Congestive heart failure differential diagnosis: Difference between revisions

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| [[File:Siren.gif|30px|link= Heart failure resident survival guide]]|| <br> || <br>
|[[File:Siren.gif|30px|link= Heart failure resident survival guide]]||<br>||<br>
| [[Heart failure resident survival guide|'''Resident'''<br>'''Survival'''<br>'''Guide''']]
|[[Heart failure resident survival guide|'''Resident'''<br>'''Survival'''<br>'''Guide''']]
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{{Congestive heart failure}}
[[Image:Home_logo1.png|right|250px|link=http://www.wikidoc.org/index.php/Congestive_heart_failure]]
{{CMG}};{{AE}}{{MehdiP}}
{{CMG}};{{AE}}{{MehdiP}}{{HK}}


==Overview==
==Overview==
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==Differentiating Congestive Heart Failure from other Diseases==
==Differentiating Congestive Heart Failure from other Diseases==
Heart failure is a clinical syndrome of [[dyspnea]], [[fatigue]] and [[edema]]. There are several disorders that cause [[heart failure]] and should not be confused with the syndrome of heart failure.
Heart failure is a clinical syndrome of [[dyspnea]], [[fatigue]] and [[edema]]. There are several disorders that cause [[heart failure]] and should not be confused with the syndrome of heart failure.
*[[Cardiac arrest]] and [[asystole]] refer to situations in which there is ''no'' cardiac output at all. Without urgent treatment these result in [[sudden death]].
*[[Cardiac arrest]] and [[asystole]] refer to situations in which there is ''no'' cardiac output at all. Without urgent treatment these result in [[sudden death]].
*[[Myocardial infarction]] ("Heart attack") refers to heart muscle damage due to an insufficient blood supply to the heart, usually as a result of a blocked [[coronary artery]].
*[[Myocardial infarction]] ("Heart attack") refers to heart muscle damage due to an insufficient blood supply to the heart, usually as a result of a blocked [[coronary artery]].
*[[Cardiomyopathy]] refers specifically to problems within the heart muscle, and these problems can result in heart failure. [[Ischemic cardiomyopathy]] implies that the cause of muscle damage is [[coronary artery disease]]. [[Dilated cardiomyopathy]] implies that the muscle damage has resulted in enlargement of the heart. [[Hypertrophic cardiomyopathy]] involves enlargement and ''thickening'' of the heart muscle.
*[[Cardiomyopathy]] refers specifically to problems within the heart muscle, and these problems can result in heart failure. [[Ischemic cardiomyopathy]] implies that the cause of muscle damage is [[coronary artery disease]]. [[Dilated cardiomyopathy]] implies that the muscle damage has resulted in enlargement of the heart. [[Hypertrophic cardiomyopathy]] involves enlargement and ''thickening'' of the heart muscle.
*There are non-cardiac causes of [[edema]] that primarily involve the lung or respiratory system.  These conditions are distinguished from heart failure in so far as they do not cause [[peripheral edema]], and they are not be associated with an elevation in [[BNP]].




