Signs and Symptoms of HF| Mechanism of HF | LV | RV |
|---|
| Impaired output or perfusion (“Forward” HF) | Organ ischemia and dysfunctions (altered mentation or somnolence, azotemia, oliguria, hepatic insufficiency) Low cardiac index, low mixed venous oxygen saturation Mitral regurgitation On examination, pallor, cool extremities, impaired capillary refill, hypotension, narrow pulse pressure (<25% of systolic blood pressure), pulsus alternans Symptoms: fatigue, dyspnea
| Insufficient LV preload, with manifestations of impaired forward LV flow Tricuspid regurgitation Elevated CVP:PCWP (>0.6:1) Low RV pulse pressure Low PAPI (pulmonary arterial pulsatility index) Low cardiac index, low mixed venous oxygen saturation
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| Congestion (“Backward” HF) | Elevated PCWP Pulmonary edema, pleural effusion, secondary pulmonary hypertension RV congestion and dysfunction On examination, pulmonary rales, S3 heart sound Symptoms: dyspnea, orthopnea, paroxysmal nocturnal dyspnea
| Elevated CVP Renal congestion (may manifest as AKI) Visceral congestion (may impact intestinal medication absorption, liver function) Hepatic congestion (unconjugated hyperbilirubinemia, prolonged INR) On exam: ascites, pulsatile liver, leg edema, elevated JVP. Symptoms: Satiety, anorexia
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AKI, acute kidney injury; CVP, central venous pressure; HF, heart failure; LV, left ventricle; PCWP, pulmonary capillary wedge pressure; RV, right ventricle.