Heart Failure

Consider primarily among persons with other cardiovascular risk factors (especially age).

  • Dyspnea (often only on exertion)
  • Orthopnea, Paroxysmal Nocturnal Dyspnea, Pedal Edema
  • Chest Pain (“pressure” / “tightness” / “discomfort”) — i.e. Sx of recent MI.
  • If cough:  primarily nocturnal
  • Bibasilar rales, JVD, Hepatojugular Reflux, S3 or S4, Pedal Edema
  • Valvular Lesions, Arrhythmias  (potential causes of CHF)
  • Serum BNP  (Brain-type Natriuretic Peptide)
  • CXR
  • EKG (for recent MI)
  • Echo (clinical gold standard for ventricular function)
Some Causes of CHF (must identify these if you make the Dx):
  • Cardiac:  M.I., Valve Disorder, Arrhythmia, Hypertension
  • Viral Myocarditis (if failure occurs in young people)
  • Cardiomyopathy  (alcohol, toxic, collagen-vascular, metabolic diseases)
  • Renal Failure, Anemia

See postings Acute Dyspnea – 3 and Chronic Dyspnea – 1.