Internal Diseases and Therapy · MU Sofia

23. Chronic congestive heart failure – etiology, pathogenesis, clinical features.

Covers the definition and classification of chronic heart failure, its etiology grouped by cause with a table, and the pathogenesis through the Frank–Starling mechanism, neurohormonal activation and remodelling. It then sets out the symptoms and signs of left and right failure in a comparison table, the NYHA and ACC/AHA classifications, the diagnostic pathway with natriuretic peptides, ECG, chest X-ray (ABCDE), echocardiography and Framingham criteria, followed by differential diagnosis, complications and prognosis.

Inside: 9 sections · 2 labelled pictures · 9 tables · 16 flashcards · 13 min

Topic 23 of 139 in the MU Sofia syllabus for Internal Diseases and Therapy (Medicine, Years 4 and 5). The free AceMed note covers it in 9 sections, about 1,299 words (13 min of reading), with 16 flashcards.

In this note

  1. Definition
  2. Etiology
  3. Pathogenesis
  4. Classification
  5. Clinical features
  6. Diagnosis
  7. Differential diagnosis
  8. Complications
  9. Prognosis

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.

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