{"id":9675,"date":"2021-12-29T14:03:36","date_gmt":"2021-12-29T12:03:36","guid":{"rendered":"https:\/\/meddists.com\/learn\/clinical\/internal-medicine\/cardiology\/chronic-heart-failure-symptoms-diagnostic-treatment-2\/"},"modified":"2022-01-20T22:13:02","modified_gmt":"2022-01-20T20:13:02","slug":"chronic-heart-failure-symptoms-diagnostic-treatment-2","status":"publish","type":"page","link":"https:\/\/meddists.com\/learn\/clinical\/internal-medicine\/cardiology\/chronic-heart-failure-symptoms-diagnostic-treatment-2\/","title":{"rendered":"Chronic heart failure (symptoms, diagnostic, treatment)"},"content":{"rendered":"\n<p class=\"wp-block-paragraph\">Heart failure is a syndrome in which the heart cannot meet the body&#8217;s circulatory demands under physiological conditions.<\/p>\n\n\n\n<ul class=\"wp-block-list\"><li>Chronic heart failure is a progressive syndrome which can take years to manifest.<\/li><li>It can be described based on the <strong>ejection fraction<\/strong>:<ul><li>Heart failure with preserved ejection fraction (<strong>HFpEF<\/strong>) means that the EF&gt;50%<ul><li>Dyastolid dysfunction; HTN leading to hypertrophy, valvular disease (mitral stenosis, aortic stenosis\/regurgitation), restrictive cardiomyopathy.<\/li><\/ul><\/li><\/ul><ul><li>Heart failure with reduced ejection fraction (<strong>HFrEF<\/strong>) means that the EF&lt;40%<ul><li>Systolic dysfunction; due to acute MI, HTN, valvular disease (mitral regurgitation, aortic stenosis\/regurgitation), myocarditis.<\/li><\/ul><\/li><li>A newly added category, heart failure with mid-range ejection fraction (<strong>HFmEF<\/strong>) means that the EF=40-50%<\/li><\/ul><\/li><\/ul>\n\n\n<span class=\"block-heading\" id=\"header_1\">\n<h4 class=\"wp-block-heading\" class=\"wp-block-heading\" class=\"title_collection title1\">Classification<\/h4>\n<\/span><span class=\"block-content\" id=\"contents_1\">\n\n\n<p class=\"wp-block-paragraph\">The <strong>NYHA classification system<\/strong> classifies patients into four categories (I-IV) based on the severity of their symptoms.<\/p>\n\n\n\n<ul class=\"wp-block-list\"><li><strong>NYHA class I.<\/strong> No symptoms during rest or normal physical activity.<\/li><li><strong>NYHA class II.<\/strong> Mild symptoms only during normal physical activity.<\/li><li><strong>NYHA class III.<\/strong>  Moderate symptoms at light physical activity.<\/li><li><strong>NYHA class IV.<\/strong> Severe symptoms even at light physical activity.<\/li><\/ul>\n\n\n<\/span><span class=\"block-heading\" id=\"header_2\">\n<h4 class=\"wp-block-heading\" class=\"wp-block-heading\" class=\"title_collection title1\">Symptoms<\/h4>\n<\/span><span class=\"block-content\" id=\"contents_2\">\n\n\n<ul class=\"wp-block-list\"><li>Left-sided heart failure leads to pulmonary hypertension and edema<ul><li>Dyspnea<\/li><li>Orthopnea<\/li><li>Paroxysmal nocturnal dyspnea<\/li><li>Nonproductive cough<\/li><li>Cold extremities<\/li><\/ul><\/li><li>Right-sided heart failure leads to peripheral congestion<ul><li>Peripheral edema<\/li><li>Distended veins<\/li><li>Hepatosplenomegaly<\/li><li>Ascites<\/li><\/ul><\/li><\/ul>\n\n\n<\/span><span class=\"block-heading\" id=\"header_3\">\n<h4 class=\"wp-block-heading\" class=\"wp-block-heading\" class=\"title_collection title1\">Diagnosis<\/h4>\n<\/span><span class=\"block-content\" id=\"contents_3\">\n\n\n<ul class=\"wp-block-list\"><li>Physical examination<ul><li>Heart: S3 (ventricular) and S4 gallop can be heard<\/li><\/ul><ul><li>Lungs: Crackles\/rales at the base of the lungs; decreased auscultation; increased tactile fermitus<\/li><\/ul><\/li><li>Cardiac markers (CK-MB, cTn, BNP, NT-proBNP)<ul><li>BNP and NT-proBNP are markers for the identification of decompensated HF.