 
{| style="border: 0px; font-size: 90%; margin: 3px;" align="center"
{| style="border: 0px; font-size: 90%; margin: 3px;" align=center
! colspan="1" rowspan="1" style="background: #4479BA; padding: 5px 5px;" |{{fontcolor|#FFFFFF|Organ System}}
! style="background: #4479BA; padding: 5px 5px;" rowspan=1 colspan=1  | {{fontcolor|#FFFFFF|Organ System}}
! colspan="1" rowspan="1" style="background: #4479BA; padding: 5px 5px;" |{{fontcolor|#FFFFFF|Disease}}
! style="background: #4479BA; padding: 5px 5px;" rowspan=1 colspan=1  | {{fontcolor|#FFFFFF|Disease}}
! colspan="1" rowspan="1" style="background: #4479BA; padding: 5px 5px;" |{{fontcolor|#FFFFFF|Symptoms}}
! style="background: #4479BA; padding: 5px 5px;" rowspan=1 colspan=1  | {{fontcolor|#FFFFFF|Symptoms}}
! colspan="1" rowspan="1" style="background: #4479BA; padding: 5px 5px;" |{{fontcolor|#FFFFFF|Signs}}
! style="background: #4479BA; padding: 5px 5px;" rowspan=1 colspan=1  | {{fontcolor|#FFFFFF|Signs}}
! colspan="1" rowspan="1" style="background: #4479BA; padding: 5px 5px;" |{{fontcolor|#FFFFFF|Laboratory findings}}
! style="background: #4479BA; padding: 5px 5px;" rowspan=1 colspan=1  | {{fontcolor|#FFFFFF|Laboratory findings}}
! colspan="1" rowspan="1" style="background: #4479BA; padding: 5px 5px;" |{{fontcolor|#FFFFFF|Diagnostic modality}}
! style="background: #4479BA; padding: 5px 5px;" rowspan=1 colspan=1  | {{fontcolor|#FFFFFF|Diagnostic modality}}
! colspan="1" rowspan="1" style="background: #4479BA; padding: 5px 5px;" |{{fontcolor|#FFFFFF|Management}}
! style="background: #4479BA; padding: 5px 5px;" rowspan=1 colspan=1  | {{fontcolor|#FFFFFF|Management}}
|-
|-
| style="background: #4479BA; padding: 5px 5px;" rowspan=6 colspan=1 |{{fontcolor|#FFFFFF|Cardiac}}
| colspan="1" rowspan="6" style="background: #4479BA; padding: 5px 5px;" |{{fontcolor|#FFFFFF|Cardiac}}
| style="padding: 5px 5px; background: #F5F5F5;" | HFpEF
| style="padding: 5px 5px; background: #F5F5F5;" |HFpEF (Heart Failure with preserved Ejection Fraction
| style="padding: 5px 5px; background: #F5F5F5;" |Exertional [[dyspnea]], reduced exercise tolerance, [[orthopnea]], [[paroxysmal nocturnal dyspnea]], edema
| style="padding: 5px 5px; background: #F5F5F5;" |Exertional [[dyspnea]], reduced exercise tolerance, [[orthopnea]], [[paroxysmal nocturnal dyspnea]], edema
| style="padding: 5px 5px; background: #F5F5F5;" |Elevated [[Jugular venous pressure|JVP]], fine [[Rales|crackles]], [[edema]]
| style="padding: 5px 5px; background: #F5F5F5;" |Elevated [[Jugular venous pressure|JVP]], fine [[Rales|crackles]], [[edema]]
| style="padding: 5px 5px; background: #F5F5F5;" |Increased [[Brain natriuretic peptide|BNP]]
| style="padding: 5px 5px; background: #F5F5F5;" |Increased [[Brain natriuretic peptide|BNP]]
| style="padding: 5px 5px; background: #F5F5F5;" |[[Echocardiography]] (normal EF)
| style="padding: 5px 5px; background: #F5F5F5;" |[[Echocardiography]] (EF ≥ 50 %)
| style="padding: 5px 5px; background: #F5F5F5;" |Control of volume overload and [[hypertension]],
| style="padding: 5px 5px; background: #F5F5F5;" |Control of volume overload and [[hypertension]],
treatment of underlying condition ([[obesity]], [[Atrial fibrillation|AF]], [[coronary artery disease]], [[anemia]])
treatment of underlying condition ([[obesity]], [[Atrial fibrillation|AF]], [[coronary artery disease]], [[anemia]])
|-
|-
| style="padding: 5px 5px; background: #F5F5F5;" |HFrEF
| style="padding: 5px 5px; background: #F5F5F5;" |HFrEF (Heart Failure with reduced Ejection Fraction)
| style="padding: 5px 5px; background: #F5F5F5;" |Exertional [[dyspnea]], reduced exercise tolerance, [[orthopnea]], [[paroxysmal nocturnal dyspnea]], edema
| style="padding: 5px 5px; background: #F5F5F5;" |Exertional [[dyspnea]], reduced exercise tolerance, [[orthopnea]], [[paroxysmal nocturnal dyspnea]], edema
| style="padding: 5px 5px; background: #F5F5F5;" |Elevated [[Jugular venous pressure|JVP]], fine [[Rales|crackles]], [[edema]]
| style="padding: 5px 5px; background: #F5F5F5;" |Elevated [[Jugular venous pressure|JVP]], fine [[Rales|crackles]], [[edema]]
| style="padding: 5px 5px; background: #F5F5F5;" |Increased [[Brain natriuretic peptide|BNP]]
| style="padding: 5px 5px; background: #F5F5F5;" |Increased [[Brain natriuretic peptide|BNP]]
| style="padding: 5px 5px; background: #F5F5F5;" |[[Echocardiography]] (reduced EF)
| style="padding: 5px 5px; background: #F5F5F5;" |[[Echocardiography]] (EF ≤ 40 %)
| style="padding: 5px 5px; background: #F5F5F5;" |[[Diuretics]], [[ACE inhibitor|ACE inhibitors]], [[Angiotensin II receptor antagonist|ARBs]], [[beta blockers]], [[nitrates]]
| style="padding: 5px 5px; background: #F5F5F5;" |[[Diuretics]], [[ACE inhibitor|ACE inhibitors]], [[Angiotensin II receptor antagonist|ARBs]], [[beta blockers]], [[nitrates]]
|-
|-
| style="padding: 5px 5px; background: #F5F5F5;" |Pericardial disease
| style="padding: 5px 5px; background: #F5F5F5;" |Pericardial disease
| style="padding: 5px 5px; background: #F5F5F5;" |Exercise intolerance, [[dyspnea]], [[fatigue]]  
| style="padding: 5px 5px; background: #F5F5F5;" |Exercise intolerance, [[dyspnea]], [[fatigue]]
| style="padding: 5px 5px; background: #F5F5F5;" |Elevated [[Jugular venous pressure|JVP]], pericardial knock, [[kussmaul's sign]], [[pulsus paradoxus]]  
| style="padding: 5px 5px; background: #F5F5F5;" |Elevated [[Jugular venous pressure|JVP]], pericardial knock, [[kussmaul's sign]], [[pulsus paradoxus]]
| style="padding: 5px 5px; background: #F5F5F5;" |<nowiki>-</nowiki>
| style="padding: 5px 5px; background: #F5F5F5;" |<nowiki>-</nowiki>
| style="padding: 5px 5px; background: #F5F5F5;" |Echocardiography, ECG
| style="padding: 5px 5px; background: #F5F5F5;" |Echocardiography, ECG
| style="padding: 5px 5px; background: #F5F5F5;" |Diuretics, [[pericardiectomy]]  
| style="padding: 5px 5px; background: #F5F5F5;" |Diuretics, [[pericardiectomy]]
|-
|-
| style="padding: 5px 5px; background: #F5F5F5;" |[[Hypertrophic cardiomyopathy]]
| style="padding: 5px 5px; background: #F5F5F5;" |[[Hypertrophic cardiomyopathy]]
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| style="padding: 5px 5px; background: #F5F5F5;" |Edema, [[fatigue]], exercise intolerance, dyspnea, [[lightheadedness]]
| style="padding: 5px 5px; background: #F5F5F5;" |Edema, [[fatigue]], exercise intolerance, dyspnea, [[lightheadedness]]
| style="padding: 5px 5px; background: #F5F5F5;" |[[Cardiac murmur]]
| style="padding: 5px 5px; background: #F5F5F5;" |[[Cardiac murmur]]
| style="padding: 5px 5px; background: #F5F5F5;" | <nowiki>-</nowiki>
| style="padding: 5px 5px; background: #F5F5F5;" |<nowiki>-</nowiki>
| style="padding: 5px 5px; background: #F5F5F5;" |Echocardiography, ECG
| style="padding: 5px 5px; background: #F5F5F5;" |Echocardiography, ECG
| style="padding: 5px 5px; background: #F5F5F5;" |Valve repair or replacement, diuretics, [[beta blockers]]
| style="padding: 5px 5px; background: #F5F5F5;" |Valve repair or replacement, diuretics, [[beta blockers]]
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| style="padding: 5px 5px; background: #F5F5F5;" |Palpitation, lightheadedness, [[Chest pain|chest tightness]]
| style="padding: 5px 5px; background: #F5F5F5;" |Palpitation, lightheadedness, [[Chest pain|chest tightness]]
| style="padding: 5px 5px; background: #F5F5F5;" |[[Tachycardia]], abnormal pulse
| style="padding: 5px 5px; background: #F5F5F5;" |[[Tachycardia]], abnormal pulse
| style="padding: 5px 5px; background: #F5F5F5;" | <nowiki>-</nowiki>
| style="padding: 5px 5px; background: #F5F5F5;" |<nowiki>-</nowiki>
| style="padding: 5px 5px; background: #F5F5F5;" |Echocardiography, ECG, [[holter monitoring]]
| style="padding: 5px 5px; background: #F5F5F5;" |Echocardiography, ECG, [[holter monitoring]]
| style="padding: 5px 5px; background: #F5F5F5;" |[[Cardioversion|Pharmacological cardioversion]] (anti arrhythmics), [[Cardioversion|electrical cardioversion]], [[ablation]]
| style="padding: 5px 5px; background: #F5F5F5;" |[[Cardioversion|Pharmacological cardioversion]] (anti arrhythmics), [[Cardioversion|electrical cardioversion]], [[ablation]]
|-
|-
| style="background: #4479BA; padding: 5px 5px;" rowspan=4 colspan=1 |{{fontcolor|#FFFFFF|Pulmonary}}
| colspan="1" rowspan="4" style="background: #4479BA; padding: 5px 5px;" |{{fontcolor|#FFFFFF|Pulmonary}}
| style="padding: 5px 5px; background: #F5F5F5;" |[[Chronic obstructive pulmonary disease|Chronic airway disease]]
| style="padding: 5px 5px; background: #F5F5F5;" |[[Chronic obstructive pulmonary disease|Chronic airway disease]]
| style="padding: 5px 5px; background: #F5F5F5;" |[[Cough]], dyspnea, chest pain, exercise intolerance
| style="padding: 5px 5px; background: #F5F5F5;" |[[Cough]], dyspnea, chest pain, exercise intolerance
Line 102: Line 103:
| style="padding: 5px 5px; background: #F5F5F5;" |Weight reduction, [[CPAP]]
| style="padding: 5px 5px; background: #F5F5F5;" |Weight reduction, [[CPAP]]
|-
|-
| style="background: #4479BA; padding: 5px 5px;" rowspan=2 colspan=1 |{{fontcolor|#FFFFFF|High output status}}
| colspan="1" rowspan="2" style="background: #4479BA; padding: 5px 5px;" |{{fontcolor|#FFFFFF|High output status}}
| style="padding: 5px 5px; background: #F5F5F5;" |[[Anemia]]
| style="padding: 5px 5px; background: #F5F5F5;" |[[Anemia]]
| style="padding: 5px 5px; background: #F5F5F5;" |Palpitation, lightheadedness, fatigue
| style="padding: 5px 5px; background: #F5F5F5;" |Palpitation, lightheadedness, fatigue
| style="padding: 5px 5px; background: #F5F5F5;" |[[Cheilosis]], delayed capillary refill  
| style="padding: 5px 5px; background: #F5F5F5;" |[[Cheilosis]], delayed capillary refill
| style="padding: 5px 5px; background: #F5F5F5;" |Decreased [[Hemoglobin|Hb]] and [[Hematocrit|HCT]]
| style="padding: 5px 5px; background: #F5F5F5;" |Decreased [[Hemoglobin|Hb]] and [[Hematocrit|HCT]]
| style="padding: 5px 5px; background: #F5F5F5;" |CBC, Iron study, [[Bone marrow examination|bone marrow aspiration]] and biopsy
| style="padding: 5px 5px; background: #F5F5F5;" |CBC, Iron study, [[Bone marrow examination|bone marrow aspiration]] and biopsy
Line 112: Line 113:
| style="padding: 5px 5px; background: #F5F5F5;" |[[Thyrotoxicosis]]
| style="padding: 5px 5px; background: #F5F5F5;" |[[Thyrotoxicosis]]
| style="padding: 5px 5px; background: #F5F5F5;" |Palpitation, [[sweating]], weight loss
| style="padding: 5px 5px; background: #F5F5F5;" |Palpitation, [[sweating]], weight loss
| style="padding: 5px 5px; background: #F5F5F5;" |[[Proptosis]], tachycardia  
| style="padding: 5px 5px; background: #F5F5F5;" |[[Proptosis]], tachycardia
| style="padding: 5px 5px; background: #F5F5F5;" |Decreased [[TSH]], increased [[Thyroid function tests|T3,T4]]
| style="padding: 5px 5px; background: #F5F5F5;" |Decreased [[TSH]], increased [[Thyroid function tests|T3,T4]]
| style="padding: 5px 5px; background: #F5F5F5;" |[[Thyroid function tests|Thyroid function test]]
| style="padding: 5px 5px; background: #F5F5F5;" |[[Thyroid function tests|Thyroid function test]]
| style="padding: 5px 5px; background: #F5F5F5;" |[[Methimazole|Thyrostatics]], beta blockers, ablation
| style="padding: 5px 5px; background: #F5F5F5;" |[[Methimazole|Thyrostatics]], beta blockers, ablation
|-
|-
| style="background: #4479BA; padding: 5px 5px;" rowspan=2 colspan=1 |{{fontcolor|#FFFFFF| |Others}}
| colspan="1" rowspan="2" style="background: #4479BA; padding: 5px 5px;" |{{fontcolor|#FFFFFF| |Others}}
| style="padding: 5px 5px; background: #F5F5F5;" |Liver disease
| style="padding: 5px 5px; background: #F5F5F5;" |Liver disease
| style="padding: 5px 5px; background: #F5F5F5;" |Fatigue, edema, [[jaundice]]
| style="padding: 5px 5px; background: #F5F5F5;" |Fatigue, edema, [[jaundice]]
Line 134: Line 135:




