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==Differentiating Congestive Heart Failure from other Diseases==
==Differentiating Congestive Heart Failure from other Diseases==
Heart failure is a clinical syndrome of dyspnea, fatigue and edema. There are several disorders that cause heart failure and should not be confused with the syndrome of heart failure.
Heart failure is a clinical syndrome of [[dyspnea]], [[fatigue]] and [[edema]]. There are several disorders that cause [[heart failure]] and should not be confused with the syndrome of heart failure.
*[[Cardiac arrest]] and [[asystole]] refer to situations in which there is ''no'' cardiac output at all. Without urgent treatment these result in [[sudden death]].
*[[Cardiac arrest]] and [[asystole]] refer to situations in which there is ''no'' cardiac output at all. Without urgent treatment these result in [[sudden death]].
*[[Myocardial infarction]] ("Heart attack") refers to heart muscle damage due to an insufficient blood supply to the heart, usually as a result of a blocked [[coronary artery]].
*[[Myocardial infarction]] ("Heart attack") refers to heart muscle damage due to an insufficient blood supply to the heart, usually as a result of a blocked [[coronary artery]].
*[[Cardiomyopathy]] refers specifically to problems within the heart muscle, and these problems can result in heart failure. Ischemic cardiomyopathy implies that the cause of muscle damage is [[coronary artery disease]]. [[Dilated cardiomyopathy]] implies that the muscle damage has resulted in enlargement of the heart. [[Hypertrophic cardiomyopathy]] involves enlargement and ''thickening'' of the heart muscle.
*[[Cardiomyopathy]] refers specifically to problems within the heart muscle, and these problems can result in heart failure. [[Ischemic cardiomyopathy]] implies that the cause of muscle damage is [[coronary artery disease]]. [[Dilated cardiomyopathy]] implies that the muscle damage has resulted in enlargement of the heart. [[Hypertrophic cardiomyopathy]] involves enlargement and ''thickening'' of the heart muscle.




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===Other Causes of Dyspnea===
===Other Causes of Dyspnea===
There are non-cardiac causes of edema that primarily involve the lung or respiratory system.  These conditions are distinguished from heart failure in so far as they do not cause [[peripheral edema]], and they are not be associated with an elevation in [[BNP]].
There are non-cardiac causes of [[edema]] that primarily involve the lung or respiratory system.  These conditions are distinguished from heart failure in so far as they do not cause [[peripheral edema]], and they are not be associated with an elevation in [[BNP]].


=====Other Conditions that Cause Dyspnea that are Emergencies=====
=====Other Conditions that Cause Dyspnea that are Emergencies=====

Revision as of 13:53, 7 April 2017



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Congestive Heart Failure Microchapters

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Patient Information

Overview

Historical Perspective

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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

Echocardiography

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Cardiac Catheterization

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Other Diagnostic Studies

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
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Angiotensin Receptor-Neprilysin Inhibitor
Antiarrhythmic Drugs
Nutritional Supplements
Hormonal Therapies
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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(s)-in-Chief: Seyedmahdi Pahlavani, M.D. [2]

Overview

Congestive heart failure should be distinguished from other conditions that cause dyspnea, fatigue and edema.

Differentiating Congestive Heart Failure from other Diseases

Heart failure is a clinical syndrome of dyspnea, fatigue and edema. There are several disorders that cause heart failure and should not be confused with the syndrome of heart failure.


Organ System Disease Symptoms Signs Laboratory findings Diagnostic modality Management
Cardiac HFpEF Exertional dyspnea, reduced exercise tolerance, orthopnea, paroxysmal nocturnal dyspnea, edema Elevated JVP, fine crackles, edema Increased BNP Echocardiography (normal EF) Control of volume overload and hypertension,

treatment of underlying condition (obesity, AF, coronary artery disease, anemia)

HFrEF Exertional dyspnea, reduced exercise tolerance, orthopnea, paroxysmal nocturnal dyspnea, edema Elevated JVP, fine crackles, edema Increased BNP Echocardiography (reduced EF) Diuretics, ACE inhibitors, ARBs, beta blockers, nitrates
Pericardial disease Exercise intolerance, dyspnea, fatigue Elevated JVP, pericardial knock, kussmaul's sign, pulsus paradoxus - Echocardiography, ECG Diuretics, pericardiectomy
Hypertrophic cardiomyopathy Dyspnea, chest pain, palpitation, lightheadedness Systolic murmur - Echocardiography, ECG Beta blockers, verapamil
Valvular disease (MR, TR) Edema, fatigue, exercise intolerance, dyspnea, lightheadedness Cardiac murmur - Echocardiography, ECG Valve repair or replacement, diuretics, beta blockers
Arrhythmia Palpitation, lightheadedness, chest tightness Tachycardia, abnormal pulse - Echocardiography, ECG, holter monitoring Pharmacological cardioversion (anti arrhythmics), electrical cardioversion, ablation
Pulmonary Chronic airway disease Cough, dyspnea, chest pain, exercise intolerance Tachypnea, respiratory distress, cyanosis, edema, rhonchi and crackles Hypoxemia, hypercapnea, polycythemia, PFT, chest imaging Bronchodilators, corticosteroids, anticholinergics
Interstitial lung diseaee Exercise intolerance, cough Crackles, clubbing, cyanosis Hypoxemia PFT, Chest imaging, lung biopsy Corticosteroids, bronchodilators
Pulmonary hypertension Dyspnea, fatigue, chest pain, syncope, palpitation Edema, clubbing, elevated JVP, TR murmur Elevated BNP, elevated d-dimer Echocardiography, cardiac cathaterization Diuretics, calcium channel blockers, endothelin receptor antagonist, phosphodiesterase 5 inhibitor
Sleep apnea Snoring, somnolence, headache, fatigue, irritability tachypnea, hypertension, tachycardia Hypoxemia, polycythemia Polysomnography Weight reduction, CPAP
High output status Anemia Palpitation, lightheadedness, fatigue Cheilosis, delayed capillary refill Decreased Hb and HCT CBC, Iron study, bone marrow aspiration and biopsy Iron replacement, nutritional support
Thyrotoxicosis Palpitation, sweating, weight loss Proptosis, tachycardia Decreased TSH, increased T3,T4 Thyroid function test Thyrostatics, beta blockers, ablation
Others Liver disease Fatigue, edema, jaundice Ascites, palmar erythema, gynecomastia Increased AST and ALT, decreased albumin, increased Br Liver function test, Liver biopsy Diuretics, treatment of underlying disease
Chronic kidney disease Fatigue, anorexia, nausea, edema, decreased exercise tolerance Edema, hypertension, crackles Increased BUN and Cr BUN, Cr Control of blood pressure, anemia, dialysis, kidney transplant


Other Causes of Dyspnea

There are non-cardiac causes of edema that primarily involve the lung or respiratory system. These conditions are distinguished from heart failure in so far as they do not cause peripheral edema, and they are not be associated with an elevation in BNP.

Other Conditions that Cause Dyspnea that are Emergencies

The following emergency conditions should be excluded when diagnosing a patient with heart failure:

Non Cardiac Causes of Dyspnea

Other Causes of Fatigue

There are numerous non-cardiac causes of fatigue. Again, these non-cardiac causes are not associated with dyspnea and edema.

Other Causes of Edema

Other non cardiac causes of pedal edema are listed below. Obviously, the majority of these disorders do not also cause dyspnea and fatigue, and that distinguishes them form heart failure.

References


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