Definition
- Heart failure (HF): a clinical syndrome of typical symptoms (breathlessness, ankle swelling, fatigue), often with signs (raised jugular venous pressure, JVP, crackles, peripheral oedema), caused by a structural or functional abnormality of the heart that raises intracardiac pressures and/or lowers cardiac output, at rest or on exertion (European Society of Cardiology, ESC 2021).
- Chronic HF: established HF that is stable or slowly progressive, interrupted by episodes of decompensation. Congestive means with salt and water retention (venous congestion, oedema).
- The 2021 universal definition adds that the syndrome is supported by raised natriuretic peptides or objective evidence of pulmonary or systemic congestion.
- Affects about 1–2% of adults and more than 10% of people over 70 years; roughly half have a reduced ejection fraction (EF).
Etiology
Coronary artery disease and hypertension cause most cases in Europe; always look for a cause, because some are reversible.
- Right HF: most often secondary to left HF; also cor pulmonale (chronic obstructive pulmonary disease, interstitial lung disease, sleep apnoea), pulmonary arterial or chronic thromboembolic pulmonary hypertension, right ventricular infarction, tricuspid or pulmonary valve disease, arrhythmogenic cardiomyopathy.