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*There are several general causes of heart failure. Heart failure may be of pericardial origin such as [[tamponade]] and [[pericardial constriction]], of valvular origin such as aortic or [[mitral regurgitation]]; of myocardial origin such as [[idiopathic dilated cardiomyopathy]], [[familial dilated cardiomyopathy]], [[ischemic cardiomyopathy]], valvular cardiomyopathy; or of coronary vascular origin such as acute ischemic episodes, and rhythm disturbances such as [[tachycardia-induced heart failure]].
==Overview==
*Other secondary causes include:
There are several general causes of heart failure. Heart failure may be of pericardial origin such as [[tamponade]] and [[pericardial constriction]], of valvular origin such as aortic or [[mitral regurgitation]]; of myocardial origin such as [[idiopathic dilated cardiomyopathy]], [[familial dilated cardiomyopathy]], [[ischemic cardiomyopathy]], [[valvular heart disease]]; or of coronary vascular origin such as acute ischemic episodes, and rhythm disturbances such as [[tachycardia-induced heart failure]].
**[[anemia]]
Other common secondary causes include [[anemia]], [[obesity]],[[drugs]] [(such as first generation [[calcium channel blockers]], [[disopyramide]], and [[sotalol]], [[NSAIDs]] (may cause [[fluid retention]]), [[beta blockers]] (may cause heart failure with their negative inotropic effects)].
**[[obesity]]
 
**[[drugs]] [(such as first generation [[calcium channel blockers]], [[disopyramide]], and [[sotalol]], [[NSAIDs]] (may cause [[fluid retention]]), [[beta blockers]] (may cause heart failure with their negative inotropic effects)].
==Differential Diagnosis of the Underlying Causes of Heart Failure==
 
===Heart Failure Secondary to Coronary Artery Disease===
 
====A. Underlying Mechanisms====
#Ischemic Preconditioning
#:*Reductions in ischemia-related apoptosis
#:*Increases in endogenous adenosine
#:*Activation of potassium-adenosine triphosphate (K+-ATP) channels
#Electrical Dysfunction
#:*QT prolongation
#:*Increased susceptibility to arrhythmia
#:*QT dispersion
#Mechanical Dysfunction
#:*Systolic dysfunction
#:*Diastolic dysfunction
#Biochemical Dysfunction
#:*Increases in beta-adrenergic receptor density
#:*Changes in structural and regulatory proteins
#:*Shift to FFA as a proffered metabolic substrate
#:*Lactate production
#:*Elevated BNP concentration
 
====B. Utilisation of Clinical Data====
 
Management of heart failure due to coronary artery disease are primarily influenced by following parameters:
#An estimate of the relative proportions of:
#:*Viable but ischemic myocardium
#:*Nonviable myocardium
#:*Viable non-ischemic myocardium
#The technical feasibility of successful mechanical revascularization
#The extent and severity of comorbidities in the individual patient
 
===Cardiomyopathies and Inflammatory Diseases===
 
=====[[Restrictive Cardiomyopathies]]=====
*Primary (idiopathic)
*Tumor infiltration
*[[Amyloidosis]]
*Storage diseases
*Endocardial fibrosis
*[[Anthracyclines]]
*Eosinophilic heart disease
*Radiation
*[[Hemochromatosis]]
*Cardiac transplant
*[[Sarcoidosis]]
 
=====[[Dilated Cardiomyopathies]]=====
*[[Duchenne muscular dystrophy]]
*[[Becker's muscular dystrophy]]
*[[Limb-girdle muscular dystrophy]]
*[[Mitochondrial myopathy]]
*:*[[Kearns-Sayre syndrome]]
*[[Arrhythmogenic right ventricular dysplasia]]
*[[Alcohol-Induced cardiomyopathy]]
*[[Cocaine related cardiomyopathy]]
*[[Diabetic cardiomyopathy]]
*[[Peripartum cardiomyopathy]]
*[[Anthracycline induced cardiomyopathy]]
*[[Trastuzumab]] [[Herceptin-lnduced Cardiomyopathy]]
 
=====Inflammations=====
*[[Viral Myocarditis]]
*[[Rickettsial Myocarditis]]
*[[Bacterial Myocarditis]]
*Spirochetal Infections
*[[Myocarditis|Protozoal Myocarditis]]: [[Trypanosomiasis]] ([[Chagas Disease]])
*[[Fungal myocarditis]]
*[[Giant Cell Myocarditis]]
*[[Sarcoidosis]]
 
===Congestive Heart Failure as a Consequence of Valvular Heart Disease===
*[[Aortic stenosis with Left Ventricular Systolic Dysfunction]]
*[[Chronic aortic regurgitation]]
*[[Mitral Stenosis]]
*[[Chronic mitral regurgitation]]
*[[Acute aortic regurgitation]]
*[[Acute mitral regurgitation]]
 
