com]

• Abdominal Distension

  After 2 weeks of treatment, the scores of acid reflux/heartburn, epigastric/hypochondriac pain, post-sternal burning pain, dietary deficiency, abdominal distension, abnormal stool, tongue, tongue coating, irritability/depression and total score in the [tjzhongyiyao.com]

• Heart Failure

  […] and mortality of [heart failure]." [3] Table 3, below, summarizes the development of heart failure. [emedicine.medscape.com]

  Abstract The burden of heart failure is projected to increase over the next decade; it is predicted that 1 in every 33 Americans will be affected by heart failure. [ncbi.nlm.nih.gov]

  heart disease, no symptoms of heart failure until now. [flexikon.doccheck.com]

• Chest Pain

  Here are seven conditions that can cause chest pain—and what everyone should know about to treat them. [health.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]

  A 63-year-old female was admitted to the emergency department with acute onset of chest pain, electrocardiogram showed ST segment elevation in precordium leads. [ncbi.nlm.nih.gov]

  Doctors and nurses in Emergency Departments take an individual experiencing chest pain very seriously. You are not wasting anybody's time, and you are not bothering anybody when you seek care for chest pain. [emedicinehealth.com]

  These include pain in the jaw, neck or back; pain in the arms or shoulder; chest pain; lightheadedness or weakness; and shortness of breath, Phillips said. Heart disease symptoms may differ for men and women, according to the Mayo Clinic. [livescience.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]

  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]

• Palpitations

  II Mild Ordinary physical activity causes tiredness, shortness of breath, palpitations, or chest discomfort (angina). [msdmanuals.com]

  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]

• 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]

  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]

  The heart’s response to the systemic effects of circulatory failure is to enlarge the chambers (cardiomegaly) and increase the muscle mass (hypertrophy). Treatment of heart failure is complex and multifaceted. [britannica.com]

• Hepatomegaly

  A physical examination revealed a systolic murmur, which was best audible in the right parasternal side, ascites, and hepatomegaly. [ncbi.nlm.nih.gov]

  · 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]

  Typical signs: tachycardia, tachypnoea, pulmonary rales, pleural effusion, raised jugular venous pressure (JVP), peripheral oedema, hepatomegaly. [patient.info]

• Jaundice

  […] and perinatal jaundice 33 35 88 89 1 Pneumonia (except that caused by tuberculosis and sexually transmitted diseases) 55 25 148 61 -59 Short gestation, low birth weight, and fetal growth retardation 22 20 59 50 -16 1-17 years, total stays 1,821 1,402 [hcup-us.ahrq.gov]

  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]

• Sweating

  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]

  An angina attack is also associated with shortness of breath and sweating. If you are a woman you may experience angina slightly differently. [world-heart-federation.org]

  […] than a few pounds or your symptoms start to get worse, let your health care team know Cut down on salt by not eating salty foods and snacks and not adding salt to food on your plate or when cooking Stay as active as you can, even if you can’t work up a sweat [merckmanuals.com]

  […] or labored breathing Fatigue Nausea Falling asleep when feeding or becoming too tired to eat Lack of appetite Weight gain over a short period of time, even when the appetite is poor, typically due to fluid retention Cough and congestion in the lungs Sweating [stanfordchildrens.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]

  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]

  You might experience a hot flush (lasting a few seconds) in the area being examined when contrast medium is injected. [insideradiology.com.au]

  Safety Side effects caused by Bidil include flushing, headache, upset stomach, vomiting, loss of appetite, diarrhea, constipation, tearing, stuffy nose, and rash. [consumerreports.org]

• Cold, Clammy Skin

  clammy skin, and normal or elevated blood pressure. [doi.org]

• Renal Insufficiency

  We introduced oxycodone for medically refractory dyspnea instead of morphine because of the patient's renal insufficiency. [ncbi.nlm.nih.gov]

  Intravenous iron reduces NT-pro-brain natriuretic peptide in anemic patients with chronic heart failure and renal insufficiency. J Am Coll Cardiol 2007;50:1657-1665. 15) Okonko DO, Grzeslo A, Witkowski T, et al. [web.archive.org]

  insufficiency when treatment with calcineurin inhibitors is delayed to prevent the development of acute renal failure. [doi.org]

• Nocturia

  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]

  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 Dry [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]

• 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]

  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

  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]

  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]

  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]

  […] legs or abdomen, weight gain), nocturia Dry cough (" heart cough "), especially at night Dizziness, palpitations, syncopes Loss of appetite, nausea, bloating, meteorism, constipation, abdominal pain, possibly weight loss, memory disorders, states of confusion [flexikon.doccheck.com]

• Dizziness

  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]

  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]

  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]

  Symptoms Fatigue and dizziness are possible symptoms of heart failure. [medicalnewstoday.com]

  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]

• 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]

  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]

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

  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]

• Insomnia

  […] 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]

  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]

  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]

• Agitation

  Patients with severe LV failure may appear visibly dyspneic or cyanotic, hypotensive, and confused or agitated because of hypoxia and poor cerebral perfusion. Some of these less specific symptoms (eg, confusion) are more common in older patients. [msdmanuals.com]

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

• Hypoalbuminemia

  Chronic venous congestion in the viscera can cause anorexia, malabsorption of nutrients and drugs, protein-losing enteropathy (characterized by diarrhea and marked hypoalbuminemia), chronic gastrointestinal blood loss, and rarely ischemic bowel infarction [msdmanuals.com]

  Juan Luis Bonilla-Palomas, Antonio Luis Gámez-López, Mirian Moreno-Conde, María Cristina López-Ibáñez, Manuel Anguita-Sánchez, Ángel Gallego de la Sacristana, Francisco García-Catalán and Antonia Villar-Ráez, Hypoalbuminemia in Acute Heart Failure Patients [dx.doi.org]

• Abnormal ECG

  ECG findings are not diagnostic, but an abnormal ECG, especially showing previous myocardial infarction, left ventricular hypertrophy, left bundle branch block, or tachyarrhythmia (eg, rapid atrial fibrillation), increases suspicion for HF and may help [msdmanuals.com]

  (Level of Evidence: C) Patients with reduced LVEF may not have HF symptoms and are most often identified during an evaluation for another disorder (eg, abnormal heart sounds, abnormal ECG, abnormal chest x-ray, hypertension or hypotension, an arrhythmia [doi.org]

• Pleural Effusion

  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]

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

  Typical signs: tachycardia, tachypnoea, pulmonary rales, pleural effusion, raised jugular venous pressure (JVP), peripheral oedema, hepatomegaly. [patient.info]

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.

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%.

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: 

• Excessive vitamin E
• HIV/AIDS
• Alcohol abuse
• Thyroid disorders
• Chemotherapy
• Congenital heart defects
• Cardiac arrhythmias
• Heart valve disease
• Cardiomyopathy

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.

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.

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

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.

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.