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Pathology
A disorder of heart structure or function that impairs its ability to fill and pump blood at a rate proportionate to the body’s requirements, resulting in pulmonary or peripheral oedema.
Aetiology
Ischaemic heart disease, Dilated cardiomyopathy, Hypertension, Valvular heart disease, Drugs (e.g. chemotherapy), Radiotherapy, Pregnancy, Amyloidosis, Sarcoidosis, Stress cardiomyopathy, Post viral, Alcohol, Hypothyroidism, Familial, Haemochromatosis, Infections (Chagas’ disease), Nutritional (Beri-Beri)
Signs
Dyspnoea, raised JVP, distended neck veins, pleural effusions, peripheral oedema, crepitations, hepatomegaly, ascites, tachycardia, 3rd heart sound, RV heave, low-volume pulse, poor peripheral perfusion, hypotension, displaced apex
Symptoms
LVF: dyspnoea, reduced exercise tolerance, fatigue, syncope, nocturnal cough
RVF: weight gain, peripheral oedema, nausea and anorexia, facial engorgement
Investigations
Bloods: FBC, U&E, LFTs, TFTs, serum nt-proBNP, uric acid, troponin
ECG: arrhythmia, LVH, prolonged QRS, evidence of old infarct
Chest X-Ray: cardiomegaly, pleural effusions, upper lobe diversion, and alveolar
oedema, (Kerley B lines)
Echo: Assess ventricular function
Treatment
Acute heart failure: Fluid and salt restriction, daily weights, fluid balance chart,
Vasodilators and diuretics (e.g. isosorbide dinitrate and furosemide), IV Dopamine in hypotensive patients
Chronic heart failure: Cardiac rehabilitation, low-salt diet, fluid restriction,
pneumonia and influenza vaccines, diuretics, beta
blockers and ACE inhibitors
Device therapy: Implantable cardiac defibrillators reduce mortality when
used in patients with LVEF <35%
Surgical: CABG, mitral valve surgery, LV reduction surgery, LVAD and
transplantation
Prognosis
Treatment side-effects including nausea, gout, impotence, diabetes, postural hypotension, headaches, worsening heart failure, arrhythmias, and death.
5-year mortality in men and women 62% and 42% respectively
New York Heart Association Classification Of Heart Failure
NYHA I: No limitation of physical activity
NYHA II: Slight limitation of physical activity Symptoms with ordinary levels of exertion, such as walking up stairs
NYHA III: Marked limitation of physical activity Symptoms with minimal level of exertion, such as dressing
NYHA IV: Symptoms at rest
Key Facts
Chest X-ray Heart Failure Findings Mnemonic
‘ABCDE’
Alveolar oedema (bat’s wings)
B Kerley lines (interstitial oedema)
Cardiomegaly
Dilated prominent upper lobe vessels
Effusion (pleural)
Key Images
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Key References
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