===Other Causes of Dyspnea===
CHF should be differentiated from other diseases presenting with [[shortness of breath]] and [[tachypnea]]. The differentials include the following:<ref name="pmid24550636">{{cite journal |vauthors=Brenes-Salazar JA |title=Westermark's and Palla's signs in acute and chronic pulmonary embolism: Still valid in the current computed tomography era |journal=J Emerg Trauma Shock |volume=7 |issue=1 |pages=57–8 |year=2014 |pmid=24550636 |pmc=3912657 |doi=10.4103/0974-2700.125645 |url=}}</ref><ref name="urlCT Angiography of Pulmonary Embolism: Diagnostic Criteria and Causes of Misdiagnosis | RadioGraphics">{{cite web |url=http://pubs.rsna.org/doi/full/10.1148/rg.245045008 |title=CT Angiography of Pulmonary Embolism: Diagnostic Criteria and Causes of Misdiagnosis &#124; RadioGraphics |format= |work= |accessdate=}}</ref><ref name="pmid23940438">{{cite journal |vauthors=Bĕlohlávek J, Dytrych V, Linhart A |title=Pulmonary embolism, part I: Epidemiology, risk factors and risk stratification, pathophysiology, clinical presentation, diagnosis and nonthrombotic pulmonary embolism |journal=Exp Clin Cardiol |volume=18 |issue=2 |pages=129–38 |year=2013 |pmid=23940438 |pmc=3718593 |doi= |url=}}</ref><ref name="urlPulmonary Embolism: Symptoms - National Library of Medicine - PubMed Health">{{cite web |url=https://www.ncbi.nlm.nih.gov/pubmedhealth/PMHT0022657/ |title=Pulmonary Embolism: Symptoms - National Library of Medicine - PubMed Health |format= |work= |accessdate=}}</ref><ref name="pmid20118395">{{cite journal |vauthors=Ramani GV, Uber PA, Mehra MR |title=Chronic heart failure: contemporary diagnosis and management |journal=Mayo Clin. Proc. |volume=85 |issue=2 |pages=180–95 |year=2010 |pmid=20118395 |pmc=2813829 |doi=10.4065/mcp.2009.0494 |url=}}</ref><ref name="pmid18215495">{{cite journal |vauthors=Blinderman CD, Homel P, Billings JA, Portenoy RK, Tennstedt SL |title=Symptom distress and quality of life in patients with advanced congestive heart failure |journal=J Pain Symptom Manage |volume=35 |issue=6 |pages=594–603 |year=2008 |pmid=18215495 |pmc=2662445 |doi=10.1016/j.jpainsymman.2007.06.007 |url=}}</ref><ref name="pmid19168510">{{cite journal |vauthors=Hawkins NM, Petrie MC, Jhund PS, Chalmers GW, Dunn FG, McMurray JJ |title=Heart failure and chronic obstructive pulmonary disease: diagnostic pitfalls and epidemiology |journal=Eur. J. Heart Fail. |volume=11 |issue=2 |pages=130–9 |year=2009 |pmid=19168510 |pmc=2639415 |doi=10.1093/eurjhf/hfn013 |url=}}</ref><ref name="pmid9465867">{{cite journal |vauthors=Takasugi JE, Godwin JD |title=Radiology of chronic obstructive pulmonary disease |journal=Radiol. Clin. North Am. |volume=36 |issue=1 |pages=29–55 |year=1998 |pmid=9465867 |doi= |url=}}</ref><ref name="pmid14651761">{{cite journal |vauthors=Wedzicha JA, Donaldson GC |title=Exacerbations of chronic obstructive pulmonary disease |journal=Respir Care |volume=48 |issue=12 |pages=1204–13; discussion 1213–5 |year=2003 |pmid=14651761 |doi= |url=}}</ref><ref name="pmid23833163">{{cite journal |vauthors=Nakawah MO, Hawkins C, Barbandi F |title=Asthma, chronic obstructive pulmonary disease (COPD), and the overlap syndrome |journal=J Am Board Fam Med |volume=26 |issue=4 |pages=470–7 |year=2013 |pmid=23833163 |doi=10.3122/jabfm.2013.04.120256 |url=}}</ref><ref name="pmid20511488">{{cite journal |vauthors=Khandaker MH, Espinosa RE, Nishimura RA, Sinak LJ, Hayes SN, Melduni RM, Oh JK |title=Pericardial disease: diagnosis and management |journal=Mayo Clin. Proc. |volume=85 |issue=6 |pages=572–93 |year=2010 |pmid=20511488 |pmc=2878263 |doi=10.4065/mcp.2010.0046 |url=}}</ref><ref name="pmid23610095">{{cite journal |vauthors=Bogaert J, Francone M |title=Pericardial disease: value of CT and MR imaging |journal=Radiology |volume=267 |issue=2 |pages=340–56 |year=2013 |pmid=23610095 |doi=10.1148/radiol.13121059 |url=}}</ref><ref name="pmid11680112">{{cite journal |vauthors=Gharib AM, Stern EJ |title=Radiology of pneumonia |journal=Med. Clin. North Am. |volume=85 |issue=6 |pages=1461–91, x |year=2001 |pmid=11680112 |doi= |url=}}</ref><ref name="pmid23507061">{{cite journal |vauthors=Schmidt WA |title=Imaging in vasculitis |journal=Best Pract Res Clin Rheumatol |volume=27 |issue=1 |pages=107–18 |year=2013 |pmid=23507061 |doi=10.1016/j.berh.2013.01.001 |url=}}</ref><ref name="pmid16891436">{{cite journal |vauthors=Suresh E |title=Diagnostic approach to patients with suspected vasculitis |journal=Postgrad Med J |volume=82 |issue=970 |pages=483–8 |year=2006 |pmid=16891436 |pmc=2585712 |doi=10.1136/pgmj.2005.042648 |url=}}</ref><ref name="pmid123074">{{cite journal |vauthors=Stein PD, Dalen JE, McIntyre KM, Sasahara AA, Wenger NK, Willis PW |title=The electrocardiogram in acute pulmonary embolism |journal=Prog Cardiovasc Dis |volume=17 |issue=4 |pages=247–57 |year=1975 |pmid=123074 |doi= |url=}}</ref><ref name="pmid23413894">{{cite journal |vauthors=Warnier MJ, Rutten FH, Numans ME, Kors JA, Tan HL, de Boer A, Hoes AW, De Bruin ML |title=Electrocardiographic characteristics of patients with chronic obstructive pulmonary disease |journal=COPD |volume=10 |issue=1 |pages=62–71 |year=2013 |pmid=23413894 |doi=10.3109/15412555.2012.727918 |url=}}</ref><ref name="pmid23000104">{{cite journal |vauthors=Stein PD, Matta F, Ekkah M, Saleh T, Janjua M, Patel YR, Khadra H |title=Electrocardiogram in pneumonia |journal=Am. J. Cardiol. |volume=110 |issue=12 |pages=1836–40 |year=2012 |pmid=23000104 |doi=10.1016/j.amjcard.2012.08.019 |url=}}</ref><ref name="pmid26209947">{{cite journal |vauthors=Hazebroek MR, Kemna MJ, Schalla S, Sanders-van Wijk S, Gerretsen SC, Dennert R, Merken J, Kuznetsova T, Staessen JA, Brunner-La Rocca HP, van Paassen P, Cohen Tervaert JW, Heymans S |title=Prevalence and prognostic relevance of cardiac involvement in ANCA-associated vasculitis: eosinophilic granulomatosis with polyangiitis and granulomatosis with polyangiitis |journal=Int. J. Cardiol. |volume=199 |issue= |pages=170–9 |year=2015 |pmid=26209947 |doi=10.1016/j.ijcard.2015.06.087 |url=}}</ref><ref name="pmid20112390">{{cite journal |vauthors=Dennert RM, van Paassen P, Schalla S, Kuznetsova T, Alzand BS, Staessen JA, Velthuis S, Crijns HJ, Tervaert JW, Heymans S |title=Cardiac involvement in Churg-Strauss syndrome |journal=Arthritis Rheum. |volume=62 |issue=2 |pages=627–34 |year=2010 |pmid=20112390 |doi=10.1002/art.27263 |url=}}</ref>
<small>
{|
|- style="background: #4479BA; color: #FFFFFF; text-align: center;"
! rowspan="2" |<small>Diseases</small>
! colspan="3" |<small>Diagnostic tests</small>
! colspan="3" |<small>Physical Examination</small>
| colspan="7" |<small>Symptoms
! colspan="1" rowspan="2" |<small>Past medical history</small>
! rowspan="2" |<small>Other Findings</small>
|- style="background: #4479BA; color: #FFFFFF; text-align: center;"
!<small>CT scan and MRI</small>
!<small>EKG</small>
!<small>Chest X-ray</small>
!<small>Tachypnea</small>
!<small>Tachycardia</small>
!<small>Fever</small>
!<small>Chest Pain</small>
!<small>Hemoptysis</small>
!<small>Dyspnea on Exertion</small>
!<small>Wheezing</small>
!<small>Chest Tenderness</small>
!<small>Nasalopharyngeal Ulceration</small>
!<small>Carotid Bruit</small>
|-
| style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Pulmonary embolism]]
| style="background: #F5F5F5; padding: 5px; text-align:center" |
*On [[CT angiography]]:
