Clinical Presentation And Diagnosis Of Chronic Hf

In low-output HF, symptoms are generally related to either congestion behind the failing ventricle(s), hypoperfusion (decreased tissue blood supply), or both. Congestion is the most common symptom in HF, followed by symptoms related to decreased perfusion to peripheral tissues including decreased renal output, mental confusion, and cold extremities. Activation of the compensatory mechanisms occurs in an effort to increase CO and preserve blood flow to vital organs. However, the increase in preload and afterload in the setting of a failing ventricle leads to elevated filling pressures and further impairment of cardiac function, which manifests as systemic and/or pulmonary congestion. It is important to remember that congestion develops behind the failing ventricle, caused by the inability of that ventricle to eject the blood that it receives from the atria and venous return. As such, signs and symptoms may be classified as left sided or right sided. Symptoms of left-sided HF include dyspnea, orthopnea, and paroxysmal nocturnal dyspnea (PND), whereas symptoms of right-sided HF include fluid retention, GI bloating, and fatigue. Although most patients initially have left ventricular failure (LVF; pulmonary congestion), the ventricles share a septal wall, and because LVF increases the workload of the right ventricle, both ventricles eventually fail and contribute to the HF syndrome. Because of the complex nature of this syndrome, it has become exceedingly more difficult to attribute a specific sign or symptom as caused by either right ventricular failure (RVF; systemic congestion) or LVF. Therefore, the numerous signs and symptoms associated with this disorder are collectively attributed to HF rather than to dysfunction of a specific ventricle.

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