Congestive heart failure differential diagnosis: Difference between revisions

	Congestive Heart Failure Microchapters
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Chronic Pharmacotherapy in HFrEF Diuretics ACE Inhibitors Angiotensin receptor blockers Aldosterone Antagonists Beta Blockers Ca Channel Blockers Nitrates Hydralazine Positive Inotropics Anticoagulants Angiotensin Receptor-Neprilysin Inhibitor Antiarrhythmic Drugs Nutritional Supplements Hormonal Therapies Drugs to Avoid Drug Interactions Treatment of underlying causes Associated conditions
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Congestive heart failure end-of-life considerations
Specific Groups: Special Populations Patients who have concomitant disorders Obstructive Sleep Apnea in the Patient with CHF NSTEMI with Heart Failure and Cardiogenic Shock
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Revision as of 19:35, 16 November 2016

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]

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.

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.
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.

Organ System	Disease	Symptoms	Signs	Laboratory findings	Diagnostic modality	Management
Cardiac	HFpEF	Exertional dyspnea, reduced exercise tolerance, orthopnea, paroxysmal nocturnal dyspnea, edema	Elevated JVP, fine crackles, edema	Increased BNP	Echocardiography (normal EF)	Control of volume overload and hypertension, treatment of underlying condition (obesity, AF, coronary artery disease, anemia)
	HFrEF	Exertional dyspnea, reduced exercise tolerance, orthopnea, paroxysmal nocturnal dyspnea, edema	Elevated JVP, fine crackles, edema	Increased BNP	Echocardiography (reduced EF)	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
High output status	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
Others	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

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.

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

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

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.