**Intra-luminal filling defect
*On [[MRI]]:
**Narrowing of involved [[Blood vessel|vessel]]
**No contrast seen distal to [[obstruction]]
**Polo-mint sign (partial filling defect surrounded by contrast)
| style="background: #F5F5F5; padding: 5px;" |
*[[Pulmonary embolism electrocardiogram|S1Q3T3]] pattern representing acute [[right heart]] strain
| style="background: #F5F5F5; padding: 5px;" |
*[[Fleischner sign]] (enlarged pulmonary artery), [[Hampton's hump|Hampton hump]], [[Westermark's sign]]
| style="background: #F5F5F5; padding: 5px;" |✔
| style="background: #F5F5F5; padding: 5px;" |✔
| style="background: #F5F5F5; padding: 5px;" |✔ (Low grade)
| style="background: #F5F5F5; padding: 5px;" |✔
| style="background: #F5F5F5; padding: 5px;" |✔ (In case of massive PE)
| style="background: #F5F5F5; padding: 5px;" |✔
| style="background: #F5F5F5; padding: 5px;" | -
| style="background: #F5F5F5; padding: 5px;" | -
| style="background: #F5F5F5; padding: 5px;" | -
| style="background: #F5F5F5; padding: 5px;" | -
| style="background: #F5F5F5; padding: 5px;" |
*Hypercoagulating conditions ([[Factor V Leiden]], [[thrombophilia]], [[deep vein thrombosis]], immobilization, [[malignancy]], [[pregnancy]])
| style="background: #F5F5F5; padding: 5px;" |
*May be associated with [[metabolic alkalosis]] and [[syncope]]
|-
| style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Congestive heart failure]]
| style="background: #F5F5F5; padding: 5px;" |
*On [[Computed tomography|CT scan]]:
**[[Mediastinal lymphadenopathy]]
**Hazy [[mediastinal]] fat
*On [[Magnetic resonance imaging|MRI]]:
**Abnormality of [[cardiac]] chambers ([[Hypertrophy (medical)|hypertrophy]], dilation)
**Delayed enhancement [[MRI]] may help characterize the [[myocardial]] [[Tissue (biology)|tissue]] ([[fibrosis]])
**Late enhancement of contrast in conditions such as [[myocarditis]], [[sarcoidosis]], [[amyloidosis]], [[Anderson-Fabry disease|Anderson-Fabry]]'s disease, [[Chagas disease]])
| style="background: #F5F5F5; padding: 5px;" |
*Goldberg's criteria may aid in diagnosis of left ventricular dysfunction: (High specificity)
**[[S wave|S]]V1 or [[S wave|S]]V2 + [[R wave|R]]V5 or [[R wave|R]]V6 ≥3.5 mV
**Total [[QRS complex|QRS]] amplitude in each of the limb leads ≤0.8 mV
**[[R wave|R]]/[[S wave|S]] ratio <1 in lead V4
| style="background: #F5F5F5; padding: 5px;" |
*[[Cardiomegaly]]
| style="background: #F5F5F5; padding: 5px;" |✔
| style="background: #F5F5F5; padding: 5px;" |✔
| style="background: #F5F5F5; padding: 5px;" |✔
| style="background: #F5F5F5; padding: 5px;" | -
| style="background: #F5F5F5; padding: 5px;" | -
| style="background: #F5F5F5; padding: 5px;" |✔
| style="background: #F5F5F5; padding: 5px;" | -
| style="background: #F5F5F5; padding: 5px;" | -
| style="background: #F5F5F5; padding: 5px;" | -
| style="background: #F5F5F5; padding: 5px;" | -
| style="background: #F5F5F5; padding: 5px;" |
*Previous [[myocardial infarction]]
*[[Hypertension]] ([[Systemic hypertension|systemic]] and [[Pulmonary hypertension|pulmonary]])
*[[Cardiac arrhythmia|Cardiac arrythmias]]
*[[Viral]] infections ([[myocarditis]])
*[[Congenital heart disease|Congenital heart defects]]
| style="background: #F5F5F5; padding: 5px;" |
*[[Right heart failure]] associated with:
**[[Hepatomegaly]]
**Positive hepato-jugular reflex
**Increased [[jugular venous pressure]]
**[[Peripheral edema]]
*[[Left heart failure]] associated with:
**[[Pulmonary edema]]
**Eventual [[right heart failure]]
|-
| style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Percarditis]]
| style="background: #F5F5F5; padding: 5px;" |
*On contrast enhanced [[Computed tomography|CT scan]]:
**Enhancement of the [[pericardium]] (due to [[inflammation]])
**[[Pericardial effusion]]
**[[Pericardial calcification]]
*On [[gadolinium]]-enhanced fat-saturated [[Magnetic resonance imaging|T1-weighted MRI]]:
**[[Pericardial]] enhancement (due to [[inflammation]])
**[[Pericardial effusion]]
| style="background: #F5F5F5; padding: 5px;" |
*ST elevation
*PR depression
| style="background: #F5F5F5; padding: 5px;" |
*Large collection of fluid inside the pericardial sac (pericardial effusion)
*Calcification of pericardial sac
| style="background: #F5F5F5; padding: 5px;" |✔
| style="background: #F5F5F5; padding: 5px;" |✔
| style="background: #F5F5F5; padding: 5px;" |✔ (Low grade)
| style="background: #F5F5F5; padding: 5px;" |✔ (Relieved by sitting up and leaning forward)
| style="background: #F5F5F5; padding: 5px;" | -
| style="background: #F5F5F5; padding: 5px;" |✔
| style="background: #F5F5F5; padding: 5px;" | -
| style="background: #F5F5F5; padding: 5px;" | -
| style="background: #F5F5F5; padding: 5px;" | -
| style="background: #F5F5F5; padding: 5px;" | -
| style="background: #F5F5F5; padding: 5px;" |
*Infections:
**[[Viral]] (Coxsackie virus, [[Herpes simplex virus|Herpes virus]], [[Mumps virus]], [[Human Immunodeficiency Virus (HIV)|HIV]])
**[[Bacteria]] ([[Mycobacterium tuberculosis]]-common in developing countries)
**[[Fungal]] ([[Histoplasmosis]])
*Idiopathic in a large number of cases
*[[Autoimmune]]
*[[Uremia]]
*[[Malignancy]]
*Previous [[myocardial infarction]]
| style="background: #F5F5F5; padding: 5px;" |
*May be clinically classified into:
**Acute (< 6 weeks)
**Sub-acute (6 weeks - 6 months)
**Chronic (> 6 months)
|-
| style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Pneumonia]]
| style="background: #F5F5F5; padding: 5px;" |
*On [[Computed tomography|CT scan]]: (not generally indicated)
**[[Consolidation (medicine)|Consolidation]] ([[alveolar]]/lobar pneumonia)
**Peribronchial [[nodules]] ([[bronchopneumonia]])
**[[Ground glass opacification on CT|Ground-glass opacity]] (GGO)
**[[Abscess]]
**[[Pleural effusion]]
**On [[MRI]]:
*Not indicated
| style="background: #F5F5F5; padding: 5px;" |
*Prolonged [[PR interval]]
*Transient [[T wave]] inversions
| style="background: #F5F5F5; padding: 5px;" |
*[[Consolidation (medicine)|Consolidation]] ([[alveolar]]/lobar [[pneumonia]])
*Peribronchial [[nodules]] (bronchopneumonia)
*Ground-glass opacity (GGO)
| style="background: #F5F5F5; padding: 5px;" |✔
| style="background: #F5F5F5; padding: 5px;" |✔
| style="background: #F5F5F5; padding: 5px;" |✔
| style="background: #F5F5F5; padding: 5px;" |✔
| style="background: #F5F5F5; padding: 5px;" | -
| style="background: #F5F5F5; padding: 5px;" |✔
| style="background: #F5F5F5; padding: 5px;" |✔
| style="background: #F5F5F5; padding: 5px;" | -
| style="background: #F5F5F5; padding: 5px;" | -
| style="background: #F5F5F5; padding: 5px;" | -
| style="background: #F5F5F5; padding: 5px;" |
*Ill-contact
*Travelling
*[[Smoking]]
*[[Diabetes mellitus|Diabetic]]
*Recent hospitalization
*[[Chronic obstructive pulmonary disease]]
| style="background: #F5F5F5; padding: 5px;" |
*Requires [[Sputum|sputum stain]] and culture for diagnosis
*[[Empiric therapy|Empiric management]] usually started before [[Culture collection|culture]] results
|-
| style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Vasculitis]]
| style="background: #F5F5F5; padding: 5px;" |
*On [[Computed tomography|CT scan]]: ([[Takayasu's arteritis|Takayasu arteritis]])
**[[Blood vessel|Vessel]] wall thickening
**Luminal narrowing of [[pulmonary artery]]
**Masses or nodules ([[Anti-neutrophil cytoplasmic antibody|ANCA]]-associated granulomatous vasculitis)
*On [[Magnetic resonance imaging|MRI]]:


