Heart Failure Definition and Symptoms
- Heart failure is a syndrome caused by impaired heart function.
- It is characterized by signs and symptoms such as shortness of breath, fatigue, and leg swelling.
- The heart fails to pump blood effectively, leading to decreased cardiac output.
- Fluid accumulation in the veins and tissues causes congestion.
- Inadequate blood flow can result in ischemia.
- Congestive heart failure is characterized by fluid accumulation in the lungs and other parts of the body.
- Symptoms include peripheral edema, pulmonary edema, and ascites.
- Low pulse pressure can be an early warning sign.
- Left-sided heart failure causes breathing difficulties and fatigue.
- Signs of left ventricular failure include displaced apex beat and gallop rhythm.
Left-Sided Heart Failure
- Left side of the heart pumps oxygen-rich blood to the body.
- Failure of the left side causes blood to back up into the lungs.
- Common signs include increased respiratory rate and labored breathing.
- Pulmonary edema can be indicated by rales or crackles in the lungs.
- Cyanosis may occur in severe cases.
Right-Sided Heart Failure
- Right side of the heart pumps blood to the lungs.
- Failure of the right side causes blood to back up in the veins.
- Signs include peripheral edema and ascites.
- Increased jugular venous distension may be observed.
- Hepatomegaly and splenomegaly can occur.
Diagnosis and Treatment
- Diagnosis is based on symptoms, physical findings, and echocardiography.
- Blood tests and chest x-ray can help determine the underlying cause.
- Treatment depends on severity and may include lifestyle changes.
- Medications like ACE inhibitors, beta blockers, and diuretics are commonly prescribed.
- In severe cases, implanted devices or heart transplantation may be recommended.
Causes, Pathophysiology, and Diagnostic Tools
- Heart failure is a syndrome, not a disease.
- Common causes include coronary artery disease, high blood pressure, atrial fibrillation, valvular heart disease, excess alcohol use, infection, and cardiomyopathy.
- Heart failure is caused by conditions that reduce the efficiency of the heart muscle.
- Long-term activation of neurohormonal systems leads to fibrosis, dilation, and structural changes in the left ventricle.
- No agreed-upon gold standard diagnostic criteria for heart failure.
- N-terminal pro-BNP (NT-proBNP) measurement followed by an ultrasound is recommended in the UK.
- NT-proBNP or BNP measurement followed by an ultrasound is recommended in Europe and the US.
- Echocardiogram (ultrasound) commonly used to support heart failure diagnosis.
- Chest X-rays used to aid in heart failure diagnosis.
Heart failure (HF), also known as congestive heart failure (CHF), is a syndrome, a group of signs and symptoms, caused by an impairment of the heart's blood pumping function. Symptoms typically include shortness of breath, excessive fatigue, and leg swelling. The shortness of breath may occur with exertion or while lying down, and may wake people up during the night. Chest pain, including angina, is not usually caused by heart failure, but may occur if the heart failure was caused by a heart attack. The severity of the heart failure is mainly decided based on ejection fraction and also measured by the severity of symptoms . Other conditions that may have symptoms similar to heart failure include obesity, kidney failure, liver disease, anemia, and thyroid disease.
Heart failure | |
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Other names | Congestive heart failure (CHF), congestive cardiac failure (CCF) |
A man with congestive heart failure and marked jugular venous distension. External jugular vein marked by an arrow. | |
Specialty | Cardiology |
Symptoms | Shortness of breath, exhaustion, swollen legs |
Duration | Lifetime |
Causes | Heart attack, high blood pressure, abnormal heart rhythm, excessive alcohol use, infection, heart damage |
Risk factors | Smoking, sedentary lifestyle, obesity, exposure to second-hand smoke |
Diagnostic method | Echocardiogram |
Differential diagnosis | Kidney failure, thyroid disease, liver disease, anemia, obesity |
Medication | Diuretics, cardiac medications |
Frequency | 40 million (2015), 1–2% of adults (developed countries) |
Deaths | 35% risk of death in first year |
Common causes of heart failure include coronary artery disease, heart attack, high blood pressure, atrial fibrillation, valvular heart disease, excessive alcohol consumption, infection, and cardiomyopathy. These cause heart failure by altering the structure or the function of the heart or in some cases both. There are different types of heart failure: right-sided heart failure, which affects the right heart, left-sided heart failure, which affects the left heart, and biventricular heart failure, which affects both sides of the heart. Left-sided heart failure may be present with a reduced ejection fraction or with a preserved ejection fraction. Heart failure is not the same as cardiac arrest, in which blood flow stops completely due to the failure of the heart to pump.
Diagnosis is based on symptoms, physical findings, and echocardiography. Blood tests, and a chest x-ray may be useful to determine the underlying cause. Treatment depends on severity and case. For people with chronic, stable, mild heart failure, treatment usually consists of lifestyle changes, such as not smoking, physical exercise, and dietary changes, as well as medications. In heart failure due to left ventricular dysfunction, angiotensin-converting-enzyme inhibitors, angiotensin receptor blockers, or angiotensin receptor-neprilysin inhibitors, along with beta blockers, mineralocorticoid receptor antagonists and SGLT2 inhibitors are recommended. Diuretics may also be prescribed to prevent fluid retention and the resulting shortness of breath. Depending on the case, an implanted device such as a pacemaker or implantable cardiac defibrillator may sometimes be recommended. In some moderate or more severe cases, cardiac resynchronization therapy (CRT) or cardiac contractility modulation may be beneficial. In severe disease that persists despite all other measures, a cardiac assist device ventricular assist device, or, occasionally, heart transplantation may be recommended.
Heart failure is a common, costly, and potentially fatal condition, and is the leading cause of hospitalization and readmission in older adults. Heart failure often leads to more drastic health impairments than failure of other, similarly complex organs such as the kidneys or liver. In 2015, it affected about 40 million people worldwide. Overall, heart failure affects about 2% of adults, and more than 10% of those over the age of 70. Rates are predicted to increase. The risk of death in the first year after diagnosis is about 35%, while the risk of death in the second year is less than 10% in those still alive. The risk of death is comparable to that of some cancers. In the United Kingdom, the disease is the reason for 5% of emergency hospital admissions. Heart failure has been known since ancient times; it is mentioned in the Ebers Papyrus around 1550 BCE.
heart failure (countable and uncountable, plural heart failures)