Diastolic dysfunction history and symptoms: Difference between revisions
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{{Diastolic dysfunction}} | {{Diastolic dysfunction}} | ||
{{CMG}} | {{CMG}}; '''Associate Editor(s)-in-Chief:''' [[User: Shankar Kumar |Shankar Kumar, M.B.B.S.]] [mailto:kumarshankar@wikidoc.org] | ||
==Overview== | ==Overview== | ||
The classic symptoms of heart failure include [[dyspnea]], [[fatigue]], and [[fluid retention]]. Patients with heart failure present in different ways. Some patients present with [[exercise intolerance]] but show little evidence of [[congestion]] or [[edema]]. Other patients present with mild symptoms of [[edema]] and [[pulmonary congestion]]. | The classic symptoms of heart failure include [[dyspnea]], [[fatigue]], and [[fluid retention]]. Patients with diastolic heart failure may present in different ways. Some patients present with [[exercise intolerance]] but show little evidence of [[congestion]] or [[edema]]. Other patients present with mild symptoms of [[edema]] and [[pulmonary congestion]]. | ||
==History and Symptoms== | |||
The clinical manifestations of diastolic heart failure are as follows- | ==History== | ||
The onset, duration and progression of dyspnea and NYHA grading (see below) should be ascertained. A history of co-morbid conditions like diabetes and hypertension must also be ascertained to guide medical therapy. | |||
==Common Symptoms== | |||
The clinical manifestations of diastolic [[heart failure]] are as follows- | |||
* [[Dyspnea|Dyspnea on ordinary exertion]] or greater shortness of breath with usual activities | |||
* [[Paroxysmal nocturnal dyspnea]] or awakening at night with shortness of breath | |||
* [[Ankle edema]] or [[swelling of the feet]] and legs | * [[Ankle edema]] or [[swelling of the feet]] and legs | ||
* [[ | * [[Orthopnea]] or [[sleeping on pillows]] | ||
* [[Hemoptysis]] or frothy sputum | |||
==Less Common Symptoms== | |||
* [[Fainting]] | * [[Fainting]] | ||
* [[Fatigue]] | * [[Fatigue]] | ||
* [[Syncope]] or [[passing out]] | * [[Syncope]] or [[passing out]] | ||
* [[ | * Life threatening flash [[pulmonary edema]]<ref name="pmid18794390">{{cite journal| author=Zile MR, Bennett TD, St John Sutton M, Cho YK, Adamson PB, Aaron MF et al.| title=Transition from chronic compensated to acute decompensated heart failure: pathophysiological insights obtained from continuous monitoring of intracardiac pressures. | journal=Circulation | year= 2008 | volume= 118 | issue= 14 | pages= 1433-41 | pmid=18794390 | doi=10.1161/CIRCULATIONAHA.108.783910 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=18794390 }} </ref>. | ||
In a cross sectional survey of 2042 randomly selected residents of Olmstead County, Minnesota, diastolic dysfunction was often not accompanied by recognized CHF but was associated with marked increases in all-cause mortality. Thus, possibility of asymptomatic diastolic heart failure should also be kept in mind.<ref name="pmid12517230">{{cite journal| author=Redfield MM, Jacobsen SJ, Burnett JC, Mahoney DW, Bailey KR, Rodeheffer RJ| title=Burden of systolic and diastolic ventricular dysfunction in the community: appreciating the scope of the heart failure epidemic. | journal=JAMA | year= 2003 | volume= 289 | issue= 2 | pages= 194-202 | pmid=12517230 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=12517230 }} [http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=12954043 Review in: ACP J Club. 2003 Sep-Oct;139(2):51] </ref>. | |||
The manifestations of overt systolic and diastolic heart failure | The manifestations of overt systolic and diastolic heart failure are similar. Patients with diastolic dysfunction may have an exacerbation of their symptoms in the following settings: | ||
* [[Tachycardia]], increased heart rate would hamper proper and complete filling of left ventricle. | * [[Tachycardia]], increased heart rate would hamper proper and complete filling of left ventricle. | ||
