Clinical features

Decreased forward flow leading to poor tissue perfusion

• Muscle fatigue leading ultimately to hypercapnia and collapse

• Confusion, agitation, drowsiness, coma

• Increasing metabolic acidosis, arterial hypoxaemia and dyspnoea

Increased venous congestion secondary to right heart failure

• Peripheral oedema

• Hepatic congestion

• Splanchnic ischaemia

• Raised intracranial pressure

Increased pulmonary hydrostatic pressure secondary to left heart failure

• Pulmonary oedema, dyspnoea

• Hypoxaemia

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