===Congestive Hert Failure Secondary to Congenital Heart Disease===
 
'''A. Causes of Congestive Heart Failure in Adults with Unoperated Congenital Heart Diseases'''
*[[Eisenmenger's syndrome]]
*Fibrocalcific degeneration of abnormal [[aortic valve]]
*Systemic ventricular dysfunction and/or [[tricuspid regurgitation]] in congenitally corrected transposition of the great arteries
*[[Atrial septal defect]] with [[mitral regurgitation]]] secondary to myxomatous mitral valve
*[[Congenital mitral regurgitation]]
*[[Arrhythmia]]
*[[Endocarditis]]
*Other degenerative diseases ([[coronary artery disease]], [[hypertension]])
*[[Drug abuse]], [[alcohol abuse]]
*[[Pregnancy]]
 
'''B. Causes of Congestive Heart Failure in Adults with Operated Congenital Heart Diseases'''
*Myocardial dysfunction
*Valvular regurgitation
*Persistent left-to-right shunt
*Pulmonary vascular disease
*Prosthetic valve dysfunction
*Status post [[Fontan operation]]
*[[Arrhythmia]]
*[[Endocarditis]]
*Other degenerative diseases ([[coronary artery disease]], [[hypertension]])
 
=== Right Ventricular Failure ===
Factors affected right ventricle and to be eliminated during management of congestive heart failure.
A. Right ventricular myocardial dysfunction
#[[Right ventricular myocardial infarction]]
#[[Dilated cardiomyopathy]]
#[[Arrhythmogenic right ventricular dysplasia|Right ventricular dysplasia]]
B. Primary right ventricular pressure overload
#[[Left ventricular failure]]
#[[Mitral valve]] disease
#[[Atrial myxoma]]
#[[Pulmonary veno-occlusive disease]]
#[[Cor pulmonale]]
#:*[[Chronic obstructive pulmonary disease]]
#:*[[Primary pulmonary hypertension]]
#:*[[Pulmonary embolism]]
#[[Pulmonic stenosis]]
#:*[[Supravalvular pulmonic stenosis]]
#:*[[Valvular pulmonic stenosis]]
#:*[[Subvalvular pulmonic stenosis]]
#[[Ventricular septal defect]]
#Aortopulmonary communication
C. Primary right ventricular volume overload
#[[Pulmonic regurgitation]]
#[[Tricuspid regurgitation]]
#[[Atrial septal defect]]
#[[Partial anomalous pulmonary venous return]]
D. Impediment to right ventricular inflow
#[[Tricuspid stenosis]]
#[[Cardiac tamponade]]
#[[pericarditis |Constrictive pericarditis]]
#[[cardiomyopathy|Restrictive cardiomyopathy]]
 
== Differential Diagnosis of Causes of Heart Failure==
 
===A. Left Ventricular Failure===
 
====Most Common Causes:====
* [[Aortic Regurgitation|Aortic regurgitation]]
* [[Aortic Stenosis|Aortic stenosis]]
* [[Hypertension]]
* [[Mitral Regurgitation|Mitral regurgitation]]
* [[Myocardial ischemia]]
 
====Expanded List of Causes:====
* [[Atrial fibrillation]]
* [[Alcoholism]]
* [[Anemia]]
* [[Angina]]
* [[Aortic Regurgitation|Aortic regurgitation]]
* [[Aortic Stenosis]]
* [[Arteriovenous fistula]]
* [[Beriberi]]
* [[aneurysm|Cardiac aneurysm]]
* [[Cardiomyopathy]]
* [[pericarditis|Constrictive pericarditis]]
* [[Drugs]], [[toxin]]s
* [[Hypertension]]
* [[Hyperthyroidism]]
* [[Hypovolemia]]
* [[Hypoxia]]
* Mediastinal tumors
* [[Mitral Regurgitation]]
* [[Myocardial Infarction]]
* [[Paget's Disease]]
* [[Pancoast's Tumor]]
* [[Pericardial effusion]]
* [[Pericardial tamponade]]
* [[Perimyocarditis]]
* [[Protein deficiency]]
* [[Restrictive cardiomyopathy]]
* [[Papillary muscle rupture|Rupture of the papillary muscles]]
* [[Sepsis]]
* Vena Cava Superior Thrombosis
 
===B. Right Ventricular Failure ===
 
====Most Common Causes:====
* [[Cardiomyopathy]]
* [[Cor pulmonale]]
* [[myocarditis|Diffuse myocarditis]]
* Left heart failure
 
