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