Congestive Heart Failure

Sep 16, 2019 admin TIM MẠCH 0

Congestive Heart Failure

Aka: Congestive Heart Failure, CHF, Heart Failure, Dropsy

II. Epidemiology

  1. Lifetime risk: 20% in U.S.
  2. Prevalence: 5.2 Million with CHF in the United States
  3. Incidence: 400,000 cases CHF diagnosed per year
  4. Morbidity: 870,000 hospitalizations (estimates in 2013 approach 1 Million)
    1. Re-hospitalization rate within 30 days approaches 20%
  5. Mortality: 200,000 patients die from CHF per year
  6. CHF costs
    1. Accounts for 5-10% of all hospital admissions
    2. Annual U.S. Cost: $38.1 billion ($44.6 billion by 2015)

III. Pathophysiology

  1. Heart Failure is a syndrome, not a disease
    1. Heart Failure is a final common pathway
    2. Maximize treatment of the underlying causes
    3. Control the causes and prevent end organ damage

IV. Precautions

  1. Heart Failure is a clinical diagnosis best made by an astute clinician with history and exam
  2. Labs (e.g. BNP) and diagnostics (e.g. Echocardiogram) should be adjunctive only to confirm and follow the diagnosis

V. Evaluation

  1. See Systolic Dysfunction
  2. See Diastolic Dysfunction
  3. See Framingham Heart Failure Diagnostic Criteria

VI. Causes

  1. See Heart Failure Causes

VII. Types

  1. Systolic Dysfunction (60-70% of Heart Failure cases)
    1. Decreased contractility
    2. Decreased Left Ventricular Ejection Fraction
  2. Diastolic Dysfunction (30-40% of Heart Failure cases)
    1. Decreased compliance
    2. Decreased filling
    3. Variable Left Ventricular Ejection Fraction

VIII. Labs

  1. See Systolic Heart Failure

IX. Diagnostics

  1. See Chest XRay in Congestive Heart Failure
  2. See Echocardiogram in Congestive Heart Failure
    1. All CHF patients should undergo Echocardiogram

X. Classification: Congestive Heart Failure

  1. See NYHA Heart Failure Classification

XI. Management

  1. See Systolic Dysfunction
  2. See Diastolic Dysfunction
  3. See Congestive Heart Failure Exacerbation Management
  4. See Congestive Heart Failure Exacerbation Decision Rule

XII. Resources

  1. American Heart Association CHF Website
    1. http://www.americanheart.org/chf

XIII. Associated Conditions

  1. Central Sleep Apnea (60% pretest probability)

XIV. References

  1. Hunt (2009) Circulation 119(14):e391-479 [PubMed]
  2. King (2012) Am Fam Physician 85(12): 1161-8 [PubMed]
  3. Hoyt (2001) Am Fam Physician 63(8):1593-8 [PubMed]
  4. Senni (1997) Mayo Clin Proc 72:453-60 [PubMed]
  5. (1995) Circulation 92:2764-84 [PubMed]
  6. (1999) J Card Fail 5:357-82 [PubMed]

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