===Other Causes of Dyspnea===
Homogeneous, circumferential [[Blood vessel|vessel]] wall [[swelling]]
There are non-cardiac causes of [[edema]] that primarily involve the lung or respiratory system.  These conditions are distinguished from heart failure in so far as they do not cause [[peripheral edema]], and they are not be associated with an elevation in [[BNP]].
| style="background: #F5F5F5; padding: 5px;" |
*[[Bundle branch block|Right or left bundle-branch block]] ([[Churg-Strauss syndrome]])
*[[Atrial fibrillation]] ([[Churg-Strauss syndrome]])
*Non-specific [[ST interval|ST segment]] and [[T wave]] changes
| style="background: #F5F5F5; padding: 5px;" |
*[[Nodule (medicine)|Nodules]]
*[[Cavitation]]
| style="background: #F5F5F5; padding: 5px;" |✔
| style="background: #F5F5F5; padding: 5px;" |✔
| style="background: #F5F5F5; padding: 5px;" |✔
| style="background: #F5F5F5; padding: 5px;" |✔
| style="background: #F5F5F5; padding: 5px;" |✔
| style="background: #F5F5F5; padding: 5px;" |✔
| style="background: #F5F5F5; padding: 5px;" | -
| style="background: #F5F5F5; padding: 5px;" |✔
| style="background: #F5F5F5; padding: 5px;" |✔
| style="background: #F5F5F5; padding: 5px;" |✔
| style="background: #F5F5F5; padding: 5px;" |
*[[Takayasu's arteritis|Takayasu arteritis]] usually found in persons aged 4-60 years with a mean of 30
*[[Giant-cell arteritis]] usually occurrs in persons aged > 60 years
*[[Churg-Strauss syndrome]] may present with [[asthma]], [[sinusitis]], transient [[pulmonary]] infiltrates and neuropathy alongwith [[cardiac]] involvement
*Granulomatous vasculitides may present with [[nephritis]] and [[upper airway]] ([[nasopharyngeal]]) destruction
| style="background: #F5F5F5; padding: 5px;" |
|-
| style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Chronic obstructive pulmonary disease]] (COPD)
| style="background: #F5F5F5; padding: 5px;" |
*On [[Computed tomography|CT scan]]:
**[[Chronic bronchitis]] may show [[bronchial]] wall thickening, scarring with bronchovascular irregularity, [[fibrosis]]
**[[Emphysema]] may show [[alveolar]] septal destruction and airspace enlargement (Centrilobular- upper lobe, panlobular- lower lobe)
**Giant bubbles
*On [[MRI]]:
**Increased diameter of [[pulmonary arteries]]
**Peripheral [[pulmonary]] [[vasculature]] attentuation
**Loss of retrosternal airspace due to right ventricular enlargement
**Hyperpolarized Helium MRI may show progressively poor ventilation and destruction of lung
| style="background: #F5F5F5; padding: 5px;" |
*[[Multifocal atrial tachycardia]] (atleast 3 distinct [[P waves|P wave]] morphologies)
| style="background: #F5F5F5; padding: 5px;" |
*Enlarged [[lung]] shadows ([[emphysema]])
*Flattening of [[diaphragm]] ([[emphysema]])
| style="background: #F5F5F5; padding: 5px;" |✔
| style="background: #F5F5F5; padding: 5px;" |✔
| style="background: #F5F5F5; padding: 5px;" | -
| style="background: #F5F5F5; padding: 5px;" | -
| style="background: #F5F5F5; padding: 5px;" | -
| style="background: #F5F5F5; padding: 5px;" |✔
| style="background: #F5F5F5; padding: 5px;" |✔
| style="background: #F5F5F5; padding: 5px;" | -
| style="background: #F5F5F5; padding: 5px;" | -
| style="background: #F5F5F5; padding: 5px;" | -
| style="background: #F5F5F5; padding: 5px;" |
*[[Smoking]]
*[[Alpha 1-antitrypsin deficiency|Alpha-1 antitrypsin deficiency]]
*Increased [[sputum]] production ([[chronic bronchitis]])
*[[Cough]]
| style="background: #F5F5F5; padding: 5px;" |
*[[Alpha 1-antitrypsin deficiency|Alpha 1 antitrypsin deficiency]] may be associated with [[hepatomegaly]]
|-
| style="background: #DCDCDC; padding: 5px; text-align: center;" |[[COVID-19-associated heart failure]]
| style="background: #F5F5F5; padding: 5px;" |
*CT: [[Cardiomegaly]], [[Pulmonary edema]]
*CMR: Signs of underlying [[myocarditis]] may be seen.
| style="background: #F5F5F5; padding: 5px;" |
*[[Left ventricular hypertrophy]]
*[[Low-voltage]] QRS
*Non-specific ST-T change
| style="background: #F5F5F5; padding: 5px;" |
*[[Cardiomegaly]]
*[[Pulmonary edema]] (interstitial, alveolar)
| style="background: #F5F5F5; padding: 5px;" |✔
| style="background: #F5F5F5; padding: 5px;" |✔
| style="background: #F5F5F5; padding: 5px;" | -
| style="background: #F5F5F5; padding: 5px;" | -
| style="background: #F5F5F5; padding: 5px;" |✔
| style="background: #F5F5F5; padding: 5px;" |✔
| style="background: #F5F5F5; padding: 5px;" | -
| style="background: #F5F5F5; padding: 5px;" | -
| style="background: #F5F5F5; padding: 5px;" | -
| style="background: #F5F5F5; padding: 5px;" | -
| style="background: #F5F5F5; padding: 5px;" | -
| style="background: #F5F5F5; padding: 5px;" |
*Increased [[NT-proBNP]] and cardiac [[troponin]]s levels
|}


