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.
Chronic heart failure is a state where patient's signs and symptoms have been unchanged (stable) for at least a month but may decompensate suddenly or slowly when stable chronic heart failure deteriorates leading to hospitalization.

Heart%20failure%20-%20chronic Signs and Symptoms

Definition

Heart Failure (HF)
  • 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 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, pneumonia)
  • Endocrine disorders (eg DM, hypo/hyperthyroidism)
  • Nutritional disorders (eg deficiency of thiamine, selenium, iron, calcium, phosphates and L-carnitine, obesity, cachexia)
  • Toxins (eg alcohol, medications, cocaine, trace elements)
  • Drugs (eg beta-blockers, calcium antagonists, antiarrhythmics, cytotoxic agents, NSAIDs, non-compliance to medications)
  • Other diseases (eg inflammatory/immunological diseases, malignancies, severe 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 reflux

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 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
  • Bloated feeling
  • Anorexia
  • Confusion (especially in the elderly)
  • Depression
  • Syncope

Presentation of Patients with Heart Failure

Decreased Exercise Tolerance

  • Dyspnea and/or fatigue occurring at rest or during exercise

Fluid Retention

  • Complaints of leg or abdominal swelling as primary symptom
  • Impaired exercise tolerance not noticed by patient as it occurs gradually

No Symptom or Symptoms of Another Cardiac or Other Disease

  • Cardiac enlargement or dysfunction may be noted during their evaluation for a disease other than HF
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
Elvira Manzano, 28 Jul 2020
The efficacy and cardiovascular (CV) safety of the SGLT2* inhibitor empagliflozin vs DPP-4** inhibitors and GLP-1*** receptor agonists in real-world patients were demonstrated in two interim analyses of the EMPRISE+ study presented at ADA 2020.
Roshini Claire Anthony, 14 Sep 2020

Patients hospitalized with mild-to-moderate COVID-19 who are on angiotensin-converting enzyme (ACE) inhibitors or angiotensin receptor blockers (ARBs) for hypertension should continue these medications, according to primary results of the BRACE CORONA trial presented at ESC 2020.

Tristan Manalac, 09 Jul 2020
Left ventricular assist devices (LVADs) trigger almost immediate favourable metabolic changes in both diabetics and nondiabetics, according to a recent study.
29 Mar 2020
Targeting a low-density lipoprotein cholesterol level <70 mg/dL following an ischaemic stroke of atherosclerotic origin helps to avoid one in four subsequent major vascular events without increasing the risk of intracranial haemorrhage over about 5 years of follow-up, according to data from the Treat Stroke to Target trial.