Congestive heart failure differential diagnosis: Difference between revisions

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{{Infobox_Disease |
__NOTOC__
  Name          = Heart failure |
{| class="infobox" style="float:right;"
  Image          = |
|-
  Caption        = |
|[[File:Siren.gif|30px|link= Heart failure resident survival guide]]||<br>||<br>
  DiseasesDB    = 16209 |
|[[Heart failure resident survival guide|'''Resident'''<br>'''Survival'''<br>'''Guide''']]
  ICD10          = {{ICD10|I|50|0|i|50}} |
|}
  ICD9          = {{ICD9|428.0}} |
  ICDO          = |
  OMIM          = |
  MedlinePlus    = 000158 |
  eMedicineSubj  = med |
  eMedicineTopic = 3552 |
  MeshID        = D006333|
}}


{{SI}}
[[Image:Home_logo1.png|right|250px|link=http://www.wikidoc.org/index.php/Congestive_heart_failure]]
{{WikiDoc Cardiology Network Infobox}}
{{CMG}};{{AE}}{{MehdiP}}{{HK}}
{{WikiDoc Cardiology News}}
{{CMG}}


==Differential Diagnosis of Heart Failure==
==Overview==
Congestive heart failure should be distinguished from other conditions that cause [[dyspnea]], [[fatigue]] and [[edema]].


===Heart Failure Secondary to Coronary Artery Disease===
==Differentiating Congestive Heart Failure from other Diseases==
Heart failure is a clinical syndrome of [[dyspnea]], [[fatigue]] and [[edema]]. There are several disorders that cause [[heart failure]] and should not be confused with the syndrome of heart failure.


====A. Underlying Mechanisms====
*[[Cardiac arrest]] and [[asystole]] refer to situations in which there is ''no'' cardiac output at all. Without urgent treatment these result in [[sudden death]].
#Ischemic Preconditioning
*[[Myocardial infarction]] ("Heart attack") refers to heart muscle damage due to an insufficient blood supply to the heart, usually as a result of a blocked [[coronary artery]].
#:*Reductions in ischemia-related apoptosis
*[[Cardiomyopathy]] refers specifically to problems within the heart muscle, and these problems can result in heart failure. [[Ischemic cardiomyopathy]] implies that the cause of muscle damage is [[coronary artery disease]]. [[Dilated cardiomyopathy]] implies that the muscle damage has resulted in enlargement of the heart. [[Hypertrophic cardiomyopathy]] involves enlargement and ''thickening'' of the heart muscle.
#:*Increases in endogenous adenosine
*There are non-cardiac causes of [[edema]] that primarily involve the lung or respiratory system.  These conditions are distinguished from heart failure in so far as they do not cause [[peripheral edema]], and they are not be associated with an elevation in [[BNP]].
#:*Activation of potassium-adenosine triphosphate (K+-ATP) channels
#Electrical Dysfunction
#:*QT prolongation
#:*Increased susceptibility to arrhythmia
#:*QT dispersion
#Mechanical Dysfunction
#:*Systolic dysfunction
#:*Diastolic dysfunction
#Biochemical Dysfunction
#:*Increases in beta-adrenergic receptor density
#:*Changes in structural and regulatory proteins
#:*Shift to FFA as a proffered metabolic substrate
#:*Lactate production
#:*Elevated BNP concentration


====B. Utilisation of Clinical Data====


Management of heart failure due to coronary artery disease are primarily influenced by following parameters:
{| style="border: 0px; font-size: 90%; margin: 3px;" align="center"
#An estimate of the relative proportions of:
! colspan="1" rowspan="1" style="background: #4479BA; padding: 5px 5px;" |{{fontcolor|#FFFFFF|Organ System}}