=====Other Conditions that Cause Dyspnea that are Emergencies=====
=====Other Conditions that Cause Dyspnea that are Emergencies=====
The following emergency conditions should be excluded when diagnosing a patient with heart failure:
The following emergency conditions should be excluded when diagnosing a patient with heart failure:
* [[Asthma]] or [[bronchospasm]]
 
* [[Foreign body aspiration]]
*[[Asthma]] or [[bronchospasm]]
* [[H. influenza epiglottitis]]
*[[Foreign body aspiration]]
* [[Spontaneous pneumothorax]]
*[[H. influenza epiglottitis]]
*[[Spontaneous pneumothorax]]


=====Non Cardiac Causes of Dyspnea=====
=====Non Cardiac Causes of Dyspnea=====
* [[Abdominal masses]]
 
* [[Acute bronchitis]]  
*[[Abdominal masses]]
* [[Acute Chest Syndrome]]
*[[Acute bronchitis]]
* [[Acute myeloid leukemia]]
*[[Acute Chest Syndrome]]
* [[Acute promyelocytic leukemia]]
*[[Acute myeloid leukemia]]
* [[Acute tracheobronchitis]]
*[[Acute promyelocytic leukemia]]
* [[AIDS]]
*[[Acute tracheobronchitis]]
* [[Air pollution]]
*[[AIDS]]
* [[Air-conditioner lung]]
*[[Air pollution]]
* [[Allergy]]
*[[Air-conditioner lung]]
* [[Alpha 1-antitrypsin deficiency]]
*[[Allergy]]
* [[Altitude sickness]]
*[[Alpha 1-antitrypsin deficiency]]
* [[Amniotic fluid embolism]]
*[[Altitude sickness]]
* [[Amphotericin B]]
*[[Amniotic fluid embolism]]
* [[Amyl nitrite]]
*[[Amphotericin B]]
* [[Amyotrophic Lateral Sclerosis]] ([[ALS]])
*[[Amyl nitrite]]
* [[Anaphylactoid reactions]]
*[[Amyotrophic Lateral Sclerosis]] ([[ALS]])
* [[Anaphylaxis]]
*[[Anaphylactoid reactions]]
* [[Anemia]]
*[[Anaphylaxis]]
* [[Anthrax]]
*[[Anemia]]
* [[Anxiety]]
*[[Anthrax]]
* [[Asbestosis]]
*[[Anxiety]]
* [[Aspergillus clavatus]]
*[[Asbestosis]]
* [[Aspiration]]
*[[Aspergillus clavatus]]
* [[Asthma]]
*[[Aspiration]]
* [[Atelectasis]]
*[[Asthma]]
* [[Atypical pneumonia]]
*[[Atelectasis]]
* [[Barium]]
*[[Atypical pneumonia]]
* [[Beta-blockers]]
*[[Barium]]
* [[Betazole]]
*[[Beta-blockers]]
* [[Bird breeder's lung]]
*[[Betazole]]
* [[Bird fancier's lung]]
*[[Bird breeder's lung]]
* [[Bland-White-Garland Syndrome]]
*[[Bird fancier's lung]]
* [[Bleomycin]] in [[ABVD]]
*[[Bland-White-Garland Syndrome]]
* [[Blood transfusion]]
*[[Bleomycin]] in [[ABVD]]
* [[Brain stem infarction]]
*[[Blood transfusion]]
* [[Bronchial asthma]]
*[[Brain stem infarction]]
* [[Bronchial tumors]]
*[[Bronchial asthma]]
* [[Bronchiolitis]]
*[[Bronchial tumors]]
* [[Bronchiolitis obliterans]]
*[[Bronchiolitis]]
* [[Bronchiolitis obliterans organizing pneumonia]]
*[[Bronchiolitis obliterans]]
* [[Bronchitis]]
*[[Bronchiolitis obliterans organizing pneumonia]]
* [[Bronchogenic carcinoma]]
*[[Bronchitis]]
* [[Bronchoscopy]]
*[[Bronchogenic carcinoma]]
*[[Bronchoscopy]]
*[[Cardiovascular syphilis]]
*[[Cardiovascular syphilis]]
* [[Caspofungin]]
*[[Caspofungin]]
* [[Cheese worker's lung]]
*[[Cheese worker's lung]]
* [[Chemical worker's lung]]
*[[Chemical worker's lung]]
* [[Chest trauma]]
*[[Chest trauma]]
* [[Chest tube]]
*[[Chest tube]]
* [[Cholesterol pericarditis]]
*[[Cholesterol pericarditis]]
* [[Bronchitis|Chronic bronchitis]]
*[[Bronchitis|Chronic bronchitis]]
* [[Chronic fatigue syndrome]]
*[[Chronic fatigue syndrome]]
* [[Chronic Obstructive Pulmonary Disease]] (COPD)
*[[Chronic Obstructive Pulmonary Disease]] (COPD)
* [[Chylothorax]]
*[[Chylothorax]]
* [[Cirrhosis]]
*[[Cirrhosis]]
* [[Cladosporium]]
*[[Cladosporium]]
* [[CMV Pneumonitis]]
*[[CMV Pneumonitis]]
* [[Community-acquired pneumonia]]
*[[Community-acquired pneumonia]]
* [[Croup]]
*[[Croup]]
* [[Cystic Fibrosis]]
*[[Cystic Fibrosis]]
* [[Daptomycin]]
*[[Daptomycin]]
* [[Decompression sickness]]
*[[Decompression sickness]]
* Decreased thoracic or [[diaphragm]]atic excursion
*Decreased thoracic or [[diaphragm]]atic excursion
* [[Diabetic coma]]
*[[Diabetic coma]]
* [[Diffuse panbronchiolitis]]
*[[Diffuse panbronchiolitis]]
* [[Diverticulosis]]
*[[Diverticulosis]]
* [[Drugs]]
*[[Drugs]]
* [[Ehrlichiosis (canine)]]
*[[Ehrlichiosis (canine)]]
* [[Empty nose syndrome]]
*[[Empty nose syndrome]]
* [[Empyema, pleural]]  
*[[Empyema, pleural]]
* [[Encephalitis]]
*[[Encephalitis]]
* [[Eosinophilic pneumonia]]
*[[Eosinophilic pneumonia]]
* [[Ephedrine]]
*[[Ephedrine]]
* [[Epidemic dropsy]]
*[[Epidemic dropsy]]
* [[Erdheim-Chester disease]]
*[[Erdheim-Chester disease]]
* [[Esophageal cancer]]
*[[Esophageal cancer]]
* Esophageal diseases with [[trachea]]l compression
*Esophageal diseases with [[trachea]]l compression
* [[Exercise-induced asthma]]
*[[Exercise-induced asthma]]
* [[Extrinsic allergic alveolitis]]
*[[Extrinsic allergic alveolitis]]
* [[Fat embolism]]
*[[Fat embolism]]
* [[Fibrosing alveolitis, cryptogenic]]
*[[Fibrosing alveolitis, cryptogenic]]
* [[Gamma-Hydroxybutyric acid]]
*[[Gamma-Hydroxybutyric acid]]
* [[Gastroesophageal reflux]]
*[[Gastroesophageal reflux]]
* [[Gemeprost]]
*[[Gemeprost]]
* [[Glatiramer acetate]]
*[[Glatiramer acetate]]
* Glottal edema
*Glottal edema
* [[Goiter]]
*[[Goiter]]
* [[Goodpasture syndrome]]
*[[Goodpasture syndrome]]
* [[Grain handler's lung]]
*[[Grain handler's lung]]
* Gram-negative [[sepsis]]
*Gram-negative [[sepsis]]
* [[Guillain-Barre Syndrome]]
*[[Guillain-Barre Syndrome]]
* [[Hemochlyothorax]]
*[[Hemochlyothorax]]
* [[Hemothorax]]
*[[Hemothorax]]
* [[Histiocytosis X]]
*[[Histiocytosis X]]
* [[Hoose (disease)]]
*[[Hoose (disease)]]
* [[Humidifier lung]]
*[[Humidifier lung]]
* [[Hydrochlyothorax]]
*[[Hydrochlyothorax]]
* [[Hypersensitivity Pneumonitis]]
*[[Hypersensitivity Pneumonitis]]
* [[Hyperthyroidism]]
*[[Hyperthyroidism]]
* [[Hypoxia]]
*[[Hypoxia]]
* [[Hysteria]]
*[[Hysteria]]
* [[Idiopathic pulmonary fibrosis]]
*[[Idiopathic pulmonary fibrosis]]
* [[Iloprost]]
*[[Iloprost]]
* [[Interstitial lung disease]]
*[[Interstitial lung disease]]
* [[Intoxication]] ([[carbon monoxide]], [[cyanide]])
*[[Intoxication]] ([[carbon monoxide]], [[cyanide]])
* Intrapulmonary receptor stimulation
*Intrapulmonary receptor stimulation
* [[Intussusception (medical disorder)]]
*[[Intussusception (medical disorder)]]
* [[Iron deficiency anemia]]
*[[Iron deficiency anemia]]
* [[Irregular Heart Rhythms]]
*[[Irregular Heart Rhythms]]
* [[Ketorolac]]
*[[Ketorolac]]
* [[Kyphoscoliosis]]
*[[Kyphoscoliosis]]
* [[Laryngeal]]/[[bronchospasm]]
*[[Laryngeal]]/[[bronchospasm]]
* [[Leukemia]]
*[[Leukemia]]
* [[Lung cancer]]
*[[Lung cancer]]
* [[Lymphangitic metastases]]
*[[Lymphangitic metastases]]
* [[Lymphocytic interstitial pneumonia]]
*[[Lymphocytic interstitial pneumonia]]
* [[Lymphoma]]
*[[Lymphoma]]
* [[Malignant Mesothelioma]]
*[[Malignant Mesothelioma]]
* [[Malt worker's lung]]
*[[Malt worker's lung]]
* [[Mediastinal tumors]]
*[[Mediastinal tumors]]
* [[Megaloblastic Anemias]]
*[[Megaloblastic Anemias]]
* [[Mercury (element)]]
*[[Mercury (element)]]
* [[Metabolic acidosis]]
*[[Metabolic acidosis]]
* [[Methyl isocyanate]]
*[[Methyl isocyanate]]
* [[Micropolyspora faeni]]
*[[Micropolyspora faeni]]
* [[Miliary tuberculosis]]
*[[Miliary tuberculosis]]
* [[Mollusk shell hypersensitivity]]
*[[Mollusk shell hypersensitivity]]
* [[Mucor stolonifer]]
*[[Mucor stolonifer]]
* Multiple [[rib fractures]]
*Multiple [[rib fractures]]
* [[Myasthenia Gravis]]
*[[Myasthenia Gravis]]
* [[Myxoma]]
*[[Myxoma]]
* [[Neuromuscular disease]]
*[[Neuromuscular disease]]
* [[Obesity]]
*[[Obesity]]
* [[Phrenic nerve paralysis]]
*[[Phrenic nerve paralysis]]
* Pleural callosity
*Pleural callosity
* [[Pneumoconiosis]]
*[[Pneumoconiosis]]
* [[Pneumonia]]
*[[Pneumonia]]
* [[Pneumochlyothorax]]
*[[Pneumochlyothorax]]
* [[Pneumothorax]]
*[[Pneumothorax]]
* [[Pleural Effusion]]
*[[Pleural Effusion]]
* Pleural fibrosis
*Pleural fibrosis
* [[Polyradiculitis]]
*[[Polyradiculitis]]
* Pulmonary [[arteriovenous malformation]]
*Pulmonary [[arteriovenous malformation]]
* [[Pulmonary Emphysema]]
*[[Pulmonary Emphysema]]
* [[Pulmonary fibrosis]]
*[[Pulmonary fibrosis]]
* [[Quincke's Edema]]
*[[Quincke's Edema]]
* [[Radiation]] pneumonitis
*[[Radiation]] pneumonitis
* [[Respiratory tract infection]]
*[[Respiratory tract infection]]
* [[Sarcoidosis]]
*[[Sarcoidosis]]
* [[Shock]]
*[[Shock]]
* [[Shock lung]]
*[[Shock lung]]
* [[Sleep Apnea Syndrome]]
*[[Sleep Apnea Syndrome]]
* [[Trauma]]
*[[Trauma]]
* [[Tracheal stenosis]]
*[[Tracheal stenosis]]
* [[Tracheal tumors]]
*[[Tracheal tumors]]
* [[Tracheomalacia]]
*[[Tracheomalacia]]
* [[Tracheobronchial collapse]]
*[[Tracheobronchial collapse]]
* [[Uremia]]
*[[Uremia]]


===Other Causes of Fatigue===
===Other Causes of Fatigue===
Line 312: Line 579:
Other non cardiac causes of [[pedal edema]] are listed below.  Obviously, the majority of these disorders do not also cause dyspnea and fatigue, and that distinguishes them form heart failure.
Other non cardiac causes of [[pedal edema]] are listed below.  Obviously, the majority of these disorders do not also cause dyspnea and fatigue, and that distinguishes them form heart failure.


