Heart Failure

             Heart failure is one of the fastest-growing, cardiovascular diagnose in the United States, where therea re over 1 million hospitalizations for heart failure annually, at a cost exceeding $33 billion. Despite significant advancements in the management of Heart Failure, the mortality remains high; once a patient is hospitalized for Heart failure, the 1 - and 5 - years death are 30% and 50% respectively, In order to improve HF outcomes and reduce hospitalizations, physicians must be able to identify these patients early in their disease and initiate appropiate lifesaving and symptom-reducing therapies.

             The clinical presentations of Heart Failure can be quite variable. However, patients can be devided into useful subgroups based on the constellation of findings that brings them to medical attention. The purpose of this chapter is to illustrate the manifestations of Heart Failure by highlighting different patient presentations.

Definition

             What is Heart Failure? Heart Failure is a clinical syndrome characterized by dyspnea, exercise intolerance, and fluid retention in the setting of abnormal cardiac function. Most frequently, patients will present with either manifestations of poor cardiac output, such as fatigue and exercise intolerance, or volume overload/congestion, such as pulmonary and peripheral edema.

Clinical Presentation

             The clinical presentations of Heart failure are higly variable and range from acute respiratory or circulatory compromise to gradual worsening of dyspnea on exertion. In general, patients with HF can be devided into THREE BASIC PRESENTATION PHENOTYPES:

              a. Flash or acute pulmonary edema with hypertension

              b. Slowly progressive fluid accumulation

              c. Low output state

       The most dramatic presentation is Acute Pulmonary Edema (ALO/acute lung oedema). Frequently these patient have a rapid onset of symptoms and elevated blood pressure. The problem is usually not significant volume overload but instead volume redistribution secondary to increased vascular tone and poor left ventricular relaxation. The slowly progressive Heart Failure phenotype most commonly occurs in patients with chronic systolic dysfunction and is typified by normal to mildly elevated blood pressure and signs or symptoms of slowly progressive fluid accumulation. These patients have dyspnea and exertion, paroxysmal nocturnal dyspnea/orthopnea, lower extremity edema, and increased weight. The third and least common hypotensive and have evidence of end-organ hypoperfusion (prerenal azotemia, cold extremities, poor mentation).