Clinical Presentation of Heart Failure
- Acute Heart Failure
- Chronic Heart Failure
- Heart failure with preserved systolic function
- Factors precipitating acute decompensation of chronic heart failure
Acute heart failure usually presents as shortness of breath, culminating, sometimes in a matter of minutes, with pulmonary edema. A more subacute presentation is of progressive dyspnea associated with systemic fluid retention over days to a few weeks. The precipitous form usually suggests extensive acute damage, most commonly as an ongoing or recent MI. Other insults include the acute development of valvular regurgitation from ruptured chordae tendineae, bacterial endocarditis, or aortic dissection or of rapidly progressive myocarditis or toxic damage. The syndrome may progress to cardiogenic shock.
[...] FACTORS PRECIPITATING ACUTE DECOMPENSATION OF CHRONIC HEART FAILURE Many patients with chronic heart failure maintain a stable course, then abruptly present with acutely or subacutely worsening symptoms. Although this decompensation may reflect unrecognized gradual progression of the underlying disorder, many precipitating events must be considered and, if present, addressed. An important focus is on changes in medications (by patient or physician), diet, or activity. Superimposed new or altered cardiovascular conditions, such as arrhythmias, ischemic events, hypertension, or valvular abnormalities, should be considered. [...]
[...] Chronic Heart Failure LEFT-SIDED AND RIGHT-SIDED HEART FAILURE Most adult patients with heart failure have abnormalities of the left ventricle as the underlying cause. Nonetheless, the clinical presentation may be variable, sometimes suggesting predominantly or even exclusively right ventricular dysfunction. The manifestations of left ventricular dysfunction are related to elevated filling (diastolic) pressures, which are transmitted backward to the left atrium and pulmonary veins, or inadequate cardiac output. The former results in dyspnea, sometimes at rest but usually with activity, and, when severe, pulmonary edema, classically associated with rales and possibly pleural effusions. [...]