#:*Viable but ischemic myocardium
! colspan="1" rowspan="1" style="background: #4479BA; padding: 5px 5px;" |{{fontcolor|#FFFFFF|Disease}}
#:*Nonviable myocardium
! colspan="1" rowspan="1" style="background: #4479BA; padding: 5px 5px;" |{{fontcolor|#FFFFFF|Symptoms}}
#:*Viable non-ischemic myocardium
! colspan="1" rowspan="1" style="background: #4479BA; padding: 5px 5px;" |{{fontcolor|#FFFFFF|Signs}}
#The technical feasibility of successful mechanical revascularization
! colspan="1" rowspan="1" style="background: #4479BA; padding: 5px 5px;" |{{fontcolor|#FFFFFF|Laboratory findings}}
#The extent and severity of comorbidities in the individual patient
! colspan="1" rowspan="1" style="background: #4479BA; padding: 5px 5px;" |{{fontcolor|#FFFFFF|Diagnostic modality}}
! colspan="1" rowspan="1" style="background: #4479BA; padding: 5px 5px;" |{{fontcolor|#FFFFFF|Management}}
|-
| colspan="1" rowspan="6" style="background: #4479BA; padding: 5px 5px;" |{{fontcolor|#FFFFFF|Cardiac}}
| style="padding: 5px 5px; background: #F5F5F5;" |HFpEF (Heart Failure with preserved Ejection Fraction
| style="padding: 5px 5px; background: #F5F5F5;" |Exertional [[dyspnea]], reduced exercise tolerance, [[orthopnea]], [[paroxysmal nocturnal dyspnea]], edema
| style="padding: 5px 5px; background: #F5F5F5;" |Elevated [[Jugular venous pressure|JVP]], fine [[Rales|crackles]], [[edema]]
| style="padding: 5px 5px; background: #F5F5F5;" |Increased [[Brain natriuretic peptide|BNP]]
| style="padding: 5px 5px; background: #F5F5F5;" |[[Echocardiography]] (EF ≥ 50 %)
| style="padding: 5px 5px; background: #F5F5F5;" |Control of volume overload and [[hypertension]],
treatment of underlying condition ([[obesity]], [[Atrial fibrillation|AF]], [[coronary artery disease]], [[anemia]])
|-
| style="padding: 5px 5px; background: #F5F5F5;" |HFrEF (Heart Failure with reduced Ejection Fraction)
| style="padding: 5px 5px; background: #F5F5F5;" |Exertional [[dyspnea]], reduced exercise tolerance, [[orthopnea]], [[paroxysmal nocturnal dyspnea]], edema
| style="padding: 5px 5px; background: #F5F5F5;" |Elevated [[Jugular venous pressure|JVP]], fine [[Rales|crackles]], [[edema]]
| style="padding: 5px 5px; background: #F5F5F5;" |Increased [[Brain natriuretic peptide|BNP]]
| style="padding: 5px 5px; background: #F5F5F5;" |[[Echocardiography]] (EF ≤ 40 %)
| style="padding: 5px 5px; background: #F5F5F5;" |[[Diuretics]], [[ACE inhibitor|ACE inhibitors]], [[Angiotensin II receptor antagonist|ARBs]], [[beta blockers]], [[nitrates]]
|-
| style="padding: 5px 5px; background: #F5F5F5;" |Pericardial disease
| style="padding: 5px 5px; background: #F5F5F5;" |Exercise intolerance, [[dyspnea]], [[fatigue]]
| style="padding: 5px 5px; background: #F5F5F5;" |Elevated [[Jugular venous pressure|JVP]], pericardial knock, [[kussmaul's sign]], [[pulsus paradoxus]]
| style="padding: 5px 5px; background: #F5F5F5;" |<nowiki>-</nowiki>
| style="padding: 5px 5px; background: #F5F5F5;" |Echocardiography, ECG
| style="padding: 5px 5px; background: #F5F5F5;" |Diuretics, [[pericardiectomy]]
|-
| style="padding: 5px 5px; background: #F5F5F5;" |[[Hypertrophic cardiomyopathy]]
| style="padding: 5px 5px; background: #F5F5F5;" |Dyspnea, [[chest pain]], [[palpitation]], [[lightheadedness]]
| style="padding: 5px 5px; background: #F5F5F5;" |[[Systolic murmurs|Systolic murmur]]
| style="padding: 5px 5px; background: #F5F5F5;" |<nowiki>-</nowiki>
