Congestive heart failure history and symptoms: Difference between revisions

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| [[Heart failure resident survival guide|'''Resident'''<br>'''Survival'''<br>'''Guide''']]
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{{Congestive heart failure}}
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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 [[ejection fraction]] is usually below 35% in patients who are symptomatic with systolic heart failure.
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 [[ejection fraction]] is usually below 35% in patients who are symptomatic with systolic heart failure.


==Symptoms of Congestive Heart Failure==
==Symptoms==
* [[Ankle edema]] or [[swelling of the feet]] and legs
* Table bellow shows [[Symptoms]] and [[sign]]s of [[heart failure]]:
* [[Claudication]] or [[pain with walking]]
{| style="border: 2px solid #4479BA; align="left"
* [[Confusion]] and [[altered mentation]]  
! style="width: 200px; background: #4479BA;" | {{fontcolor|#FFF|Typical symptoms}}
* [[Cool extremities]] or [[cold and clammy hands]]
! style="width: 300px; background: #4479BA;" | {{fontcolor|#FFF|More specific signs}}
* [[Cyanosis]] or [[bluish color to the skin]]
|-
* [[Dizziness]]
| style="padding: 0 5px; background: #F5F5F5; text-align: left;" | [[Breathlessness]]
* [[Dyspnea|Dyspnea on ordinary exertion]] or greater shortness of breath with usual activities
*[[Orthopnoea]]
* [[Fainting]]
*[[Paroxysmal nocturnal dyspnoea]]
* [[Fatigue]]
*Reduced [[exercise tolerance]]
* [[Hemoptysis]] or frothy sputum
*[[Fatigue]]
* [[Nocturia]] or [[urination during the night]]
*[[Tiredness]]
* [[cough|Nocturnal cough]]  
* Increased time to recover after [[exercise]]
* [[Orthopnea]] or [[sleeping on pillows]]
*[[Ankle swelling]]
* [[Palpitation]]s or [[extra heart beats]]
| style="padding: 0 5px; background: #F5F5F5; text-align: left;" | Elevated [[jugular venous pressure]]
* [[Paroxysmal nocturnal dyspnea]] or [[awakening at night with shortness of breath]]
*[[Hepatojugular reflux]]
* [[Shortness of breath]]
*[[Third heart sound]] ([[gallop rhythm]])
* [[Syncope]] or [[passing out]]
*Laterally displaced [[apical impulse]]
* [[Weakness]]
 
* [[Wheezing]] or cardiac asthma
|-
! style="width: 200px; background: #4479BA;" | {{fontcolor|#FFF|Less typical symptoms}}
! style="width: 300px; background: #4479BA;" | {{fontcolor|#FFF|Less specific signs}}
|-
| style="padding: 0 5px; background: #F5F5F5; text-align: left;" | [[Nocturnal cough]]
*[[Wheezing]]
*[[Bloated]] feeling
*Loss of [[appetite]]
*[[Confusion]] (especially in the [[elderly]])
*[[Depression]]
*[[Palpitation]]
*[[Dizziness]]
*[[Syncope]]
*[[Bendopnea]]
| style="padding: 0 5px; background: #F5F5F5; text-align: left;" | [[Weight gain]] (>2 kg/week)
*[[Weight loss]] (in advanced [[HF]])
*Tissue [[wasting]] ([[cachexia]])
*[[Cardiac murmur]]
*[[Peripheral oedema]] ([[ankle]], [[sacral]], [[scrotal]])
*[[Pulmonary crepitations]]
*[[Pleural effusion]]
*[[Tachycardia]]
*[[Irregular pulse]]
*[[Tachypnoea]]
*[[Cheyne-Stokes respiration]]
*[[Hepatomegaly]]
*[[Ascites]]
*[[Cold extremities]]
*[[Oliguria]]
*Narrow [[pulse pressure]]
|-
|}
{|
! colspan="2" style="background: PapayaWhip;" align="center" + |The above table adopted from 2021 ESC Guideline
|-
|}<ref name="pmid34447992">{{cite journal |vauthors=McDonagh TA, Metra M, Adamo M, Gardner RS, Baumbach A, Böhm M, Burri H, Butler J, Čelutkienė J, Chioncel O, Cleland JGF, Coats AJS, Crespo-Leiro MG, Farmakis D, Gilard M, Heymans S, Hoes AW, Jaarsma T, Jankowska EA, Lainscak M, Lam CSP, Lyon AR, McMurray JJV, Mebazaa A, Mindham R, Muneretto C, Francesco Piepoli M, Price S, Rosano GMC, Ruschitzka F, Kathrine Skibelund A |title=2021 ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure |journal=Eur Heart J |volume=42 |issue=36 |pages=3599–3726 |date=September 2021 |pmid=34447992 |doi=10.1093/eurheartj/ehab368 |url=}}</ref>
 


==Symptoms of Left Sided Congestive Heart Failure==
 
 
 
 
 
 
 
 
 