* [[ACE inhibitor]]
*[[ACE inhibitor]]
* [[Aceon]]
*[[Aceon]]
* [[Acquired C1-esterase inhibitor deficiency]]
*[[Acquired C1-esterase inhibitor deficiency]]
* [[Actos]]
*[[Actos]]
* [[Acute glomerulonephritis]]
*[[Acute glomerulonephritis]]
* [[Addison's Disease]]
*[[Addison's Disease]]
* [[Aldomet]]
*[[Aldomet]]
* [[Amlodipine]]
*[[Amlodipine]]
* Amniotic band
*Amniotic band
* [[Angioneurotic edema]]
*[[Angioneurotic edema]]
* [[Angiotensin converting enzyme inhibitor]]
*[[Angiotensin converting enzyme inhibitor]]
* [[Anemia]]
*[[Anemia]]
* [[Anorexia Nervosa]]
*[[Anorexia Nervosa]]
* [[AV fistula]]
*[[AV fistula]]
* [[Avandia]]
*[[Avandia]]
* [[Bartter's Syndrome]]
*[[Bartter's Syndrome]]
* [[Beta blockers]]
*[[Beta blockers]]
* [[Boils]]
*[[Boils]]
* [[Bruise]]
*[[Bruise]]
* [[Bulimia Nervosa]]
*[[Bulimia Nervosa]]
* [[Burn]]
*[[Burn]]
* [[Cachexia]]
*[[Cachexia]]
* [[Carbuncle]]
*[[Carbuncle]]
* [[Cardura]]
*[[Cardura]]
* [[Cellulitis]]
*[[Cellulitis]]
* [[Chemotherapy]]
*[[Chemotherapy]]
* [[Cisplatin]]
*[[Cisplatin]]
* Cold (physical stimuli)
*Cold (physical stimuli)
* [[Contact dermatitis]]
*[[Contact dermatitis]]
* [[Contusion]]
*[[Contusion]]
* [[Cushing's Syndrome]]
*[[Cushing's Syndrome]]
* [[Diltiazem]]
*[[Diltiazem]]
* [[Drugs]]
*[[Drugs]]
* [[Docetax]]
*[[Docetax]]
* [[Erysipelas]]
*[[Erysipelas]]
* [[Exudative enteropathy]]
*[[Exudative enteropathy]]
* [[Filariasis]]
*[[Filariasis]]
* [[Fracture]]
*[[Fracture]]
* [[Frostbite]]
*[[Frostbite]]
* [[Gas gangrene]]
*[[Gas gangrene]]
* [[Glitazones]]
*[[Glitazones]]
* [[Gout]]
*[[Gout]]
* [[Hyperthyroidism]]
*[[Hyperthyroidism]]
* [[Hypoalbuminemia]]
*[[Hypoalbuminemia]]
* [[Hypoplasia]]
*[[Hypoplasia]]
* [[Hypothyroidism]]
*[[Hypothyroidism]]
* [[Ibuprophen]]
*[[Ibuprophen]]
* Idiopathic edema
*Idiopathic edema
* [[Insect bite]]
*[[Insect bite]]
* [[Irritant]]
*[[Irritant]]
* Ligamentous sprain
*Ligamentous sprain
* [[Liver failure]]
*[[Liver failure]]
* [[Lymph node]] mass
*[[Lymph node]] mass
* [[Malabsorption]]
*[[Malabsorption]]
* [[Malnutrition]]
*[[Malnutrition]]
* Mediastinal cancer
*Mediastinal cancer
* [[Milroy's Disease]]
*[[Milroy's Disease]]
* [[Minipress]]
*[[Minipress]]
* [[Motrin]]
*[[Motrin]]
* Musculoskeletal [[trauma]]
*Musculoskeletal [[trauma]]
* [[Neoplasm]]
*[[Neoplasm]]
* [[Nephrotic Syndrome]]
*[[Nephrotic Syndrome]]
* [[ Nifedipine]]
*[[ Nifedipine]]
* [[Norvasc]]
*[[Norvasc]]
* [[Osteomyelitis]]
*[[Osteomyelitis]]
* Peripheral nerve lesion
*Peripheral nerve lesion
* [[Premenstrual]] edema
*[[Premenstrual]] edema
* [[Scleroderma]]
*[[Scleroderma]]
*[[Sepsis syndrome]]
*[[Sepsis syndrome]]
* [[Snakebites]]
*[[Snakebites]]
* [[Starvation]] [[edema]]
*[[Starvation]] [[edema]]
* [[Sunburn]]
*[[Sunburn]]
* Surgical excision
*Surgical excision
* [[Tendon]]ous strain
*[[Tendon]]ous strain
* [[Thrombophlebitis]]
*[[Thrombophlebitis]]
* [[Thrombosis]]
*[[Thrombosis]]
* Tight clothing
*Tight clothing
* [[Trentinion]]
*[[Trentinion]]
* [[Trichinosis]]
*[[Trichinosis]]
* [[Tumor]]s
*[[Tumor]]s
* [[Univasc]]
*[[Univasc]]
* [[Valproic acid]]
*[[Valproic acid]]
* [[Varicose veins]]
*[[Varicose veins]]
* [[Vesinoid]]
*[[Vesinoid]]
* [[vytorin]]
*[[vytorin]]


==References==
==References==
{{Reflist|2}}
{{Reflist|2}}
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{{WikiDoc Sources}}


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[[Category:Up-To-Date cardiology]]
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Latest revision as of 14:10, 8 September 2020
Resident
Survival
Guide

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1];Associate Editor(s)-in-Chief: Seyedmahdi Pahlavani, M.D. [2]Syed Hassan A. Kazmi BSc, MD [3]

Overview

Congestive heart failure should be distinguished from other conditions that cause dyspnea, fatigue and edema.

Differentiating Congestive Heart Failure from other Diseases

Heart failure is a clinical syndrome of dyspnea, fatigue and edema. There are several disorders that cause heart failure and should not be confused with the syndrome of heart failure.


Organ System Disease Symptoms Signs Laboratory findings Diagnostic modality Management
Cardiac HFpEF (Heart Failure with preserved Ejection Fraction Exertional dyspnea, reduced exercise tolerance, orthopnea, paroxysmal nocturnal dyspnea, edema Elevated JVP, fine crackles, edema Increased BNP Echocardiography (EF ≥ 50 %) Control of volume overload and hypertension,

treatment of underlying condition (obesity, AF, coronary artery disease, anemia)

HFrEF (Heart Failure with reduced Ejection Fraction) Exertional dyspnea, reduced exercise tolerance, orthopnea, paroxysmal nocturnal dyspnea, edema Elevated JVP, fine crackles, edema Increased BNP Echocardiography (EF ≤ 40 %) Diuretics, ACE inhibitors, ARBs, beta blockers, nitrates
Pericardial disease Exercise intolerance, dyspnea, fatigue Elevated JVP, pericardial knock, kussmaul's sign, pulsus paradoxus - Echocardiography, ECG Diuretics, pericardiectomy
Hypertrophic cardiomyopathy Dyspnea, chest pain, palpitation, lightheadedness Systolic murmur - Echocardiography, ECG Beta blockers, verapamil
Valvular disease (MR, TR) Edema, fatigue, exercise intolerance, dyspnea, lightheadedness Cardiac murmur - Echocardiography, ECG Valve repair or replacement, diuretics, beta blockers
Arrhythmia Palpitation, lightheadedness, chest tightness Tachycardia, abnormal pulse - Echocardiography, ECG, holter monitoring Pharmacological cardioversion (anti arrhythmics), electrical cardioversion, ablation
Pulmonary Chronic airway disease Cough, dyspnea, chest pain, exercise intolerance Tachypnea, respiratory distress, cyanosis, edema, rhonchi and crackles Hypoxemia, hypercapnea, polycythemia, PFT, chest imaging Bronchodilators, corticosteroids, anticholinergics
Interstitial lung diseaee Exercise intolerance, cough Crackles, clubbing, cyanosis Hypoxemia PFT, Chest imaging, lung biopsy Corticosteroids, bronchodilators
Pulmonary hypertension Dyspnea, fatigue, chest pain, syncope, palpitation Edema, clubbing, elevated JVP, TR murmur Elevated BNP, elevated d-dimer Echocardiography, cardiac cathaterization Diuretics, calcium channel blockers, endothelin receptor antagonist, phosphodiesterase 5 inhibitor
Sleep apnea Snoring, somnolence, headache, fatigue, irritability tachypnea, hypertension, tachycardia Hypoxemia, polycythemia Polysomnography Weight reduction, CPAP
High output status Anemia Palpitation, lightheadedness, fatigue Cheilosis, delayed capillary refill Decreased Hb and HCT CBC, Iron study, bone marrow aspiration and biopsy Iron replacement, nutritional support
Thyrotoxicosis Palpitation, sweating, weight loss Proptosis, tachycardia Decreased TSH, increased T3,T4 Thyroid function test Thyrostatics, beta blockers, ablation
Others Liver disease Fatigue, edema, jaundice Ascites, palmar erythema, gynecomastia Increased AST and ALT, decreased albumin, increased Br Liver function test, Liver biopsy Diuretics, treatment of underlying disease
Chronic kidney disease Fatigue, anorexia, nausea, edema, decreased exercise tolerance Edema, hypertension, crackles Increased BUN and Cr BUN, Cr Control of blood pressure, anemia, dialysis, kidney transplant