* [[Hypertension]], especially if it is acute in onset or refractory to treatment increases the stress on the walls of the ventricle, which in turn leads to [[hypertrophy]] and impaired filling. | * [[Hypertension]], especially if it is acute in onset or refractory to treatment increases the stress on the walls of the ventricle, which in turn leads to [[hypertrophy]] and impaired filling. | ||
| Line 26: | Line 31: | ||
* Acute ischemia, leads to diastolic dysfunction which increases left atrial pressure and causes [[pulmonary edema]]. | * Acute ischemia, leads to diastolic dysfunction which increases left atrial pressure and causes [[pulmonary edema]]. | ||
== | ==New York Heart Association Criteria (NYHA)== | ||
The following criteria are often used to gauge the severity of heart failure: | |||
*'''[[New york heart association functional classification#New York Heart Association Functional Classification (NYHA)|NYHA I]]:''' No symptoms with ordinary activity. | |||
*'''[[New york heart association functional classification#New York Heart Association Functional Classification (NYHA)|NYHA II]]:''' Slight limitation of physical activity. Comfortable at rest, but ordinary physical activity results in [[fatigue]], [[palpitation]], [[dyspnea]], or [[angina]]. | |||
*'''[[New york heart association functional classification#New York Heart Association Functional Classification (NYHA)|NYHA III]]:''' Marked limitation of physical activity. Comfortable at rest, but less than ordinary physical activity results in [[fatigue]], [[palpitation]], [[dyspnea]], or [[chest pain|anginal pain]]. | |||
*'''[[New york heart association functional classification#New York Heart Association Functional Classification (NYHA)|NYHA IV]]:''' Unable to carry out any physical activity without discomfort. Symptoms of cardiac insufficiency present at rest. | |||
==ACC/AHA 2005 Guidelines for the Diagnosis and Management of Chronic Heart Failure in the Adult<ref name="Hunt"> Hunt SA, Abraham WT, Chin MH, Feldman AM, Francis GS, Ganiats TG, Jessup M, Konstam MA, Mancini DM, Michl K, Oates JA, Rahko PS, Silver MA, Stevenson LW, Yancy CW, Antman EM, Smith SC Jr, Adams CD, Anderson JL, Faxon DP, Fuster V, Halperin JL, Hiratzka LF, Jacobs AK, Nishimura R, Ornato JP, Page RL, Riegel B; American College of Cardiology; American Heart Association Task Force on Practice Guidelines; American College of Chest Physicians; International Society for Heart and Lung Transplantation; Heart Rhythm Society. ACC/AHA 2005 Guideline Update for the Diagnosis and Management of Chronic Heart Failure in the Adult: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Writing Committee to Update the 2001 Guidelines for the Evaluation and Management of Heart Failure): developed in collaboration with the American College of Chest Physicians and the International Society for Heart and Lung Transplantation: endorsed by the Heart Rhythm Society. Circulation. 2005 Sep 20; 112(12): e154-235. Epub 2005 Sep 13. PMID 16160202</ref><ref name="pmid19324967">Jessup M, Abraham WT, Casey DE, Feldman AM, Francis GS, Ganiats TG et al. (2009) [http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=19324967 2009 focused update: ACCF/AHA Guidelines for the Diagnosis and Management of Heart Failure in Adults: a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines: developed in collaboration with the International Society for Heart and Lung Transplantation.] ''Circulation'' 119 (14):1977-2016. [http://dx.doi.org/10.1161/CIRCULATIONAHA.109.192064 DOI:10.1161/CIRCULATIONAHA.109.192064] PMID: [http://pubmed.gov/19324967 19324967]</ref> (DO NOT EDIT)== | |||
===Initial Clinical Assessment Recommendation=== | |||
{|class="wikitable" | |||
|- | |||
| colspan="1" style="text-align:center; background:LightGreen"|[[ACC AHA guidelines classification scheme#Classification of Recommendations|Class I]] | |||
|- | |||