====Other Causes:====
* After [[left ventricular failure]]
* After pulmonary resection
* [[Alveolitis|Allergic alveolitis]]
* [[asthma|Bronchial asthma]]
* [[bronchitis|Chronic bronchitis]]
* [[Alveolitis|Honeycomb lung]]
* [[Hyperglobulia]]
* [[Emphysema]]
* [[Mitral Stenosis]]
* [[Right ventricular myocardial infarction]]
* [[Pickwickian Syndrome]]
* Pleural fibrosis
* [[Pneumoconiosis]]
* [[Pulmonary fibrosis]]
* [[Pulmonic regurgitation]]
* [[Pulmonic stenosis]]
* [[Sarcoidosis]]
* [[pulmonary emboli|Severe relapsing pulmonary emboli]]
* [[Silicosis]]
* [[Tachycardia]]
* [[Tricuspid insufficiency]]
 
===C. Others ===
* [[Ascorbic acid deficiency]]
* [[Cardiac amyloidosis]]
* [[Carnitine deficiency]]
* Cervical vein stasis of non-cardiac genesis
* [[Congenital heart disease]]
* [[Cyanosis]] of non-cardiac genesis
* [[Diabetes Mellitus]]
* [[Ddx:Dyspnea|Dyspnea]] of non-cardiac genesis
* [[Edema]] of non-cardiac genesis
* [[Hemochromatosis]]
* [[Pleural effusion]] of non-cardiac genesis
* [[Pulmonary edema]] of non-cardiac genesis
* [[Thiamine deficiency]]
* [[Thyroid disease]]
 


==References==
==References==

Revision as of 03:45, 2 November 2011

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

Overview

There are several general causes of heart failure. Heart failure may be of pericardial origin such as tamponade and pericardial constriction, of valvular origin such as aortic or mitral regurgitation; of myocardial origin such as idiopathic dilated cardiomyopathy, familial dilated cardiomyopathy, ischemic cardiomyopathy, valvular heart disease; or of coronary vascular origin such as acute ischemic episodes, and rhythm disturbances such as tachycardia-induced heart failure. Other common secondary causes include anemia, obesity,drugs [(such as first generation calcium channel blockers, disopyramide, and sotalol, NSAIDs (may cause fluid retention), beta blockers (may cause heart failure with their negative inotropic effects)].

Differential Diagnosis of the Underlying Causes of Heart Failure

Heart Failure Secondary to Coronary Artery Disease

A. Underlying Mechanisms

  1. Ischemic Preconditioning
    • Reductions in ischemia-related apoptosis
    • Increases in endogenous adenosine
    • Activation of potassium-adenosine triphosphate (K+-ATP) channels
  2. Electrical Dysfunction
    • QT prolongation
    • Increased susceptibility to arrhythmia
    • QT dispersion
  3. Mechanical Dysfunction
    • Systolic dysfunction
    • Diastolic dysfunction
  4. Biochemical Dysfunction
    • Increases in beta-adrenergic receptor density
    • Changes in structural and regulatory proteins
    • Shift to FFA as a proffered metabolic substrate
    • Lactate production
    • Elevated BNP concentration

B. Utilisation of Clinical Data

Management of heart failure due to coronary artery disease are primarily influenced by following parameters:

  1. An estimate of the relative proportions of:
    • Viable but ischemic myocardium
    • Nonviable myocardium
    • Viable non-ischemic myocardium
  2. The technical feasibility of successful mechanical revascularization
  3. The extent and severity of comorbidities in the individual patient

Cardiomyopathies and Inflammatory Diseases

Restrictive Cardiomyopathies
Dilated Cardiomyopathies
Inflammations

Congestive Heart Failure as a Consequence of Valvular Heart Disease

Congestive Hert Failure Secondary to Congenital Heart Disease

A. Causes of Congestive Heart Failure in Adults with Unoperated Congenital Heart Diseases

B. Causes of Congestive Heart Failure in Adults with Operated Congenital Heart Diseases

Right Ventricular Failure

Factors affected right ventricle and to be eliminated during management of congestive heart failure. A. Right ventricular myocardial dysfunction

  1. Right ventricular myocardial infarction
  2. Dilated cardiomyopathy
  3. Right ventricular dysplasia

B. Primary right ventricular pressure overload

  1. Left ventricular failure
  2. Mitral valve disease
  3. Atrial myxoma
  4. Pulmonary veno-occlusive disease
  5. Cor pulmonale
  6. Pulmonic stenosis
  7. Ventricular septal defect
  8. Aortopulmonary communication

C. Primary right ventricular volume overload

  1. Pulmonic regurgitation
  2. Tricuspid regurgitation
  3. Atrial septal defect
  4. Partial anomalous pulmonary venous return

D. Impediment to right ventricular inflow

  1. Tricuspid stenosis
  2. Cardiac tamponade
  3. Constrictive pericarditis
  4. Restrictive cardiomyopathy

Differential Diagnosis of Causes of Heart Failure

A. Left Ventricular Failure

Most Common Causes:

Expanded List of Causes:

B. Right Ventricular Failure

Most Common Causes:

Other Causes:

C. Others


References

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