Evaluation of a Patient with Possible Heart Failure
Summary :
Table of Contents
- Symptoms of heart failure
- Dyspnea
- Orthopnea and paroxysmal nocturnal dyspnea
- Acute pulmonary edema
- Exercise intolerance
- Edema and fluid retention
- Abdominal and gastrointestinal symptoms
- Sleep disorders and central nervous system manifestations
- Cardiac cachexia
- Diagnosis
- Diffrential diagnosis
- Conclusions
- Bibliography
Abstract
The common symptoms of heart failure are well known but are frequently absent and variably specific for this condition. The symptoms generally reflect, but may be dissociated from, the hemodynamic derangements of elevated left-sided and right-sided pressures and impaired cardiac output or cardiac output reserve.
Dyspnea, or perceived shortness of breath, is the most common symptom of patients with heart failure. In most patients, dyspnea is present only with activity or exertion. The underlying mechanisms are multifactorial. The most important is pulmonary congestion with increased interstitial or intra-alveolar fluid, which activates juxtacapillary J receptors, which stimulate a rapid and shallow pattern of breathing. Increased lung stiffness may enhance the work of breathing, leading to a perception of dyspnea.
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