| style="padding: 5px 5px; background: #F5F5F5;" |Echocardiography, ECG
| style="padding: 5px 5px; background: #F5F5F5;" |[[Beta blockers]], [[verapamil]]
|-
| style="padding: 5px 5px; background: #F5F5F5;" |Valvular disease ([[Mitral regurgitation|MR]], [[Tricuspid regurgitation|TR]])
| style="padding: 5px 5px; background: #F5F5F5;" |Edema, [[fatigue]], exercise intolerance, dyspnea, [[lightheadedness]]
| style="padding: 5px 5px; background: #F5F5F5;" |[[Cardiac murmur]]
| style="padding: 5px 5px; background: #F5F5F5;" |<nowiki>-</nowiki>
| style="padding: 5px 5px; background: #F5F5F5;" |Echocardiography, ECG
| style="padding: 5px 5px; background: #F5F5F5;" |Valve repair or replacement, diuretics, [[beta blockers]]
|-
| style="padding: 5px 5px; background: #F5F5F5;" |[[Arrhythmia]]
| style="padding: 5px 5px; background: #F5F5F5;" |Palpitation, lightheadedness, [[Chest pain|chest tightness]]
| style="padding: 5px 5px; background: #F5F5F5;" |[[Tachycardia]], abnormal pulse
| style="padding: 5px 5px; background: #F5F5F5;" |<nowiki>-</nowiki>
| style="padding: 5px 5px; background: #F5F5F5;" |Echocardiography, ECG, [[holter monitoring]]
| style="padding: 5px 5px; background: #F5F5F5;" |[[Cardioversion|Pharmacological cardioversion]] (anti arrhythmics), [[Cardioversion|electrical cardioversion]], [[ablation]]
|-
| colspan="1" rowspan="4" style="background: #4479BA; padding: 5px 5px;" |{{fontcolor|#FFFFFF|Pulmonary}}
| style="padding: 5px 5px; background: #F5F5F5;" |[[Chronic obstructive pulmonary disease|Chronic airway disease]]
| style="padding: 5px 5px; background: #F5F5F5;" |[[Cough]], dyspnea, chest pain, exercise intolerance
| style="padding: 5px 5px; background: #F5F5F5;" |Tachypnea, respiratory distress, [[cyanosis]], edema, [[rhonchi]] and [[crackles]]
| style="padding: 5px 5px; background: #F5F5F5;" |[[Hypoxemia]], hypercapnea, [[polycythemia]],
| style="padding: 5px 5px; background: #F5F5F5;" |[[PFTs|PFT]], chest imaging
| style="padding: 5px 5px; background: #F5F5F5;" |[[Bronchodilator|Bronchodilators]], [[Corticosteroid|corticosteroids]], [[Anticholinergic|anticholinergics]]
|-
| style="padding: 5px 5px; background: #F5F5F5;" |[[Interstitial lung disease|Interstitial lung diseaee]]
| style="padding: 5px 5px; background: #F5F5F5;" |Exercise intolerance, cough
| style="padding: 5px 5px; background: #F5F5F5;" |Crackles, [[clubbing]], cyanosis
| style="padding: 5px 5px; background: #F5F5F5;" |Hypoxemia
| style="padding: 5px 5px; background: #F5F5F5;" |PFT, Chest imaging, lung biopsy
| style="padding: 5px 5px; background: #F5F5F5;" |Corticosteroids, bronchodilators
|-
| style="padding: 5px 5px; background: #F5F5F5;" |[[Pulmonary hypertension]]
| style="padding: 5px 5px; background: #F5F5F5;" |Dyspnea, fatigue, chest pain, [[syncope]], [[palpitation]]
| style="padding: 5px 5px; background: #F5F5F5;" |Edema, clubbing, elevated [[Jugular venous pressure|JVP]], [[Tricuspid regurgitation|TR]] murmur
| style="padding: 5px 5px; background: #F5F5F5;" |Elevated BNP, elevated [[d-dimer]]
| style="padding: 5px 5px; background: #F5F5F5;" |Echocardiography, cardiac cathaterization
| style="padding: 5px 5px; background: #F5F5F5;" |Diuretics, [[Calcium channel blocker|calcium channel blockers]], [[endothelin receptor antagonist]], [[Sildenafil|phosphodiesterase 5 inhibitor]]
|-
| style="padding: 5px 5px; background: #F5F5F5;" |[[Sleep apnea]]