| bgcolor="LightGreen"|<nowiki>"</nowiki>'''1.''' A thorough history and [[Congestive heart failure physical examination|physical examination]] should be obtained/performed in patients presenting with [[heart failure]] to identify cardiac and noncardiac disorders or behaviors that might cause or accelerate the development or progression of [[heart failure]]. ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: C]])'' <nowiki>"</nowiki> | |||
|- | |||
| bgcolor="LightGreen"|<nowiki>"</nowiki>'''2.''' A careful history of current and past use of [[alcohol]], illicit drugs, current or past standard or ''alternative therapies,'' and [[chemotherapy]] drugs should be obtained from patients presenting with [[heart failure]]. ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: C]])'' <nowiki>"</nowiki> | |||
|} | |||
===Serial Clinical Assessment Recommendation=== | |||
{|class="wikitable" | |||
|- | |||
| colspan="1" style="text-align:center; background:LightGreen"|[[ACC AHA guidelines classification scheme#Classification of Recommendations|Class I]] | |||
|- | |||
| bgcolor="LightGreen"|<nowiki>"</nowiki>'''1.''' Careful history of current use of [[alcohol]], [[tobacco]], illicit drugs, ''alternative therapies,'' and [[chemotherapy]] drugs, as well as diet and [[sodium]] intake, should be obtained at each visit of a patient with [[heart failure]]. ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: C]])'' <nowiki>"</nowiki> | |||
|} | |||
==References== | ==References== | ||
{{reflist|2}} | {{reflist|2}} | ||
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[[Category:Disease]] | [[Category:Disease]] | ||
[[Category:Cardiology]] | [[Category:Cardiology]] | ||
[[Categor:Best pages]] | |||
[[Category:Up-To-Date cardiology]] | |||
[[Category:Up-To-Date]] | |||
Latest revision as of 12:06, 30 January 2013
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Shankar Kumar, M.B.B.S. [2]
Overview
The classic symptoms of heart failure include dyspnea, fatigue, and fluid retention. Patients with diastolic heart failure may present in different ways. Some patients present with exercise intolerance but show little evidence of congestion or edema. Other patients present with mild symptoms of edema and pulmonary congestion.
History
The onset, duration and progression of dyspnea and NYHA grading (see below) should be ascertained. A history of co-morbid conditions like diabetes and hypertension must also be ascertained to guide medical therapy.
Common Symptoms
The clinical manifestations of diastolic heart failure are as follows-
- Dyspnea on ordinary exertion or greater shortness of breath with usual activities
- Paroxysmal nocturnal dyspnea or awakening at night with shortness of breath
- Ankle edema or swelling of the feet and legs
- Orthopnea or sleeping on pillows
- Hemoptysis or frothy sputum
Less Common Symptoms
- Fainting
- Fatigue
- Syncope or passing out
- Life threatening flash pulmonary edema[1].
In a cross sectional survey of 2042 randomly selected residents of Olmstead County, Minnesota, diastolic dysfunction was often not accompanied by recognized CHF but was associated with marked increases in all-cause mortality. Thus, possibility of asymptomatic diastolic heart failure should also be kept in mind.[2].
The manifestations of overt systolic and diastolic heart failure are similar. Patients with diastolic dysfunction may have an exacerbation of their symptoms in the following settings:
- Tachycardia, increased heart rate would hamper proper and complete filling of left ventricle.
- Hypertension, especially if it is acute in onset or refractory to treatment increases the stress on the walls of the ventricle, which in turn leads to hypertrophy and impaired filling.
- Atrial fibrillation leads to poor coordination between atrial and ventricular contraction and contributes to further reduction in filling.
- Acute ischemia, leads to diastolic dysfunction which increases left atrial pressure and causes pulmonary edema.
