Congestive heart failure history and symptoms

Overview
The classic symptoms of heart failure include dyspnea, fatigue, and fluid retention. Patients with heart failure present in different ways. Some patients present with exercise intolerance but show little evidence of congestion or edema. Other patients present with mild symptoms of edema and pulmonary congestion. The ejection fraction is usually below 35% in patients who are symptomatic with systolic heart failure.

Symptoms of Congestive Heart Failure

 * Ankle edema or swelling of the feet and legs
 * Claudication or pain with walking
 * Confusion and altered mentation
 * Cool extremities or cold and clammy hands
 * Cyanosis or bluish color to the skin
 * Dizziness
 * Dyspnea on ordinary exertion or greater shortness of breath with usual activities
 * Fainting
 * Fatigue
 * Hemoptysis or frothy sputum
 * Nocturia or urination during the night
 * Nocturnal cough
 * Orthopnea or sleeping on pillows
 * Palpitations or extra heart beats
 * Paroxysmal nocturnal dyspnea or awakening at night with shortness of breath
 * Shortness of breath
 * Syncope or passing out
 * Weakness
 * Wheezing or cardiac asthma

Symptoms of Left Sided Congestive Heart Failure
The left side pumps blood into the systemic circulation, while the right side pumps blood into the pulmonary circulation. Although left-sided heart failure will reduce forward cardiac output to the systemic circulation, the initial symptoms are often due to pulmonary congestion. In systolic dysfunction, the ejection fraction is decreased, leaving an abnormally elevated volume of blood in the left ventricle. In diastolic dysfunction, left ventricular end-diastolic pressure will be high. This increase in volume or pressure backs up to the left atrium and then into the pulmonary veins. Increased volume or pressure in the pulmonary veins impairs the normal drainage of the alveoli and favors the flow of fluid from the capillaries to the lung parenchyma, causing pulmonary edema. This impairs gas exchange and results in hypoxemia. Thus, left-sided heart failure often presents with respiratory symptoms including:
 * Dyspnea
 * Frothy sputum
 * Nocturnal cough
 * Orthopnea
 * Paroxysmal nocturnal dyspnea
 * Shortness of breath
 * Wheezing

New York Heart Association Criteria (NYHA)
The following criteria are often used to gauge the severity of heart failure:


 * NYHA I: No symptoms with ordinary activity.


 * NYHA II: Slight limitation of physical activity. Comfortable at rest, but ordinary physical activity results in fatigue, palpitation, dyspnea, or angina.


 * NYHA III: Marked limitation of physical activity. Comfortable at rest, but less than ordinary physical activity results in fatigue, palpitation, dyspnea, or anginal pain.


 * NYHA IV: Unable to carry out any physical activity without discomfort. Symptoms of cardiac insufficiency present at rest.

==ACC/AHA Guidelines- Initial Clinical Assessment Recommendation == {{cquote|

Class I
1. A thorough history and physical examination should be obtained/performed in patients presenting with heart failure to identify cardiac and noncardiac disorders or behaviors that might cause or accelerate the development or progression of heart failure. (Level of Evidence: C)

2. A careful history of current and past use of alcohol, illicit drugs, current or past standard or alternative therapies, and chemotherapy drugs should be obtained from patients presenting with heart failure. (Level of Evidence: C)}}

==ACC/AHA Guidelines- Serial Clinical Assessment Recommendation == {{cquote|

Class I
1. Careful history of current use of alcohol, tobacco, illicit drugs, alternative therapies, and chemotherapy drugs, as well as diet and sodium intake, should be obtained at each visit of a patient with heart failure. (Level of Evidence: C)}}

Vote on and Suggest Revisions to the Current Guidelines

 * The CHF Living Guidelines: Vote on current recommendations and suggest revisions to the guidelines

Guidelines Resources

 * The ACC/AHA 2005 Guideline Update for the Diagnosis and Management of Chronic Heart Failure in the Adult


 * 2009 focused update: ACCF/AHA 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