 
===Symptoms of Left Sided Congestive Heart Failure===
The left side pumps blood into the systemic circulation, while the right side pumps blood into the [[pulmonary circulation]]. Although left-sided heart failure will reduce forward [[cardiac output]] to the systemic circulation, the initial symptoms are often due to [[pulmonary congestion]]. In systolic dysfunction, the ejection fraction is decreased, leaving an abnormally elevated volume of blood in the [[left ventricle]]. In [[diastolic dysfunction]], [[left ventricular end-diastolic pressure]] will be high. This increase in volume or pressure backs up to the [[left atrium]] and then into the [[pulmonary vein]]s. Increased volume or pressure in the pulmonary veins impairs the normal drainage of the [[alveoli]] and favors the flow of fluid from the capillaries to the lung parenchyma, causing [[pulmonary edema]]. This impairs gas exchange and results in [[hypoxemia]]. Thus, left-sided heart failure often presents with respiratory symptoms including:
The left side pumps blood into the systemic circulation, while the right side pumps blood into the [[pulmonary circulation]]. Although left-sided heart failure will reduce forward [[cardiac output]] to the systemic circulation, the initial symptoms are often due to [[pulmonary congestion]]. In systolic dysfunction, the ejection fraction is decreased, leaving an abnormally elevated volume of blood in the [[left ventricle]]. In [[diastolic dysfunction]], [[left ventricular end-diastolic pressure]] will be high. This increase in volume or pressure backs up to the [[left atrium]] and then into the [[pulmonary vein]]s. Increased volume or pressure in the pulmonary veins impairs the normal drainage of the [[alveoli]] and favors the flow of fluid from the capillaries to the lung parenchyma, causing [[pulmonary edema]]. This impairs gas exchange and results in [[hypoxemia]]. Thus, left-sided heart failure often presents with respiratory symptoms including:
*[[Dyspnea]]
*[[Dyspnea]]
Line 37: Line 89:
*[[Wheezing]]
*[[Wheezing]]


==New York Heart Association Criteria (NYHA)==
===New York Heart Association Criteria (NYHA)===
The following criteria are often used to gauge the severity of heart failure:
The following criteria are often used to gauge the severity of heart failure:


Line 47: Line 99:


*'''[[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.
*'''[[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.
==2009 ACC/AHA Focused Update and 2005 Guidelines for the Diagnosis and Management of Chronic Heart Failure in the Adult (DO NOT EDIT)<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>==
===Initial Clinical Assessment of Patients Presenting With Heart Failure (DO NOT EDIT)<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>===
{|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 of Patients Presenting With Heart Failure (DO NOT EDIT)<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>===
{|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>
|}
==Vote on and Suggest Revisions to the Current Guidelines==
*[[The Living Guidelines: Diagnosis and Management of Chronic Heart Failure | The CHF Living Guidelines: Vote on current recommendations and suggest revisions to the guidelines]]
==Guidelines Resources==
*[http://circ.ahajournals.org/content/112/12/e154.full.pdf The ACC/AHA 2005 Guideline Update 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>
*[http://content.onlinejacc.org/cgi/reprint/53/15/1343.pdf 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] <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>


==References==
==References==
{{Reflist|2}}
{{Reflist|2}}
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Latest revision as of 04:10, 10 February 2022
Resident
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Congestive Heart Failure Microchapters

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ACC/AHA Guideline Recommendations

Initial and Serial Evaluation of the HF Patient
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Patients With a Prior MI
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Patients at high risk for developing heart failure (Stage A)
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Congestive heart failure end-of-life considerations

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Obstructive Sleep Apnea in the Patient with CHF
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Risk calculators and risk factors for Congestive heart failure history and symptoms

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-In-Chief: Lakshmi Gopalakrishnan, M.B.B.S. [2]

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 ejection fraction is usually below 35% in patients who are symptomatic with systolic heart failure.

Symptoms

Typical symptoms More specific signs
Breathlessness Elevated jugular venous pressure
Less typical symptoms Less specific signs
Nocturnal cough Weight gain (>2 kg/week)
The above table adopted from 2021 ESC Guideline

[1]







Symptoms of Left Sided Congestive Heart Failure

The left side pumps blood into the systemic circulation, while the right side pumps blood into the pulmonary circulation. Although left-sided heart failure will reduce forward cardiac output to the systemic circulation, the initial symptoms are often due to pulmonary congestion. In systolic dysfunction, the ejection fraction is decreased, leaving an abnormally elevated volume of blood in the left ventricle. In diastolic dysfunction, left ventricular end-diastolic pressure will be high. This increase in volume or pressure backs up to the left atrium and then into the pulmonary veins. Increased volume or pressure in the pulmonary veins impairs the normal drainage of the alveoli and favors the flow of fluid from the capillaries to the lung parenchyma, causing pulmonary edema. This impairs gas exchange and results in hypoxemia. Thus, left-sided heart failure often presents with respiratory symptoms including:

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 IV: Unable to carry out any physical activity without discomfort. Symptoms of cardiac insufficiency present at rest.

References

  1. ↑ McDonagh TA, Metra M, Adamo M, Gardner RS, Baumbach A, Böhm M, Burri H, Butler J, Čelutkienė J, Chioncel O, Cleland J, Coats A, Crespo-Leiro MG, Farmakis D, Gilard M, Heymans S, Hoes AW, Jaarsma T, Jankowska EA, Lainscak M, Lam C, Lyon AR, McMurray J, Mebazaa A, Mindham R, Muneretto C, Francesco Piepoli M, Price S, Rosano G, Ruschitzka F, Kathrine Skibelund A (September 2021). "2021 ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure". Eur Heart J. 42 (36): 3599–3726. doi:10.1093/eurheartj/ehab368. PMID 34447992 Check |pmid= value (help). Vancouver style error: initials (help)

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