| style="padding: 5px 5px; background: #F5F5F5;" |[[Snoring]], [[somnolence]], headache, fatigue, irritability
| style="padding: 5px 5px; background: #F5F5F5;" |tachypnea, hypertension, tachycardia
| style="padding: 5px 5px; background: #F5F5F5;" |Hypoxemia, polycythemia
| style="padding: 5px 5px; background: #F5F5F5;" |[[Polysomnography]]
| style="padding: 5px 5px; background: #F5F5F5;" |Weight reduction, [[CPAP]]
|-
| colspan="1" rowspan="2" style="background: #4479BA; padding: 5px 5px;" |{{fontcolor|#FFFFFF|High output status}}
| style="padding: 5px 5px; background: #F5F5F5;" |[[Anemia]]
| style="padding: 5px 5px; background: #F5F5F5;" |Palpitation, lightheadedness, fatigue
| style="padding: 5px 5px; background: #F5F5F5;" |[[Cheilosis]], delayed capillary refill
| style="padding: 5px 5px; background: #F5F5F5;" |Decreased [[Hemoglobin|Hb]] and [[Hematocrit|HCT]]
| style="padding: 5px 5px; background: #F5F5F5;" |CBC, Iron study, [[Bone marrow examination|bone marrow aspiration]] and biopsy
| style="padding: 5px 5px; background: #F5F5F5;" |Iron replacement, nutritional support
|-
| style="padding: 5px 5px; background: #F5F5F5;" |[[Thyrotoxicosis]]
| style="padding: 5px 5px; background: #F5F5F5;" |Palpitation, [[sweating]], weight loss
| style="padding: 5px 5px; background: #F5F5F5;" |[[Proptosis]], tachycardia
| style="padding: 5px 5px; background: #F5F5F5;" |Decreased [[TSH]], increased [[Thyroid function tests|T3,T4]]
| style="padding: 5px 5px; background: #F5F5F5;" |[[Thyroid function tests|Thyroid function test]]
| style="padding: 5px 5px; background: #F5F5F5;" |[[Methimazole|Thyrostatics]], beta blockers, ablation
|-
| colspan="1" rowspan="2" style="background: #4479BA; padding: 5px 5px;" |{{fontcolor|#FFFFFF| |Others}}
| style="padding: 5px 5px; background: #F5F5F5;" |Liver disease
| style="padding: 5px 5px; background: #F5F5F5;" |Fatigue, edema, [[jaundice]]
| style="padding: 5px 5px; background: #F5F5F5;" |[[Ascites]], palmar erythema, [[gynecomastia]]
| style="padding: 5px 5px; background: #F5F5F5;" |Increased [[AST]] and [[ALT]], decreased [[albumin]], increased [[Bilirubin|Br]]
| style="padding: 5px 5px; background: #F5F5F5;" |Liver function test, Liver biopsy
| style="padding: 5px 5px; background: #F5F5F5;" |Diuretics, treatment of underlying disease
|-
| style="padding: 5px 5px; background: #F5F5F5;" |[[Chronic kidney disease]]
| style="padding: 5px 5px; background: #F5F5F5;" |Fatigue, anorexia, nausea, edema, decreased exercise tolerance
| style="padding: 5px 5px; background: #F5F5F5;" |Edema, hypertension, crackles
| style="padding: 5px 5px; background: #F5F5F5;" |Increased [[BUN]] and [[Cr]]
| style="padding: 5px 5px; background: #F5F5F5;" |BUN, Cr
| style="padding: 5px 5px; background: #F5F5F5;" |Control of blood pressure, anemia, [[dialysis]], [[Kidney transplantation|kidney transplant]]
|}


===Cardiomyopathies and Inflammatory Diseases===


=====[[Restrictive Cardiomyopathies]]=====
===Other Causes of Dyspnea===
*Primary (idiopathic)  
