Congestive heart failure overview

Congestive Heart Failure Microchapters
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Patient Information
Overview
Historical Perspective
Classification
Pathophysiology Systolic Dysfunction Diastolic Dysfunction HFpEF HFrEF
Causes
Differentiating Congestive heart failure from other Diseases
Epidemiology and Demographics
Risk Factors
Screening
Natural History, Complications and Prognosis
Diagnosis
Clinical Assessment
History and Symptoms
Physical Examination
Laboratory Findings
Electrocardiogram
Chest X Ray
Cardiac MRI
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Exercise Stress Test
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Cardiac Catheterization
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Treatment
Invasive Hemodynamic Monitoring
Medical Therapy:
Summary
Acute Pharmacotherapy
Chronic Pharmacotherapy in HFpEF
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
Exercise Training
Surgical Therapy: Biventricular Pacing or Cardiac Resynchronization Therapy (CRT) Implantation of Intracardiac Defibrillator Ultrafiltration Cardiac Surgery Left Ventricular Assist Devices (LVADs) Cardiac Transplantation
ACC/AHA Guideline Recommendations Initial and Serial Evaluation of the HF Patient Hospitalized Patient Patients With a Prior MI Sudden Cardiac Death Prevention Surgical/Percutaneous/Transcather Interventional Treatments of HF Patients at high risk for developing heart failure (Stage A) Patients with cardiac structural abnormalities or remodeling who have not developed heart failure symptoms (Stage B) Patients with current or prior symptoms of heart failure (Stage C) Patients with refractory end-stage heart failure (Stage D) Coordinating Care for Patients With Chronic HF Quality Metrics/Performance Measures
Implementation of Practice Guidelines
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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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]

Associate Editor-In-Chief: Cafer Zorkun, M.D., Ph.D. [2]; Saleh El Dassouki, M.D [3], Atif Mohammad, MD

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Overview of Congestive Heart Failure

One of the multiple definitions of heart failure is any condition of the heart that results in the inability of the heart to meet the demands of the circulation. It is also defined as complex clinical syndrome due to the abnormalities of the cardiac structure and /or function that impairs the left ventricle to fill or eject blood.The classic syndrome of heart failure is dyspnea, fatigue, and fluid retention.

Heart failure could results from abnormality of any one or combination of the components of the heart; the pericardium, myocardium, endocardium or even from the abnormality of great vessels. Heart failure was once thought to be secondary to depressed left ventricular ejection fraction, however studies have shown that approximately 50% of the patients who have heart failure have normal ejection fraction. Patient may be broadly classified as having heart failure with depressed left ventricular ejection fraction (systolic dysfunction) or normal or preserved ejection fraction (diastolic dysfunction). It is also common to have both systolic and diastolic dysfunction together at the same time.

Patients with heart failure present in different ways. Some patients present with exercise intolerance with little evidence of congestion or edema, others present with edema and congestion with minimal symptoms. Congestive heart failure is a outdated term as it was noted in the past that majority of the patients with heart failure were edematous or fluid overloaded. With the current medical and device therapy most patients are euvolumic , hence the term “heart failure” is preferred over “congestive heart failure”.

Heart failure is not synonymous with cardiomyopathy or left ventricular dysfunction, the latter terms are used to describe structural or functional abnormality that could lead to heart failure.Heart failure is as clinical syndrome charecterized by specific symptoms(dysnea and fatigue) in the history and signs(rales) on physical examination. There is no single test to diagnose heart failure.It is largely a clinical diagnosis based on careful history and physical examination.

References

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