Heart failure

Alternative Names

Symptoms

• Weight gain
• Swelling of feet and ankles
• Swelling of the abdomen
• Pronounced neck veins
• Loss of appetite, indigestion
• Nausea and vomiting
• Shortness of breath with activity, or after lying down for a while
• Difficulty sleeping
• Fatigue, weakness, faintness
• Sensation of feeling the heart beat (palpitations)
• Irregular or rapid pulse
• Decreased alertness or concentration
• Cough
• Decreased urine production
• Need to urinate at night

Infants may sweat during feeding (or other exertion).

Some patients with heart failure have no symptoms. In these people, the symptoms may develop only with these conditions:

• Infections with high fever
• Anemia
• Abnormal heart rhythm (arrhythmias)
• Hyperthyroidism
• Kidney disease

Exams and Tests

A physical examination may reveal either an irregular or a rapid heartbeat. There may be distended neck veins, enlarged liver, swelling of the limbs (peripheral edema), and signs of fluid around the lungs (pleural effusion).

Listening to the chest with a stethoscope may reveal lung crackles or abnormal heart sounds. Blood pressure may be normal, high, or low.

An enlargement of the heart or decreased heart functioning may be seen on several tests, including the following:

• Echocardiogram
• Heart catheterization
• Chest x-ray
• Chest CT scan
• Cardiac MRI
• Nuclear heart scans (MUGA, RNV)
• ECG, which may also show arrhythmias

This disease may also alter the following test results:

• CBC
• Blood chemistry
• Serum sodium
• BUN
• Creatinine
• Liver function tests
• Serum uric acid
• Atrial natriuretic peptide (ANP) and brain natriuretic peptide (BNP)
• Urinalysis
• Urinary sodium
• Creatinine clearance
• Swan-Ganz measurements (right heart catheterization)

If excessive fluid has accumulated around the sac surrounding the heart (pericardium), you may need to have the fluid removed through a pericardiocentesis.

References

Hunt SA, Abraham WT, Chin MH, Feldman AM, Francis GS, Ganiats TG, et al. ACC/AHA 2005 Guideline Update for the Diagnosis and Management of Chronic Heart Failure in the Adult. J Am Coll Cardiol. 2005;46:1-82.