CHF should be differentiated from other diseases presenting with [[shortness of breath]] and [[tachypnea]]. The differentials include the following:<ref name="pmid24550636">{{cite journal |vauthors=Brenes-Salazar JA |title=Westermark's and Palla's signs in acute and chronic pulmonary embolism: Still valid in the current computed tomography era |journal=J Emerg Trauma Shock |volume=7 |issue=1 |pages=57–8 |year=2014 |pmid=24550636 |pmc=3912657 |doi=10.4103/0974-2700.125645 |url=}}</ref><ref name="urlCT Angiography of Pulmonary Embolism: Diagnostic Criteria and Causes of Misdiagnosis | RadioGraphics">{{cite web |url=http://pubs.rsna.org/doi/full/10.1148/rg.245045008 |title=CT Angiography of Pulmonary Embolism: Diagnostic Criteria and Causes of Misdiagnosis &#124; RadioGraphics |format= |work= |accessdate=}}</ref><ref name="pmid23940438">{{cite journal |vauthors=Bĕlohlávek J, Dytrych V, Linhart A |title=Pulmonary embolism, part I: Epidemiology, risk factors and risk stratification, pathophysiology, clinical presentation, diagnosis and nonthrombotic pulmonary embolism |journal=Exp Clin Cardiol |volume=18 |issue=2 |pages=129–38 |year=2013 |pmid=23940438 |pmc=3718593 |doi= |url=}}</ref><ref name="urlPulmonary Embolism: Symptoms - National Library of Medicine - PubMed Health">{{cite web |url=https://www.ncbi.nlm.nih.gov/pubmedhealth/PMHT0022657/ |title=Pulmonary Embolism: Symptoms - National Library of Medicine - PubMed Health |format= |work= |accessdate=}}</ref><ref name="pmid20118395">{{cite journal |vauthors=Ramani GV, Uber PA, Mehra MR |title=Chronic heart failure: contemporary diagnosis and management |journal=Mayo Clin. Proc. |volume=85 |issue=2 |pages=180–95 |year=2010 |pmid=20118395 |pmc=2813829 |doi=10.4065/mcp.2009.0494 |url=}}</ref><ref name="pmid18215495">{{cite journal |vauthors=Blinderman CD, Homel P, Billings JA, Portenoy RK, Tennstedt SL |title=Symptom distress and quality of life in patients with advanced congestive heart failure |journal=J Pain Symptom Manage |volume=35 |issue=6 |pages=594–603 |year=2008 |pmid=18215495 |pmc=2662445 |doi=10.1016/j.jpainsymman.2007.06.007 |url=}}</ref><ref name="pmid19168510">{{cite journal |vauthors=Hawkins NM, Petrie MC, Jhund PS, Chalmers GW, Dunn FG, McMurray JJ |title=Heart failure and chronic obstructive pulmonary disease: diagnostic pitfalls and epidemiology |journal=Eur. J. Heart Fail. |volume=11 |issue=2 |pages=130–9 |year=2009 |pmid=19168510 |pmc=2639415 |doi=10.1093/eurjhf/hfn013 |url=}}</ref><ref name="pmid9465867">{{cite journal |vauthors=Takasugi JE, Godwin JD |title=Radiology of chronic obstructive pulmonary disease |journal=Radiol. Clin. North Am. |volume=36 |issue=1 |pages=29–55 |year=1998 |pmid=9465867 |doi= |url=}}</ref><ref name="pmid14651761">{{cite journal |vauthors=Wedzicha JA, Donaldson GC |title=Exacerbations of chronic obstructive pulmonary disease |journal=Respir Care |volume=48 |issue=12 |pages=1204–13; discussion 1213–5 |year=2003 |pmid=14651761 |doi= |url=}}</ref><ref name="pmid23833163">{{cite journal |vauthors=Nakawah MO, Hawkins C, Barbandi F |title=Asthma, chronic obstructive pulmonary disease (COPD), and the overlap syndrome |journal=J Am Board Fam Med |volume=26 |issue=4 |pages=470–7 |year=2013 |pmid=23833163 |doi=10.3122/jabfm.2013.04.120256 |url=}}</ref><ref name="pmid20511488">{{cite journal |vauthors=Khandaker MH, Espinosa RE, Nishimura RA, Sinak LJ, Hayes SN, Melduni RM, Oh JK |title=Pericardial disease: diagnosis and management |journal=Mayo Clin. Proc. |volume=85 |issue=6 |pages=572–93 |year=2010 |pmid=20511488 |pmc=2878263 |doi=10.4065/mcp.2010.0046 |url=}}</ref><ref name="pmid23610095">{{cite journal |vauthors=Bogaert J, Francone M |title=Pericardial disease: value of CT and MR imaging |journal=Radiology |volume=267 |issue=2 |pages=340–56 |year=2013 |pmid=23610095 |doi=10.1148/radiol.13121059 |url=}}</ref><ref name="pmid11680112">{{cite