Congestive Heart Failure (CHF) Part 1

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Inability of heart to pump blood out, resulting in the fluid build up in lungs and other body tissues is called heart failure or congestive heart failure. This condition usually is attributable to the left heart failure but it can occur due to left, right, or failure of both sides. Remember as a rule the fluid will build up behind the heart that is failing. Lungs are behind the left heart and rest of the body tissue is behind the right heart.

Heart failure is a disease of aging. 75% of new cases occur in individuals over 65 years of age.

Some conditions leading to the CHF can be reversed while many conditions can only be slowed down in their progress.

Diagnostic Essentials

For the left heart fluid build up in the lungs leading to dyspnea and symptoms of the low cardiac output to body tissues.

Right hear failure is usually due to the left heart failure. Fluid overload is predominant cause of clinical signs and symptoms.

It is said that left heart failure has symptoms (dyspnea for example) and right heart failure has signs (ankle edema for example). This is a quick aid for approaching the patient, but not the whole story.

Clinical Signs and Symptoms

Left Heart Failure

  1. Dyspnea due to fluid build up (edema) in the lungs.
    • Exertional dyspnea -> Othopnea -> Proxysmal Nocturnal Dyspnea -> Rest Dypnea.
    • Dyspnea during conversation.
  2. Persistent non-productive Cough. (J receptors in the lungs irritated due to the edematous exudate.)
  3. Nocturia due to fluid pressure on the kidneys at night.
  4. Fatique and exercise intolerence
  5. Elevated pulmonary venous pressure. (Same reason as point 1.)
  6. Crackles at the base of the lungs.
  7. Listen for murmurs to exclude other heart conditions.

Right Heart Failure

  1. Can be primary (without left heart failure) 50%, or secondary (due to the left heart failure.) 50%.
  2. Gravitational edema is common sign. (Ankle or lower back.)
    1. Ankle edema
    2. Hepatic congestion
    3. Lower-back Edema at nigh
    4. Edema of the gut causing anorexia and nausea
    5. Ascites
  3. When right heart failure is due to the left heart failure then distinguishing between the two can become difficult.
  4. High jugular venous pulse.
  5. May have tender liver.
  6. Tricuspid regurge.
  7. Listen for murmurs to exclude other heart conditions.

Common Signs


  1. Observe neck, lungs, trunk and extremities for signs.
  2. Cachexia
  3. Tachycardia with hypotension and reduced pulse pressure
  4. Crackles


NYHA Classification

  • Class I: Asymptomatic
  • Class II: Symptomatic after moderate activity
  • Class III: Symptomatic after mild activity
  • Class IV: Symptomatic even at rest


Common causes are

  1. Systolic Dysfunction

    1. Systemic Hypertension
    2. Coronary Artery Disease
    3. Alcoholic Cardiac Myopathy
    4. Viral Myocarditis including HIV
    5. Idiopathic Cardiomyopathy
    6. Persistent Tachycardia due to Atrial Arrythmia
  2. Diastolic Dysfunction

    1. Aging
    2. Hypertension leading to Left Ventricular Hypertrophy (LVH)
    3. Restrictive/Hypertrophic Cardiac Myopathies
    4. Diabetes

We will continue Labs, ECG changes, and Treatment in the next parts




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