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

References

Template:WikiDoc Sources

@@ Line 17: / Line 17: @@
 *[[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.
+{| style="border: 0px; font-size: 90%; margin: 3px;" align=center
+! style="background: #4479BA; padding: 5px 5px;" rowspan=1 colspan=1  | {{fontcolor|#FFFFFF|Organ System}}
+! style="background: #4479BA; padding: 5px 5px;" rowspan=1 colspan=1  | {{fontcolor|#FFFFFF|Disease}}
+! style="background: #4479BA; padding: 5px 5px;" rowspan=1 colspan=1  | {{fontcolor|#FFFFFF|Symptoms}}
+! style="background: #4479BA; padding: 5px 5px;" rowspan=1 colspan=1  | {{fontcolor|#FFFFFF|Signs}}
+! style="background: #4479BA; padding: 5px 5px;" rowspan=1 colspan=1  | {{fontcolor|#FFFFFF|Laboratory findings}}
+! style="background: #4479BA; padding: 5px 5px;" rowspan=1 colspan=1  | {{fontcolor|#FFFFFF|Diagnostic modality}}
+! 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}}
+| style="padding: 5px 5px; background: #F5F5F5;" | HFpEF
+| 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;" |Increased [[Brain natriuretic peptide|BNP]]
+| style="padding: 5px 5px; background: #F5F5F5;" |[[Echocardiography]] (normal EF)
+| style="padding: 5px 5px; background: #F5F5F5;" |Control of volume overload and [[hypertension]],
+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;" |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;" |Increased [[Brain natriuretic peptide|BNP]]
+| style="padding: 5px 5px; background: #F5F5F5;" |[[Echocardiography]] (reduced EF)
+| 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;" |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;" |<nowiki>-</nowiki>
+| style="padding: 5px 5px; background: #F5F5F5;" |Echocardiography, ECG
+| style="padding: 5px 5px; background: #F5F5F5;" |Diuretics, [[pericardiectomy]]
+|-
+| style="padding: 5px 5px; background: #F5F5F5;" |[[Hypertrophic cardiomyopathy]]
+| style="padding: 5px 5px; background: #F5F5F5;" |Dyspnea, [[chest pain]], [[palpitation]], [[lightheadedness]]
+| style="padding: 5px 5px; background: #F5F5F5;" |[[Systolic murmurs|Systolic murmur]]
+| style="padding: 5px 5px; background: #F5F5F5;" |<nowiki>-</nowiki>
+| style="padding: 5px 5px; background: #F5F5F5;" |Echocardiography, ECG
+| style="padding: 5px 5px; background: #F5F5F5;" |[[Beta blockers]], [[verapamil]]
+|-
+| style="padding: 5px 5px; background: #F5F5F5;" |Valvular disease ([[Mitral regurgitation|MR]], [[Tricuspid regurgitation|TR]])
+| 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;" | <nowiki>-</nowiki>
+| 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;" |[[Arrhythmia]]
+| 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;" | <nowiki>-</nowiki>
+| 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="background: #4479BA; padding: 5px 5px;" rowspan=4 colspan=1 |{{fontcolor|#FFFFFF|Pulmonary}}
+| 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;" |Tachypnea, respiratory distress, [[cyanosis]], edema, [[rhonchi]] and [[crackles]]
+| style="padding: 5px 5px; background: #F5F5F5;" |[[Hypoxemia]], hypercapnea, [[polycythemia]],
+| style="padding: 5px 5px; background: #F5F5F5;" |[[PFTs|PFT]], chest imaging
+| style="padding: 5px 5px; background: #F5F5F5;" |[[Bronchodilator|Bronchodilators]], [[Corticosteroid|corticosteroids]], [[Anticholinergic|anticholinergics]]
+|-
+| style="padding: 5px 5px; background: #F5F5F5;" |[[Interstitial lung disease|Interstitial lung diseaee]]
+| style="padding: 5px 5px; background: #F5F5F5;" |Exercise intolerance, cough
+| style="padding: 5px 5px; background: #F5F5F5;" |Crackles, [[clubbing]], cyanosis
+| style="padding: 5px 5px; background: #F5F5F5;" |Hypoxemia
+| style="padding: 5px 5px; background: #F5F5F5;" |PFT, Chest imaging, lung biopsy
+| style="padding: 5px 5px; background: #F5F5F5;" |Corticosteroids, bronchodilators
+|-
+| style="padding: 5px 5px; background: #F5F5F5;" |[[Pulmonary hypertension]]
+| style="padding: 5px 5px; background: #F5F5F5;" |Dyspnea, fatigue, chest pain, [[syncope]], [[palpitation]]
+| style="padding: 5px 5px; background: #F5F5F5;" |Edema, clubbing, elevated [[Jugular venous pressure|JVP]], [[Tricuspid regurgitation|TR]] murmur
+| style="padding: 5px 5px; background: #F5F5F5;" |Elevated BNP, elevated [[d-dimer]]
+| style="padding: 5px 5px; background: #F5F5F5;" |Echocardiography, cardiac cathaterization
+| style="padding: 5px 5px; background: #F5F5F5;" |Diuretics, [[Calcium channel blocker|calcium channel blockers]], [[endothelin receptor antagonist]], [[Sildenafil|phosphodiesterase 5 inhibitor]]
+|-
+| style="padding: 5px 5px; background: #F5F5F5;" |[[Sleep apnea]]
+| style="padding: 5px 5px; background: #F5F5F5;" |[[Snoring]], [[somnolence]], headache, fatigue, irritability
+| style="padding: 5px 5px; background: #F5F5F5;" |tachypnea, hypertension, tachycardia
+| style="padding: 5px 5px; background: #F5F5F5;" |Hypoxemia, polycythemia
+| style="padding: 5px 5px; background: #F5F5F5;" |[[Polysomnography]]
+| style="padding: 5px 5px; background: #F5F5F5;" |Weight reduction, [[CPAP]]
+|-
+| style="background: #4479BA; padding: 5px 5px;" rowspan=2 colspan=1 |{{fontcolor|#FFFFFF|High output status}}
+| style="padding: 5px 5px; background: #F5F5F5;" |[[Anemia]]
+| 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;" |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;" |Iron replacement, nutritional support
+|-
+| style="padding: 5px 5px; background: #F5F5F5;" |[[Thyrotoxicosis]]
+| style="padding: 5px 5px; background: #F5F5F5;" |Palpitation, [[sweating]], weight loss
+| 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;" |[[Thyroid function tests|Thyroid function test]]
+| style="padding: 5px 5px; background: #F5F5F5;" |[[Methimazole|Thyrostatics]], beta blockers, ablation
+|-
+| style="background: #4479BA; padding: 5px 5px;" rowspan=2 colspan=1 |{{fontcolor|#FFFFFF| |Others}}
+| style="padding: 5px 5px; background: #F5F5F5;" |Liver disease
+| style="padding: 5px 5px; background: #F5F5F5;" |Fatigue, edema, [[jaundice]]
+| style="padding: 5px 5px; background: #F5F5F5;" |[[Ascites]], palmar erythema, [[gynecomastia]]
+| style="padding: 5px 5px; background: #F5F5F5;" |Increased [[AST]] and [[ALT]], decreased [[albumin]], increased [[Bilirubin|Br]]
+| style="padding: 5px 5px; background: #F5F5F5;" |Liver function test, Liver biopsy
+| style="padding: 5px 5px; background: #F5F5F5;" |Diuretics, treatment of underlying disease
+|-
+| style="padding: 5px 5px; background: #F5F5F5;" |[[Chronic kidney disease]]
+| style="padding: 5px 5px; background: #F5F5F5;" |Fatigue, anorexia, nausea, edema, decreased exercise tolerance
+| style="padding: 5px 5px; background: #F5F5F5;" |Edema, hypertension, crackles
+| style="padding: 5px 5px; background: #F5F5F5;" |Increased [[BUN]] and [[Cr]]
+| style="padding: 5px 5px; background: #F5F5F5;" |BUN, Cr
+| style="padding: 5px 5px; background: #F5F5F5;" |Control of blood pressure, anemia, [[dialysis]], [[Kidney transplantation|kidney transplant]]
+|}
 ===Other Causes of Dyspnea===