Congestive heart failure causes
| Congestive Heart Failure Microchapters |
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Pathophysiology |
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Differentiating Congestive heart failure from other Diseases |
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Diagnosis |
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Treatment |
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ACC/AHA Guideline Recommendations
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Congestive heart failure causes On the Web |
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]
Overview
Etiology
Heart failure may be caused by coronary heart disease, hypertension, ethanol, myocarditis, connective tissue disease and others.[1]
Pathophysiology
There are several classification schemes used to characterize the pathophysiology of heart failure as either systolic vs diastolic; left vs right; or low output vs high output. The anatomic structure underlying the disease process is often characterized as well. The causes of heart failure are also often characterized by their chronicity (acute/decompensated or chronic).
Underlying Anatomic Abnormalities Causing Heart Failure
Heart failure may result from an abnormality of any one of the anatomical structures of the heart:
- Pericardium
- Myocardium
- Endocardium
- Valvular heart disease or
- Disorders of the great vessels (e.g. pulmonary hypertension)
Systolic versus Diastolic Heart Failure
Patients may be broadly classified as having heart failure with depressed contractility or depressed relaxation
Systolic Dysfunction
The left ventricular ejection fraction is reduced in systolic dysfunction and there is depressed contractility of the heart.
Disastolic Dysfunciton
The left ventricular ejection fraction is preserved in diastolic dysfunction and there is an abnormality in myocardial relaxation or excessive myocardial stiffness. Systolic and diastolic dysfunction commonly occur in conjunction with each other.
Left, Right and Biventricular Failure
Another common method of classifying heart failure is based upon the ventricle involved (left sided versus right sided).
Left Heart Failure
- There is impaired left ventricular function with reduced flow into the aorta.
Right Heart Failure
- There is impaired right ventricular function with reduced flow into the pulmonary artery and lungs.
Biventricular Failure
- The most common cause of right heart failure is left heart failure, and mixed presentations are common, especially when the cardiac septum is involved.
High Output Versus Low Output Failure
Low Output Failure
- The cardiac output is reduced, and the systemic vascular resistance (SVR) is high. In low output failure, there is an inadequate supply of blood flow to meet normal metabolic demands.
High Output Failure
- The cardiac output is increased, and the systemic vascular resistance (SVR) is low. Rather than an inadequate supply of blood flow to meet normal metabolic demands as occurs in low output failure, in high output failure there is an excess requirement for oxygen and nutrients and the demand outstrips what the heart can provide.[4] Causes of high output heart failure include severe anemia, Gram negative septicaemia, beriberi (vitamin B1/thiamine deficiency), thyrotoxicosis, Paget's disease, arteriovenous fistulae, or arteriovenous malformations.
Causes of Acute or Decompensated Heart Failure
Chronic stable heart failure may easily decompensate. This most commonly results from an intercurrent illness (such as pneumonia), myocardial infarction (a heart attack), arrhythmias, uncontrolled hypertension, or a patient's failure to maintain a fluid restriction, diet, or medication.[5] Other well recognized precipitating factors include anemia and hyperthyroidism which place additional strain on the heart muscle. Excessive fluid or salt intake, and medication that causes fluid retention such as NSAIDs and thiazolidinediones, may also precipitate decompensation.[6]
Differential Diagnosis of the Underlying Causes of Chronic Heart Failure
Common Causes of Left Sided Heart Failure
A 19 year study of 13,000 healthy adults in the United States (the National Health and Nutrition Examination Survey (NHANES I) found the following causes ranked by Population Attributable Risk score:[7]
- Ischaemic heart disease 62%
- Cigarette smoking 16%
- Hypertension (high blood pressure)10%
- Obesity 8%
- Diabetes 3%
- Valvular heart disease 2% (much higher in older populations)
Cardiomyopathies and Inflammatory Diseases
Restrictive Cardiomyopathies
- Amyloidosis
- Anthracyclines
- Cardiac transplant
- Endocardial fibrosis
- Eosinophilic heart disease
- Hemochromatosis
- Primary (idiopathic)
- Radiation therapy
- Sarcoidosis
- Storage diseases
- Tumor infiltration
Dilated Cardiomyopathies
- Duchenne muscular dystrophy
- Becker's muscular dystrophy
- Limb-girdle muscular dystrophy
- Mitochondrial myopathy
- Arrhythmogenic right ventricular dysplasia
- Alcohol-Induced cardiomyopathy
- Cocaine related cardiomyopathy
- Diabetic cardiomyopathy
- Peripartum cardiomyopathy
- Anthracycline induced cardiomyopathy
- Trastuzumab Herceptin-lnduced Cardiomyopathy
Inflammatory Cardiomyopathies
- Bacterial Myocarditis
- Fungal myocarditis
