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.
Types
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
Causes

Clinical features of heart failure
Reduced perfusion | Pulmonary congestion (LVF) | Systemic congestion (RVF) | |
Symptoms | •Fatigue •Exercise intolerance | •SOB on exertion, orthopnoea •Paroxysmal nocturnal dyspnoea •White/pink frothy sputum •Cardiac wheeze | •Peripheral oedema •Weight gain •Bloating and reduced appetite |
Signs | •Cyanosis •Tachypnoea/ tachycardia •Cool extremities •Oliguria | •Pulmonary oedema (fine basal creps) •Pleural effusions •S3/ventricular gallop •Hypotension (in advanced heart failure) | •Raised JVP •Peripheral oedema (pedal, sacral, scrotal) •Hepatomegaly •Ascites |
Investigations
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
Management
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What are the chest radiograph findings in heart failure?
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