Heart Failure

Updated: May 14, 2024
  • Author: Ioana Dumitru, MD; Chief Editor: Gyanendra K Sharma, MD, FACC, FASE  more...
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Overview

Practice Essentials

Heart failure develops when the heart, via an abnormality of cardiac function (detectable or not), fails to pump blood at a rate commensurate with the requirements of the metabolizing tissues or is able to do so only with an elevated diastolic filling pressure. See the image below.

Heart Failure. This chest radiograph shows an enlaHeart Failure. This chest radiograph shows an enlarged cardiac silhouette and edema at the lung bases, signs of acute heart failure.

Signs and symptoms

Signs and symptoms of heart failure include the following:

  • Exertional dyspnea and/or dyspnea at rest
  • Orthopnea
  • Acute pulmonary edema
  • Chest pain/pressure and palpitations
  • Tachycardia
  • Fatigue and weakness
  • Nocturia and oliguria
  • Anorexia, weight loss, nausea
  • Exophthalmos and/or visible pulsation of eyes
  • Distention of neck veins
  • Weak, rapid, and thready pulse
  • Rales, wheezing
  • S3 gallop and/or pulsus alternans
  • Increased intensity of P2 heart sound
  • Hepatojugular reflux
  • Ascites, hepatomegaly, and/or anasarca
  • Central or peripheral cyanosis, pallor

See Presentation for more detail.

Diagnosis

Heart failure criteria, classification, and staging

The Framingham criteria for the diagnosis of heart failure consists of the concurrent presence of either two major criteria or one major and two minor criteria. [1]

Major criteria comprise the following:

  • Paroxysmal nocturnal dyspnea
  • Weight loss of 4.5 kg in 5 days in response to treatment
  • Neck vein distention
  • Rales
  • Acute pulmonary edema
  • Hepatojugular reflux
  • S3 gallop
  • Central venous pressure
 
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