heart%20failure%20-%20chronic
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 alterans
  • Narrow pulse pressure
  • Murmurs
  • 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
Digital Edition
Asia's trusted medical magazine for healthcare professionals. Get your MIMS Cardiology - Malaysia digital copy today!
Sign In To Download
Editor's Recommendations
Most Read Articles
3 days ago
The appropriate cutoff value in predicting combined cardiovascular outcomes in patients with type 2 diabetes (T2D) is 125 mm Hg for home morning systolic blood pressure (MSBP), suggests a new study.
06 Apr 2018

Female patients with coronary artery disease (CAD) have greater regression of coronary atherosclerosis than male patients despite a lower plaque burden at baseline, data from the GLAGOV trial have shown.

26 Apr 2018
Transcatheter aortic valve replacement (TAVR) in severe symptomatic aortic stenosis (AS) patients is superior to conventional surgical aortic valve replacement (SAVR) in terms of reducing life-threatening bleeding, new-onset atrial fibrillation and acute kidney injury, a recent meta-analysis has found.
Pearl Toh, 2 days ago
Whether the 2017 ACC/AHA* blood pressure (BP) guidelines should be adopted in Asian countries was the topic of a much-anticipated discussion here at the Asian Pacific Society of Cardiology (APSC) Congress 2018 in Taiwan last week.