New York Heart Association Criteria (NYHA)
The following criteria are often used to gauge the severity of heart failure:
- NYHA I: No symptoms with ordinary activity.
- NYHA II: Slight limitation of physical activity. Comfortable at rest, but ordinary physical activity results in fatigue, palpitation, dyspnea, or angina.
- NYHA III: Marked limitation of physical activity. Comfortable at rest, but less than ordinary physical activity results in fatigue, palpitation, dyspnea, or anginal pain.
- NYHA IV: Unable to carry out any physical activity without discomfort. Symptoms of cardiac insufficiency present at rest.
ACC/AHA 2005 Guidelines for the Diagnosis and Management of Chronic Heart Failure in the Adult[3][4] (DO NOT EDIT)
Initial Clinical Assessment Recommendation
| Class I |
| "1. A thorough history and physical examination should be obtained/performed in patients presenting with heart failure to identify cardiac and noncardiac disorders or behaviors that might cause or accelerate the development or progression of heart failure. (Level of Evidence: C) " |
| "2. A careful history of current and past use of alcohol, illicit drugs, current or past standard or alternative therapies, and chemotherapy drugs should be obtained from patients presenting with heart failure. (Level of Evidence: C) " |
Serial Clinical Assessment Recommendation
| Class I |
| "1. Careful history of current use of alcohol, tobacco, illicit drugs, alternative therapies, and chemotherapy drugs, as well as diet and sodium intake, should be obtained at each visit of a patient with heart failure. (Level of Evidence: C) " |
References
- ↑ Zile MR, Bennett TD, St John Sutton M, Cho YK, Adamson PB, Aaron MF; et al. (2008). "Transition from chronic compensated to acute decompensated heart failure: pathophysiological insights obtained from continuous monitoring of intracardiac pressures". Circulation. 118 (14): 1433–41. doi:10.1161/CIRCULATIONAHA.108.783910. PMID 18794390.
- ↑ Redfield MM, Jacobsen SJ, Burnett JC, Mahoney DW, Bailey KR, Rodeheffer RJ (2003). "Burden of systolic and diastolic ventricular dysfunction in the community: appreciating the scope of the heart failure epidemic". JAMA. 289 (2): 194–202. PMID 12517230. Review in: ACP J Club. 2003 Sep-Oct;139(2):51
- ↑ Hunt SA, Abraham WT, Chin MH, Feldman AM, Francis GS, Ganiats TG, Jessup M, Konstam MA, Mancini DM, Michl K, Oates JA, Rahko PS, Silver MA, Stevenson LW, Yancy CW, Antman EM, Smith SC Jr, Adams CD, Anderson JL, Faxon DP, Fuster V, Halperin JL, Hiratzka LF, Jacobs AK, Nishimura R, Ornato JP, Page RL, Riegel B; American College of Cardiology; American Heart Association Task Force on Practice Guidelines; American College of Chest Physicians; International Society for Heart and Lung Transplantation; Heart Rhythm Society. ACC/AHA 2005 Guideline Update for the Diagnosis and Management of Chronic Heart Failure in the Adult: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Writing Committee to Update the 2001 Guidelines for the Evaluation and Management of Heart Failure): developed in collaboration with the American College of Chest Physicians and the International Society for Heart and Lung Transplantation: endorsed by the Heart Rhythm Society. Circulation. 2005 Sep 20; 112(12): e154-235. Epub 2005 Sep 13. PMID 16160202
- ↑ Jessup M, Abraham WT, Casey DE, Feldman AM, Francis GS, Ganiats TG et al. (2009) 2009 focused update: ACCF/AHA Guidelines for the Diagnosis and Management of Heart Failure in Adults: a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines: developed in collaboration with the International Society for Heart and Lung Transplantation. Circulation 119 (14):1977-2016. DOI:10.1161/CIRCULATIONAHA.109.192064 PMID: 19324967