Clinical manifestations and evaluation

A. Symptoms of heart failure include weakness, fatigue, lethargy, light-headedness, mental confusion, and ultimately "cardiac cachexia"--generalized exhaustion with loss of muscle mass. The earliest subjective symptom attributable to pulmonary congestion is dyspnea caused by interstitial edema. As the condition progresses, orthopnea and paroxysmal nocturnal dyspnea (PND) may also develop.

Class I

Asymptomatic

Class II

Symptoms with moderate activity

Class III

Symptoms with minimal activity

Class IV

Symptoms at rest

B. Common clinical signs of HF include peripheral edema, pulmonary rales, an S3 gallop, sinus tachycardia, increased jugular venous pressure, and abdominojugular reflux. Signs of chronic HF are often found in noncardiac disorders such as obesity, venous insufficiency, and pulmonary disease.

C. Other disorders may mimic HF include volume overload from renal disease, regurgitant valvular disease, aortic stenosis, high output failure (anemia, sepsis, hyperthyroidism), pericardial disease, and tachyarrhythmias.

Laboratory Workup for Suspected HF

Blood urea nitrogen

Magnesium

Cardiac enzymes (CK-MB,

Thyroid-stimulating hormone

troponin, or both)

Urinalysis

Complete blood cell count

Echocardiogram

Creatinine

Electrocardiography

Electrolytes

Liver function tests

III.Treatment of chronic heart failure

A. Nonpharmacologic treatments include salt restriction (a diet with 2 g sodium or less), alcohol restriction, water restriction for patients with severe renal impairment or psychogenic polydipsia, and regular aerobic exercise as tolerated.

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