Table of Contents
Heart failure is a clinical syndrome characterised by the symptoms and signs that occur due to a reduced cardiac output and/or increased filling pressures.
Heart failure with reduced ejection fraction – ‘systolic heart failure’
- Reduction in contractility of ventricles
- Usually divided into LVF or RVF
- LVF is more common
- The most common cause of RVF is LVF, but RVF can also occur independently due to pulmonary hypertension or right-sided valve disease
- Causes below
Heart failure with preserved ejection fraction (HFpEF) – ‘diastolic heart failure’
- Reduction in compliance of ventricles (i.e. stiff ventricles)
- Usually related to old age/chronic hypertension
Clinical features of heart failure
|Reduced perfusion||Pulmonary congestion (LVF)||Systemic congestion (RVF)|
|•SOB on exertion, orthopnoea|
•Paroxysmal nocturnal dyspnoea
•White/pink frothy sputum
•Bloating and reduced appetite
|•Pulmonary oedema (fine basal creps)|
•Hypotension (in advanced heart failure)
•Peripheral oedema (pedal, sacral, scrotal)
To confirm diagnosis
- Serum B-type natriuretic peptide
- Chest X-ray
- Echocardiography: diagnostic test and may help determine cause
To determine cause
- Bloods: FBC, U&Es, TFTs, LFTs, ferritin, transferrin saturation, lipid profile, HbA1C, vasculitic/rheumatological screen, viral serologies (e.g. HIV)
- ECG: look for ischaemia, arrhythmias, small complexes (amyloid/pericardial effusion)
- Angiogram or functional imaging: if suspect ischaemic heart disease
- Cardiac MRI: if poor echo windows, suspected infiltrative cause, or unclear cause
Try some questions
What are the chest radiograph findings in heart failure?
What does a giant V wave in the JVP suggest?
What is cardiac output dependent on?
What is Kussmaul’s sign?