journal |vauthors=Gharib AM, Stern EJ |title=Radiology of pneumonia |journal=Med. Clin. North Am. |volume=85 |issue=6 |pages=1461–91, x |year=2001 |pmid=11680112 |doi= |url=}}</ref><ref name="pmid23507061">{{cite journal |vauthors=Schmidt WA |title=Imaging in vasculitis |journal=Best Pract Res Clin Rheumatol |volume=27 |issue=1 |pages=107–18 |year=2013 |pmid=23507061 |doi=10.1016/j.berh.2013.01.001 |url=}}</ref><ref name="pmid16891436">{{cite journal |vauthors=Suresh E |title=Diagnostic approach to patients with suspected vasculitis |journal=Postgrad Med J |volume=82 |issue=970 |pages=483–8 |year=2006 |pmid=16891436 |pmc=2585712 |doi=10.1136/pgmj.2005.042648 |url=}}</ref><ref name="pmid123074">{{cite journal |vauthors=Stein PD, Dalen JE, McIntyre KM, Sasahara AA, Wenger NK, Willis PW |title=The electrocardiogram in acute pulmonary embolism |journal=Prog Cardiovasc Dis |volume=17 |issue=4 |pages=247–57 |year=1975 |pmid=123074 |doi= |url=}}</ref><ref name="pmid23413894">{{cite journal |vauthors=Warnier MJ, Rutten FH, Numans ME, Kors JA, Tan HL, de Boer A, Hoes AW, De Bruin ML |title=Electrocardiographic characteristics of patients with chronic obstructive pulmonary disease |journal=COPD |volume=10 |issue=1 |pages=62–71 |year=2013 |pmid=23413894 |doi=10.3109/15412555.2012.727918 |url=}}</ref><ref name="pmid23000104">{{cite journal |vauthors=Stein PD, Matta F, Ekkah M, Saleh T, Janjua M, Patel YR, Khadra H |title=Electrocardiogram in pneumonia |journal=Am. J. Cardiol. |volume=110 |issue=12 |pages=1836–40 |year=2012 |pmid=23000104 |doi=10.1016/j.amjcard.2012.08.019 |url=}}</ref><ref name="pmid26209947">{{cite journal |vauthors=Hazebroek MR, Kemna MJ, Schalla S, Sanders-van Wijk S, Gerretsen SC, Dennert R, Merken J, Kuznetsova T, Staessen JA, Brunner-La Rocca HP, van Paassen P, Cohen Tervaert JW, Heymans S |title=Prevalence and prognostic relevance of cardiac involvement in ANCA-associated vasculitis: eosinophilic granulomatosis with polyangiitis and granulomatosis with polyangiitis |journal=Int. J. Cardiol. |volume=199 |issue= |pages=170–9 |year=2015 |pmid=26209947 |doi=10.1016/j.ijcard.2015.06.087 |url=}}</ref><ref name="pmid20112390">{{cite journal |vauthors=Dennert RM, van Paassen P, Schalla S, Kuznetsova T, Alzand BS, Staessen JA, Velthuis S, Crijns HJ, Tervaert JW, Heymans S |title=Cardiac involvement in Churg-Strauss syndrome |journal=Arthritis Rheum. |volume=62 |issue=2 |pages=627–34 |year=2010 |pmid=20112390 |doi=10.1002/art.27263 |url=}}</ref>
*Tumor infiltration
*[[Amyloidosis]]
*Storage diseases
*Endocardial fibrosis
*[[Anthracyclines]]
*Eosinophilic heart disease  
*Radiation
*[[Hemochromatosis]]
*Cardiac transplant
*[[Sarcoidosis]]


=====[[Dilated Cardiomyopathies]]=====
<small>
*[[Duchenne muscular dystrophy]]
{|
*[[Becker's muscular dystrophy]]
|- style="background: #4479BA; color: #FFFFFF; text-align: center;"
*[[Limb-girdle muscular dystrophy]]
! rowspan="2" |<small>Diseases</small>
*[[Mitochondrial myopathy]]
! colspan="3" |<small>Diagnostic tests</small>
*:*[[Kearns-Sayre syndrome]]
! colspan="3" |<small>Physical Examination</small>
*[[Arrhythmogenic right ventricular dysplasia]]
| colspan="7" |<small>Symptoms
*[[Alcohol-Induced cardiomyopathy]]
! colspan="1" rowspan="2" |<small>Past medical history</small>
*[[Cocaine related cardiomyopathy]]
! rowspan="2" |<small>Other Findings</small>
*[[Diabetic cardiomyopathy]]