Other Causes of Dyspnea

CHF should be differentiated from other diseases presenting with shortness of breath and tachypnea. The differentials include the following:[1][2][3][4][5][6][7][8][9][10][11][12][13][14][15][16][17][18][19][20]

Diseases Diagnostic tests Physical Examination Symptoms Past medical history Other Findings
CT scan and MRI EKG Chest X-ray Tachypnea Tachycardia Fever Chest Pain Hemoptysis Dyspnea on Exertion Wheezing Chest Tenderness Nasalopharyngeal Ulceration Carotid Bruit
Pulmonary embolism
  • On CT angiography:
    • Intra-luminal filling defect
  • On MRI:
    • Narrowing of involved vessel
    • No contrast seen distal to obstruction
    • Polo-mint sign (partial filling defect surrounded by contrast)
 ✔ ✔ ✔ (Low grade) ✔ ✔ (In case of massive PE) ✔ - - - -
Congestive heart failure
  • Goldberg's criteria may aid in diagnosis of left ventricular dysfunction: (High specificity)
    • SV1 or SV2 + RV5 or RV6 ≥3.5 mV
    • Total QRS amplitude in each of the limb leads ≤0.8 mV
    • R/S ratio <1 in lead V4
 ✔ ✔ ✔ - - ✔ - - - -
Percarditis
  • ST elevation
  • PR depression
  • Large collection of fluid inside the pericardial sac (pericardial effusion)
  • Calcification of pericardial sac
 ✔ ✔ ✔ (Low grade) ✔ (Relieved by sitting up and leaning forward) - ✔ - - - -
  • May be clinically classified into:
    • Acute (< 6 weeks)
    • Sub-acute (6 weeks - 6 months)
    • Chronic (> 6 months)
Pneumonia ✔ ✔ ✔ ✔ - ✔ ✔ - - -
Vasculitis

Homogeneous, circumferential vessel wall swelling

✔ ✔ ✔ ✔ ✔ ✔ - ✔ ✔ ✔
Chronic obstructive pulmonary disease (COPD)
  • On CT scan:
  • On MRI:
    • Increased diameter of pulmonary arteries
    • Peripheral pulmonary vasculature attentuation
    • Loss of retrosternal airspace due to right ventricular enlargement
    • Hyperpolarized Helium MRI may show progressively poor ventilation and destruction of lung
 ✔ ✔ - - - ✔ ✔ - - -
COVID-19-associated heart failure ✔ ✔ - - ✔ ✔ - - - - -
Other Conditions that Cause Dyspnea that are Emergencies

The following emergency conditions should be excluded when diagnosing a patient with heart failure:

Non Cardiac Causes of Dyspnea

Other Causes of Fatigue

There are numerous non-cardiac causes of fatigue. Again, these non-cardiac causes are not associated with dyspnea and edema.

Other Causes of Edema

Other non cardiac causes of pedal edema are listed below. Obviously, the majority of these disorders do not also cause dyspnea and fatigue, and that distinguishes them form heart failure.

References

  1. ↑ Brenes-Salazar JA (2014). "Westermark's and Palla's signs in acute and chronic pulmonary embolism: Still valid in the current computed tomography era". J Emerg Trauma Shock. 7 (1): 57–8. doi:10.4103/0974-2700.125645. PMC 3912657. PMID 24550636.
  2. ↑ "CT Angiography of Pulmonary Embolism: Diagnostic Criteria and Causes of Misdiagnosis | RadioGraphics".
  3. ↑ Bĕlohlávek J, Dytrych V, Linhart A (2013). "Pulmonary embolism, part I: Epidemiology, risk factors and risk stratification, pathophysiology, clinical presentation, diagnosis and nonthrombotic pulmonary embolism". Exp Clin Cardiol. 18 (2): 129–38. PMC 3718593. PMID 23940438.
  4. ↑ "Pulmonary Embolism: Symptoms - National Library of Medicine - PubMed Health".
  5. ↑ Ramani GV, Uber PA, Mehra MR (2010). "Chronic heart failure: contemporary diagnosis and management". Mayo Clin. Proc. 85 (2): 180–95. doi:10.4065/mcp.2009.0494. PMC 2813829. PMID 20118395.
  6. ↑ Blinderman CD, Homel P, Billings JA, Portenoy RK, Tennstedt SL (2008). "Symptom distress and quality of life in patients with advanced congestive heart failure". J Pain Symptom Manage. 35 (6): 594–603. doi:10.1016/j.jpainsymman.2007.06.007. PMC 2662445. PMID 18215495.
  7. ↑ Hawkins NM, Petrie MC, Jhund PS, Chalmers GW, Dunn FG, McMurray JJ (2009). "Heart failure and chronic obstructive pulmonary disease: diagnostic pitfalls and epidemiology". Eur. J. Heart Fail. 11 (2): 130–9. doi:10.1093/eurjhf/hfn013. PMC 2639415. PMID 19168510.
  8. ↑ Takasugi JE, Godwin JD (1998). "Radiology of chronic obstructive pulmonary disease". Radiol. Clin. North Am. 36 (1): 29–55. PMID 9465867.
  9. ↑ Wedzicha JA, Donaldson GC (2003). "Exacerbations of chronic obstructive pulmonary disease". Respir Care. 48 (12): 1204–13, discussion 1213–5. PMID 14651761.
  10. ↑ Nakawah MO, Hawkins C, Barbandi F (2013). "Asthma, chronic obstructive pulmonary disease (COPD), and the overlap syndrome". J Am Board Fam Med. 26 (4): 470–7. doi:10.3122/jabfm.2013.04.120256. PMID 23833163.
  11. ↑ Khandaker MH, Espinosa RE, Nishimura RA, Sinak LJ, Hayes SN, Melduni RM, Oh JK (2010). "Pericardial disease: diagnosis and management". Mayo Clin. Proc. 85 (6): 572–93. doi:10.4065/mcp.2010.0046. PMC 2878263. PMID 20511488.
  12. ↑ Bogaert J, Francone M (2013). "Pericardial disease: value of CT and MR imaging". Radiology. 267 (2): 340–56. doi:10.1148/radiol.13121059. PMID 23610095.
  13. ↑ Gharib AM, Stern EJ (2001). "Radiology of pneumonia". Med. Clin. North Am. 85 (6): 1461–91, x. PMID 11680112.
  14. ↑ Schmidt WA (2013). "Imaging in vasculitis". Best Pract Res Clin Rheumatol. 27 (1): 107–18. doi:10.1016/j.berh.2013.01.001. PMID 23507061.
  15. ↑ Suresh E (2006). "Diagnostic approach to patients with suspected vasculitis". Postgrad Med J. 82 (970): 483–8. doi:10.1136/pgmj.2005.042648. PMC 2585712. PMID 16891436.
  16. ↑ Stein PD, Dalen JE, McIntyre KM, Sasahara AA, Wenger NK, Willis PW (1975). "The electrocardiogram in acute pulmonary embolism". Prog Cardiovasc Dis. 17 (4): 247–57. PMID 123074.
  17. ↑ Warnier MJ, Rutten FH, Numans ME, Kors JA, Tan HL, de Boer A, Hoes AW, De Bruin ML (2013). "Electrocardiographic characteristics of patients with chronic obstructive pulmonary disease". COPD. 10 (1): 62–71. doi:10.3109/15412555.2012.727918. PMID 23413894.
  18. ↑ Stein PD, Matta F, Ekkah M, Saleh T, Janjua M, Patel YR, Khadra H (2012). "Electrocardiogram in pneumonia". Am. J. Cardiol. 110 (12): 1836–40. doi:10.1016/j.amjcard.2012.08.019. PMID 23000104.
  19. ↑ Hazebroek MR, Kemna MJ, Schalla S, Sanders-van Wijk S, Gerretsen SC, Dennert R, Merken J, Kuznetsova T, Staessen JA, Brunner-La Rocca HP, van Paassen P, Cohen Tervaert JW, Heymans S (2015). "Prevalence and prognostic relevance of cardiac involvement in ANCA-associated vasculitis: eosinophilic granulomatosis with polyangiitis and granulomatosis with polyangiitis". Int. J. Cardiol. 199: 170–9. doi:10.1016/j.ijcard.2015.06.087. PMID 26209947.
  20. ↑ Dennert RM, van Paassen P, Schalla S, Kuznetsova T, Alzand BS, Staessen JA, Velthuis S, Crijns HJ, Tervaert JW, Heymans S (2010). "Cardiac involvement in Churg-Strauss syndrome". Arthritis Rheum. 62 (2): 627–34. doi:10.1002/art.27263. PMID 20112390.

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