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Overview

Topic Editor: Robert Giles, MBBS, BPharm

Review Date: 10/19/2012


Definition

Congestive heart failure (CHF) is a complex clinical syndrome in which the heart has insufficient output to meet the body's physiological needs. It results from a functional or structural cardiac disorder(s) that impairs ventricular filling or ejection. CHF may involve the left ventricle, right ventricle or both.

Description

Epidemiology

Incidence/prevalence

Age

Gender

Race

Genetics

Risk factors

Etiology


History & Physical Findings

History

Physical findings on examination

The Framingham criteria are one of several useful tools to aid the diagnosis of chronic heart failure. This criteria has a high sensitivity but low specificity. The diagnosis of CHF requires a minimum of 2 major criteria, or 1 major criteria plus 2 minor criteria.


Laboratory & Diagnostic Testing/Findings

Blood test findings

Initial evaluation of patients with suspected CHF

Other laboratory test findings

Radiographic findings

Other diagnostic test findings


Differential Diagnosis

Treatment/Medications

General treatment items

Medications indicated with specific doses

Beta-Blockers:

Angiotensin-converting enzyme inhibitors:

Angiotensin II receptor blockers:

Cardiac glycosides:

Vasodilators:

Nitrates

Loop diuretics:

Thiazide-type diuretics

Aldosterone antagonists

Dietary or Activity restrictions

Disposition

Admission criteria

Discharge criteria


Follow-up

Monitoring

Complications


Miscellaneous

Prevention

  • Primary and secondary prevention of coronary artery disease and hypertension
  • Avoidance of smoking
  • Exercise and weight loss
  • Lipid management
  • Moderation of alcohol consumption
  • Reduction of salt and fluid intake (generally in cases of CHF)

Prognosis

  • After symptoms develop, 1-year mortality is approximately 25%. 5-year mortality is approximately 50%.

Associated conditions

  • Anemia
  • Arrhythmias
  • Atrial fibrillation
  • Ventricular tachycardia/fibrillation
  • Cardiorenal syndrome
  • Coronary artery disease
  • Sleep apnea

Synonyms

  • Heart failure

Abbreviations

  • Congestive heart failure = CHF
    Heart failure = HF

ICD-9-CM

  • 428.0 Congestive heart failure

ICD-10-CM

  • I50 Heart failure
  • I50.2 Systolic (congestive) heart failure
  • I50.3 Diastolic (congestive) heart failure
  • I50.21 Acute systolic (congestive) heart failure
  • I50.22 Chronic systolic (congestive) heart failure
  • I50.31 Acute diastolic (congestive) heart failure
  • I50.32 Chronic diastolic (congestive) heart failure
  • I50.20 Unspecified systolic (congestive) heart failure
  • I50.30 Unspecified diastolic (congestive) heart failure
  • I50.43 Acute on chronic combined systolic (congestive) and diastolic (congestive) heart failure
  • I50.23 Acute on chronic systolic (congestive) heart failure
  • I50.33 Acute on chronic diastolic (congestive) heart failure
  • I50.41 Acute combined systolic (congestive) and diastolic (congestive) heart failure
  • I50.42 Chronic combined systolic (congestive) and diastolic (congestive) heart failure
  • I50.40 Unspecified combined systolic (congestive) and diastolic (congestive) heart failure
    I50.9 Heart failure, unspecified
  • I11.0 Hypertensive heart disease with heart failure

References

  1. Figueroa MS, Peters JI. Congestive heart failure: Diagnosis, pathophysiology, therapy, and implications for respiratory care. Respir Care. 2006;51(4):403-412. abstract
  2. American Heart Association. Classes of heart failure. http://www.heart.org/HEARTORG/Conditions/HeartFailure/AboutHeartFailure/Classes-of-Heart-Failure_UCM_306328_Article.jsp. Last accessed July 30, 2012.
  3. Fonarow GC. Epidemiology and risk stratification in acute heart failure. Am Heart J. 2008;155(2):200-207. abstract
  4. Roger VL, Go AS, Lloyd-Jones DM, et al. Heart disease and stroke statistics--2011 update: a report from the American Heart Association. Circulation. 2011;123(4):e18-e209.#3http://www.ncbi.nlm.nih.gov/pubmed/21160056http://www.ncbi.nlm.nih.gov/pubmed/14573332#3
  5. Schillaci G, Vaudo G, Reboldi G, et al. High-density lipoprotein cholesterol and left ventricular hypertrophy in essential hypertension. J Hypertens. 2001;19(12):2265-2270.abstract
  6. Gottdiener JS, Arnold AM, Aurigemma GP, et al. Predictors of congestive heart failure in the elderly: the Cardiovascular Health Study. J Am Coll Cardiol. 2000;35(6):1628-1637.abstract
  7. Swain SM, Whaley FS, Ewer MS. Congestive heart failure in patients treated with doxorubicin: a retrospective analysis of three trials. Cancer. 2003;97(11):2869-2879.abstract
  8. Zdanowicz MM. Congestive Heart Failure. Am. J. Pharm. Educ. 2002;66:180-185.
  9. Hunt SA, Abraham WT, Chin MH, et al. 2009 focused update incorporated into the ACC/AHA 2005 Guidelines for the Diagnosis and Management of Heart Failure in Adults: a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines: developed in collaboration with the International Society for Heart and Lung Transplantation. Circulation. 2009;119(14):e391-479. abstract