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HEART FAILURE - CHRONIC
Heart failure is a clinical syndrome due to a structural or functional cardiac disorder that impairs the ability of the ventricle to fill with or eject blood in order to deliver oxygen at a rate commensurate with the requirements of the metabolizing tissues.
Symptoms are caused by ventricular dysfunction secondary to abnormalities of the myocardium, pericardium, endocardium, valves, heart rhythm and conduction.
New onset heart failure refers to the first presentation of heart failure.
Transient heart failure refers to the symptomatic heart failure over a limited period of time although long-term therapy may be indicated.
Chronic heart failure is stable, worsening, or decompensated heart failure.

Definition

Heart Failure
  • Clinical syndrome due to a structural or functional cardiac disorder that impairs the ability of the ventricle to fill with or eject blood in order to deliver oxygen at rate commensurate with the requirements of the metabolizing tissues in spite of normal filling pressures or only at the expense of elevated filling pressures
  • Symptoms are caused by ventricular dysfunction secondary to abnormalities of the myocardium, pericardium, endocardium, valves, heart rhythm, or conduction

Etiology

Common Causes of Heart Failure

  • Cardiac pathologies (eg coronary artery disease, cardiomyopathies, congenital heart disease, tachyarrhythmia, valvular heart disease)
  • Hypertension
  • Infections (eg rheumatic fever, sexually transmitted diseases)
  • Endocrine disorders (eg DM, hypo/hyperthyroidism)
  • Nutritional disorders (eg deficiency of thiamine, selenium and carnitine, obesity, cachexia)
  • Toxins (eg alcohol, medication, cocaine, trace elements)
  • Drugs (eg beta-blockers, calcium antagonists, antiarrhythmics, cytotoxic agents)
  • Other diseases (eg inflammatory/immunological diseases, malignancies, anemia, renal dysfunction, renal artery stenosis, and end-stage renal failure)

Signs and Symptoms

Signs

More Specific Signs:

  • S3 gallop
  • Laterally displaced or prominent apical impulse
  • Elevated jugular venous pressure (JVP)
  • Hepatojugular reflex

Less Specific Signs:

  • Irregular pulse
  • Tachycardia with pulsus alternans
  • Narrow pulse pressure
  • Murmurs/S4 gallop
  • Pulmonary rales or crepitations
  • Reduced air entry or dullness at lung bases
  • Tachypnea/Orthopnea
  • Weight gain (>2 kg/week)
  • Weight loss (in advanced heart failure)
  • Oliguria
  • Other findings (eg hepatomegaly, ascites, peripheral edema/bilateral ankle edema, cold extremities, cachexia)

Symptoms

  • Many symptoms of heart failure (HF) are nonspecific and do not distinguish between HF and other diseases

More Specific Symptoms:

  • Dyspnea at rest or on exertion/breathlessness
  • Paroxysmal nocturnal dyspnea
  • Orthopnea
  • Reduced exercise capacity
  • Fatigue/longer time to recover post exercise
  • Edema/ankle swelling

Less Specific Symptoms:

  • Nocturnal cough
  • Wheezing
  • Palpitations
  • Dizziness
  • Bendopnea
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