|- style="background: #4479BA; color: #FFFFFF; text-align: center;"
*[[Peripartum cardiomyopathy]]
!<small>CT scan and MRI</small>
*[[Anthracycline induced cardiomyopathy]]
!<small>EKG</small>
*[[Trastuzumab]] [[Herceptin-lnduced Cardiomyopathy]]
!<small>Chest X-ray</small>
!<small>Tachypnea</small>
!<small>Tachycardia</small>
!<small>Fever</small>
!<small>Chest Pain</small>
!<small>Hemoptysis</small>
!<small>Dyspnea on Exertion</small>
!<small>Wheezing</small>
!<small>Chest Tenderness</small>
!<small>Nasalopharyngeal Ulceration</small>
!<small>Carotid Bruit</small>
|-
| style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Pulmonary embolism]]
| style="background: #F5F5F5; padding: 5px; text-align:center" |
*On [[CT angiography]]:
**Intra-luminal filling defect
*On [[MRI]]:
**Narrowing of involved [[Blood vessel|vessel]]
**No contrast seen distal to [[obstruction]]
**Polo-mint sign (partial filling defect surrounded by contrast)
| style="background: #F5F5F5; padding: 5px;" |
*[[Pulmonary embolism electrocardiogram|S1Q3T3]] pattern representing acute [[right heart]] strain
| style="background: #F5F5F5; padding: 5px;" |
*[[Fleischner sign]] (enlarged pulmonary artery), [[Hampton's hump|Hampton hump]], [[Westermark's sign]]
| style="background: #F5F5F5; padding: 5px;" |✔
| style="background: #F5F5F5; padding: 5px;" |✔
| style="background: #F5F5F5; padding: 5px;" |✔ (Low grade)
| style="background: #F5F5F5; padding: 5px;" |✔
| style="background: #F5F5F5; padding: 5px;" |✔ (In case of massive PE)
| style="background: #F5F5F5; padding: 5px;" |✔
| style="background: #F5F5F5; padding: 5px;" | -
| style="background: #F5F5F5; padding: 5px;" | -
| style="background: #F5F5F5; padding: 5px;" | -
| style="background: #F5F5F5; padding: 5px;" | -
| style="background: #F5F5F5; padding: 5px;" |
*Hypercoagulating conditions ([[Factor V Leiden]], [[thrombophilia]], [[deep vein thrombosis]], immobilization, [[malignancy]], [[pregnancy]])
| style="background: #F5F5F5; padding: 5px;" |
*May be associated with [[metabolic alkalosis]] and [[syncope]]
|-
| style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Congestive heart failure]]
| style="background: #F5F5F5; padding: 5px;" |
*On [[Computed tomography|CT scan]]:
**[[Mediastinal lymphadenopathy]]
**Hazy [[mediastinal]] fat
*On [[Magnetic resonance imaging|MRI]]:
**Abnormality of [[cardiac]] chambers ([[Hypertrophy (medical)|hypertrophy]], dilation)
**Delayed enhancement [[MRI]] may help characterize the [[myocardial]] [[Tissue (biology)|tissue]] ([[fibrosis]])
**Late enhancement of contrast in conditions such as [[myocarditis]], [[sarcoidosis]], [[amyloidosis]], [[Anderson-Fabry disease|Anderson-Fabry]]'s disease, [[Chagas disease]])
| style="background: #F5F5F5; padding: 5px;" |
*Goldberg's criteria may aid in diagnosis of left ventricular dysfunction: (High specificity)
**[[S wave|S]]V1 or [[S wave|S]]V2 + [[R wave|R]]V5 or [[R wave|R]]V6 ≥3.5 mV
**Total [[QRS complex|QRS]] amplitude in each of the limb leads ≤0.8 mV
**[[R wave|R]]/[[S wave|S]] ratio <1 in lead V4
| style="background: #F5F5F5; padding: 5px;" |
*[[Cardiomegaly]]
| style="background: #F5F5F5; padding: 5px;" |✔
| style="background: #F5F5F5; padding: 5px;" |✔
| style="background: #F5F5F5; padding: 5px;" |✔
| style="background: #F5F5F5; padding: 5px;" | -
| style="background: #F5F5F5; padding: 5px;" | -
| style="background: #F5F5F5; padding: 5px;" |✔
| style="background: #F5F5F5; padding: 5px;" | -
