Congestive heart failure history and symptoms
Editor-In-Chief: C. Michael Gibson, M.S., M.D. ; Associate Editor(s)-In-Chief: Lakshmi Gopalakrishnan, M.B.B.S. 
The classic symptoms of heart failure include dyspnea, fatigue, and fluid retention. Patients with heart failure present in different ways. Some patients present with exercise intolerance but show little evidence of congestion or edema. Other patients present with mild symptoms of edema and pulmonary congestion. The ejection fraction is usually below 35% in patients who are symptomatic with systolic heart failure.
- Table bellow shows Symptoms and signs of heart failure:
|Typical symptoms||More specific signs|
||Elevated jugular venous pressure
|Less typical symptoms||Less specific signs|
||Weight gain (>2 kg/week)|
|The above table adopted from 2021 ESC Guideline|
Symptoms of Left Sided Congestive Heart Failure
The left side pumps blood into the systemic circulation, while the right side pumps blood into the pulmonary circulation. Although left-sided heart failure will reduce forward cardiac output to the systemic circulation, the initial symptoms are often due to pulmonary congestion. In systolic dysfunction, the ejection fraction is decreased, leaving an abnormally elevated volume of blood in the left ventricle. In diastolic dysfunction, left ventricular end-diastolic pressure will be high. This increase in volume or pressure backs up to the left atrium and then into the pulmonary veins. Increased volume or pressure in the pulmonary veins impairs the normal drainage of the alveoli and favors the flow of fluid from the capillaries to the lung parenchyma, causing pulmonary edema. This impairs gas exchange and results in hypoxemia. Thus, left-sided heart failure often presents with respiratory symptoms including:
- Frothy sputum
- Nocturnal cough
- Paroxysmal nocturnal dyspnea
- Shortness of breath
New York Heart Association Criteria (NYHA)
The following criteria are often used to gauge the severity of heart failure:
- NYHA I: No symptoms with ordinary activity.
- NYHA II: Slight limitation of physical activity. Comfortable at rest, but ordinary physical activity results in fatigue, palpitation, dyspnea, or angina.
- NYHA III: Marked limitation of physical activity. Comfortable at rest, but less than ordinary physical activity results in fatigue, palpitation, dyspnea, or anginal pain.
- NYHA IV: Unable to carry out any physical activity without discomfort. Symptoms of cardiac insufficiency present at rest.
- ↑ McDonagh TA, Metra M, Adamo M, Gardner RS, Baumbach A, Böhm M, Burri H, Butler J, Čelutkienė J, Chioncel O, Cleland J, Coats A, Crespo-Leiro MG, Farmakis D, Gilard M, Heymans S, Hoes AW, Jaarsma T, Jankowska EA, Lainscak M, Lam C, Lyon AR, McMurray J, Mebazaa A, Mindham R, Muneretto C, Francesco Piepoli M, Price S, Rosano G, Ruschitzka F, Kathrine Skibelund A (September 2021). "2021 ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure". Eur Heart J. 42 (36): 3599–3726. doi:10.1093/eurheartj/ehab368. PMID 34447992 Check
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