- Giant Cell Myocarditis
- Protozoal Myocarditis: Trypanosomiasis (Chagas Disease)
- Rickettsial Myocarditis
- Sarcoidosis
- Spirochetal Infections
- Viral Myocarditis
Congestive Heart Failure as a Consequence of Valvular Heart Disease
- Aortic stenosis with Left Ventricular Systolic Dysfunction
- Chronic aortic regurgitation
- Mitral Stenosis
- Chronic mitral regurgitation
- Acute aortic regurgitation
- Acute mitral regurgitation
Congestive Hert Failure Secondary to Congenital Heart Disease
A. Causes of Congestive Heart Failure in Adults with Unoperated Congenital Heart Diseases
- Eisenmenger's syndrome
- Fibrocalcific degeneration of abnormal aortic valve
- Systemic ventricular dysfunction and/or tricuspid regurgitation in congenitally corrected transposition of the great arteries
- Atrial septal defect with mitral regurgitation] secondary to myxomatous mitral valve
- Congenital mitral regurgitation
- Arrhythmia
- Endocarditis
- Other degenerative diseases (coronary artery disease, hypertension)
- Drug abuse, alcohol abuse
- Pregnancy
B. Causes of Congestive Heart Failure in Adults with Operated Congenital Heart Diseases
- Myocardial dysfunction
- Valvular regurgitation
- Persistent left-to-right shunt
- Pulmonary vascular disease
- Prosthetic valve dysfunction
- Status post Fontan operation
- Arrhythmia
- Endocarditis
- Other degenerative diseases (coronary artery disease, hypertension)
Right Ventricular Failure
Factors affected right ventricle and to be eliminated during management of congestive heart failure. A. Right ventricular myocardial dysfunction
B. Primary right ventricular pressure overload
- Left ventricular failure
- Mitral valve disease
- Atrial myxoma
- Pulmonary veno-occlusive disease
- Cor pulmonale
- Pulmonic stenosis
- Ventricular septal defect
- Aortopulmonary communication
C. Primary right ventricular volume overload
- Pulmonic regurgitation
- Tricuspid regurgitation
- Atrial septal defect
- Partial anomalous pulmonary venous return
D. Impediment to right ventricular inflow
Differential Diagnosis of Causes of Heart Failure Segregated by Left and Right Sided Heart Failure
Left Ventricular Failure
Most Common Causes:
Expanded List of Causes:
- Atrial fibrillation
- Alcoholism
- Anemia
- Angina
- Aortic regurgitation
- Aortic Stenosis
- Arteriovenous fistula
- Beriberi
- Cardiac aneurysm
- Cardiomyopathy
- Constrictive pericarditis
- Drugs, toxins
- Hypertension
- Hyperthyroidism
- Hypovolemia
- Hypoxia
- Mediastinal tumors
- Mitral Regurgitation
- Myocardial Infarction
- Paget's Disease
- Pancoast's Tumor
- Pericardial effusion
- Pericardial tamponade
- Perimyocarditis
- Protein deficiency
- Restrictive cardiomyopathy
- Rupture of the papillary muscles
- Sepsis
- Superior Vena Cava thrombosis
Right Ventricular Failure
Most Common Causes:
Other Causes:
- After left ventricular failure
- After pulmonary resection
- Allergic alveolitis
- Bronchial asthma
- Chronic bronchitis
- Honeycomb lung
- Hyperglobulia
- Emphysema
- Mitral Stenosis
- Right ventricular myocardial infarction
- Pickwickian Syndrome
- Pleural fibrosis
- Pneumoconiosis
- Pulmonary fibrosis
- Pulmonic regurgitation
- Pulmonic stenosis
- Sarcoidosis
- Severe relapsing pulmonary emboli
- Silicosis
- Tachycardia
- Tricuspid insufficiency
Others
- Ascorbic acid deficiency
- Cardiac amyloidosis
- Carnitine deficiency
- Cervical vein stasis of non-cardiac genesis
- Congenital heart disease
- Cyanosis of non-cardiac genesis
- Diabetes Mellitus
- Dyspnea of non-cardiac genesis
- Edema of non-cardiac genesis
- Hemochromatosis
- Pleural effusion of non-cardiac genesis
- Pulmonary edema of non-cardiac genesis
- Thiamine deficiency
- Thyroid disease
References
- ↑ 1.0 1.1 Felker GM, Thompson RE, Hare JM, Hruban RH, Clemetson DE, Howard DL; et al. (2000). "Underlying causes and long-term survival in patients with initially unexplained cardiomyopathy". N Engl J Med. 342 (15): 1077–84. PMID 10760308.
- ↑ Burkett EL, Hershberger RE (2005). "Clinical and genetic issues in familial dilated cardiomyopathy". J Am Coll Cardiol. 45 (7): 969–81. doi:10.1016/j.jacc.2004.11.066. PMID 15808750.
- ↑ Mahon NG, Murphy RT, MacRae CA, Caforio AL, Elliott PM, McKenna WJ (2005). "Echocardiographic evaluation in asymptomatic relatives of patients with dilated cardiomyopathy reveals preclinical disease". Ann Intern Med. 143 (2): 108–15. PMID 16027452.
- ↑ Template:DorlandsDict
- ↑ Fonarow GC, Abraham WT, Albert NM; et al. (2008). "Factors Identified as Precipitating Hospital Admissions for Heart Failure and Clinical Outcomes: Findings From OPTIMIZE-HF". Arch. Intern. Med. 168 (8): 847–854. doi:10.1001/archinte.168.8.847. PMID 18443260. Unknown parameter
|month=ignored (help) - ↑ Nieminen MS, Böhm M, Cowie MR; et al. (2005). "Executive summary of the guidelines on the diagnosis and treatment of acute heart failure: the Task Force on Acute Heart Failure of the European Society of Cardiology". Eur. Heart J. 26 (4): 384–416. doi:10.1093/eurheartj/ehi044. PMID 15681577. Unknown parameter
|month=ignored (help) - ↑ He J; Ogden LG; Bazzano LA; Vupputuri S; et al. (2001). "Risk factors for congestive heart failure in US men and women: NHANES I epidemiologic follow-up study". Arch. Intern. Med. 161 (7): 996–1002. doi:10.1001/archinte.161.7.996. PMID 11295963.