<\/li><\/ul><\/li><li>Chest x-ray<ul><li>Cardiomegaly<\/li><li>Lung vasculature and interstitium is prominent<\/li><li>Kerely B lines<\/li><\/ul><\/li><li>ECG<\/li><li>Echocardiography (EF determination)<\/li><li>Nuclear imaging (MUGA scan)<\/li><li>Stress testing<\/li><\/ul>\n\n\n<\/span><span class=\"block-heading\" id=\"header_4\">\n<h4 class=\"wp-block-heading\" class=\"wp-block-heading\" class=\"title_collection title1\">Treatment<\/h4>\n<\/span><span class=\"block-content\" id=\"contents_4\">\n\n\n<ul class=\"wp-block-list\"><li>Fluid and salt restriction<\/li><li>Quality of life improving:<ul><li>Diuretics (furosemide; symtpomatic)<\/li><\/ul><\/li><li>Outcome improving:<ul><li>ACEi\/ARBs<\/li><li>BB<\/li><\/ul><ul><li>ARNI (angiotensin receptor and neprilysin inhibitors) &#8211; sacubitril\/valsartan<\/li><li>Hydralazine<\/li><li>Ivabradine (funny channel blocker)<\/li><li>Statins<\/li><li>CCBs do not improve the outcome of CHF, and may worsen it.<\/li><\/ul><\/li><li>Heart transplantation<\/li><li>Defibrilator or resyncronization theraphy<\/li><li>LVAD\/RVAD\/BiVAD<\/li><\/ul>\n<\/span><div id=\"the_titles\" style=\"display:none;\"><h4 class=\"wp-block-heading\" class=\"wp-block-heading\">Classification<\/h4><h4 class=\"wp-block-heading\" class=\"wp-block-heading\">Symptoms<\/h4><h4 class=\"wp-block-heading\" class=\"wp-block-heading\">Diagnosis<\/h4><h4 class=\"wp-block-heading\" class=\"wp-block-heading\">Treatment<\/h4><\/div>","protected":false},"excerpt":{"rendered":"<p>Heart failure is a syndrome in which the heart cannot meet the body&#8217;s circulatory demands under physiological conditions. Chronic heart failure is a progressive syndrome which can take years to manifest. It can be described based on the ejection fraction: Heart failure with preserved ejection fraction (HFpEF) means that the EF&gt;50% Dyastolid dysfunction; HTN leading [&hellip;]<\/p>\n","protected":false},"author":1,"featured_media":0,"parent":410,"menu_order":13,"comment_status":"closed","ping_status":"closed","template":"","meta":{"footnotes":""},"class_list":["post-9675","page","type-page","status-publish","hentry"],"yoast_head":"<!-- This site is optimized with the Yoast SEO plugin v27.9 - https:\/\/yoast.com\/product\/yoast-seo-wordpress\/ -->\n<title>Chronic heart failure (symptoms, diagnostic, treatment) &#8211; Meddists<\/title>\n<meta name=\"robots\" content=\"index, follow, max-snippet:-1, max-image-preview:large, max-video-preview:-1\" \/>\n<link rel=\"canonical\" href=\"https:\/\/meddists.com\/learn\/clinical\/internal-medicine\/cardiology\/chronic-heart-failure-symptoms-diagnostic-treatment-2\/\" \/>\n<meta name=\"twitter:label1\" content=\"Est. reading time\" \/>\n\t<meta name=\"twitter:data1\" content=\"2 minutes\" \/>\n<script type=\"application\/ld+json\" class=\"yoast-schema-graph\">{\"@context\":\"https:\\\/\\\/schema.org\",\"@graph\":[{\"@type\":\"WebPage\",\"@id\":\"https:\\\/\\\/meddists.com\\\/learn\\\/clinical\\\/internal-medicine\\\/cardiology\\\/chronic-heart-failure-symptoms-diagnostic-treatment-2\\\/\",\"url\":\"https:\\\/\\\/meddists.com\\\/learn\\\/clinical\\\/internal-medicine\\\/cardiology\\\/chronic-heart-failure-symptoms-diagnostic-treatment-2\\\/\",\"name\":\"Chronic heart failure (symptoms, diagnostic, treatment) &#8211; 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