ContentsSynopsisCodesLook ForDiagnostic PearlsDifferential Diagnosis & PitfallsBest TestsManagement PearlsTherapyDrug Reaction DataReferencesView all Images (8)
Emergency: requires immediate attention
Congestive heart failure
Other Resources UpToDate PubMed
Emergency: requires immediate attention

Congestive heart failure

Contributors: Lucie Ford MD, Christine Osborne MD, Peter Joo, Abhijeet Waghray MD, David Peritz MD, Ryan Hoefen MD, PhD, Bruce Lo MD
Other Resources UpToDate PubMed

Synopsis

Emergent Care / Stabilization:
Acute decompensated heart failure (ADHF) in the crashing patient:
  • Airway / Breathing: Often, positive end-expiratory pressure (PEEP) is required via a continuous positive airway pressure (CPAP) or bilevel positive airway pressure (BiPAP) machine for increased work of breathing, hypoxia, or evidence of pulmonary edema on examination or imaging.
  • Circulation: Often, the patient presents as hypertensive (> 180/110); use aggressive vasodilators such as sublingual nitroglycerin (NTG) (paste takes 30 minutes to onset) or an NTG drip.
Use parenteral diuretics if it appears there is volume overload (flash pulmonary edema from a hypertensive emergency or pulmonary edema in an anuric end-stage renal disease [ESRD] patient with HF who missed dialysis).

About Congestive Heart Failure:
Heart failure (HF) is a clinical syndrome caused by any structural or functional cardiac impairment leading to the inability of the heart to pump enough blood to meet the body's demand. HF presents with fatigue, dyspnea on exertion, orthopnea, and fluid retention (peripherally or pulmonary).

Symptoms may include not being able to walk as far as previously; needing to sleep on more pillows; waking up from sleep gasping (paroxysmal nocturnal dyspnea); clothes or shoes feeling tighter; nonproductive cough, especially when lying flat; and early satiety. HF is broken down into the following classifications:
  • Reduced ejection fraction (EF):
    • HF with reduced EF (HFrEF): systolic heart failure (left ventricular ejection fraction [LVEF] 40% or below)
    • HF with improved EF (HFimpEF): previous HFrEF on therapy and LVEF 40% or above
  • Mid-range EF:
    • HF with mildly reduced EF or mid-range EF (HFmrEF): HF with LVEF between 40% and 50%
    • Requires serial monitoring to project trajectory over time and further objective measures
  • Impaired ventricular filling:
    • HF with preserved EF (HFpEF): diastolic heart failure (LVEF 50% or above)
    • At least 50% of cases and prevalence is increasing
American College of Cardiology / American Heart Association (ACA / AHA) stages:
  • Stage A: at risk for HF
  • Stage B: pre-HF
  • Stage C: symptomatic HF
  • State D: advanced HF
New York Heart Association (NYHA) classification:
  • Characterizes symptoms and functional capacity of symptomatic and advanced HF
  • Independent predictor of mortality
    • Class 1: no limitation of physical activity
    • Class 2: slight limitation of physical activity
    • Class 3: marked limitation of physical activity
    • Class 4: symptoms with rest; discomfort with any activity
Predisposing factors: hypertension (HTN); diabetes mellitus (DM), obesity, obstructive sleep apnea (OSA), cardiovascular disease (CVD), and substance abuse (eg, nicotine, stimulants, alcohol)

Other causes:
Epidemiology:
  • New annual diagnosis: approximately 500 000 patients per year.
  • Mortality: approximately 300 000 individuals per year.
  • Self-identified non-Hispanic Black patients have highest incidence of HF hospitalizations and mortality.
  • Incidence is proportional to age and is higher in men, as women present later.
  • Lifetime risk of development is approximately 20% in those 40 years and older.
  • Survival median time once classified as NYHA class 3 is 1.7 years for men and 3.2 years for women, with a 5-year survival rate of 25% and 38%, respectively.

Codes

ICD10CM:
I50.9 – Heart failure, unspecified

SNOMEDCT:
42343007 – Congestive heart failure

Look For

Subscription Required

Diagnostic Pearls

Subscription Required

Differential Diagnosis & Pitfalls

Best Tests

Subscription Required

Management Pearls

Subscription Required

Therapy

Subscription Required

Drug Reaction Data

Below is a list of drugs with literature evidence indicating an adverse association with this diagnosis. The list is continually updated through ongoing research and new medication approvals. Click on Citations to sort by number of citations or click on Medication to sort the medications alphabetically.

Subscription Required

References

Subscription Required

Last Reviewed:08/31/2022
Last Updated:09/08/2022
Copyright © 2022 VisualDx®. All rights reserved.
Emergency: requires immediate attention
Congestive heart failure
A medical illustration showing key findings of Congestive heart failure : Fatigue, Neck vein distension, Peripheral leg edema, Dyspnea, Hypertension, Orthopnea, Rales
Imaging Studies image of Congestive heart failure - imageId=6789440. Click to open in gallery.  caption: 'PA chest xray demonstrating interstitial pulmonary edema with linear opacities throughout both lungs, peribronchial cuffing, and bilateral small pleural effusions, right, (small red arrow), and left, (small yellow arrow). In addition, there is a large hiatal hernia, (long red arrow).'
PA chest xray demonstrating interstitial pulmonary edema with linear opacities throughout both lungs, peribronchial cuffing, and bilateral small pleural effusions, right, (small red arrow), and left, (small yellow arrow). In addition, there is a large hiatal hernia, (long red arrow).
Copyright © 2022 VisualDx®. All rights reserved.