| style="background: #F5F5F5; padding: 5px;" | -
| style="background: #F5F5F5; padding: 5px;" | -
| style="background: #F5F5F5; padding: 5px;" | -
| style="background: #F5F5F5; padding: 5px;" |
*Previous [[myocardial infarction]]
*[[Hypertension]] ([[Systemic hypertension|systemic]] and [[Pulmonary hypertension|pulmonary]])
*[[Cardiac arrhythmia|Cardiac arrythmias]]
*[[Viral]] infections ([[myocarditis]])
*[[Congenital heart disease|Congenital heart defects]]
| style="background: #F5F5F5; padding: 5px;" |
*[[Right heart failure]] associated with:
**[[Hepatomegaly]]
**Positive hepato-jugular reflex
**Increased [[jugular venous pressure]]
**[[Peripheral edema]]
*[[Left heart failure]] associated with:
**[[Pulmonary edema]]
**Eventual [[right heart failure]]
|-
| style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Percarditis]]
| style="background: #F5F5F5; padding: 5px;" |
*On contrast enhanced [[Computed tomography|CT scan]]:
**Enhancement of the [[pericardium]] (due to [[inflammation]])
**[[Pericardial effusion]]
**[[Pericardial calcification]]
*On [[gadolinium]]-enhanced fat-saturated [[Magnetic resonance imaging|T1-weighted MRI]]:
**[[Pericardial]] enhancement (due to [[inflammation]])
**[[Pericardial effusion]]
| style="background: #F5F5F5; padding: 5px;" |
*ST elevation
*PR depression
| style="background: #F5F5F5; padding: 5px;" |
*Large collection of fluid inside the pericardial sac (pericardial effusion)
*Calcification of pericardial sac
| style="background: #F5F5F5; padding: 5px;" |✔
| style="background: #F5F5F5; padding: 5px;" |✔
| style="background: #F5F5F5; padding: 5px;" |✔ (Low grade)
| style="background: #F5F5F5; padding: 5px;" |✔ (Relieved by sitting up and leaning forward)
| style="background: #F5F5F5; padding: 5px;" | -
| style="background: #F5F5F5; padding: 5px;" |✔
| style="background: #F5F5F5; padding: 5px;" | -
| style="background: #F5F5F5; padding: 5px;" | -
| style="background: #F5F5F5; padding: 5px;" | -
| style="background: #F5F5F5; padding: 5px;" | -
| style="background: #F5F5F5; padding: 5px;" |
*Infections:
**[[Viral]] (Coxsackie virus, [[Herpes simplex virus|Herpes virus]], [[Mumps virus]], [[Human Immunodeficiency Virus (HIV)|HIV]])
**[[Bacteria]] ([[Mycobacterium tuberculosis]]-common in developing countries)
**[[Fungal]] ([[Histoplasmosis]])
*Idiopathic in a large number of cases
*[[Autoimmune]]
*[[Uremia]]
*[[Malignancy]]
*Previous [[myocardial infarction]]
| style="background: #F5F5F5; padding: 5px;" |
*May be clinically classified into:
**Acute (< 6 weeks)
**Sub-acute (6 weeks - 6 months)
**Chronic (> 6 months)
|-
| style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Pneumonia]]
| style="background: #F5F5F5; padding: 5px;" |
*On [[Computed tomography|CT scan]]: (not generally indicated)
**[[Consolidation (medicine)|Consolidation]] ([[alveolar]]/lobar pneumonia)
**Peribronchial [[nodules]] ([[bronchopneumonia]])
**[[Ground glass opacification on CT|Ground-glass opacity]] (GGO)
**[[Abscess]]
**[[Pleural effusion]]
**On [[MRI]]:
*Not indicated
| style="background: #F5F5F5; padding: 5px;" |
*Prolonged [[PR interval]]
*Transient [[T wave]] inversions
| style="background: #F5F5F5; padding: 5px;" |
*[[Consolidation (medicine)|Consolidation]] ([[alveolar]]/lobar [[pneumonia]])
*Peribronchial [[nodules]] (bronchopneumonia)
*Ground-glass opacity (GGO)
| style="background: #F5F5F5; padding: 5px;" |✔
| style="background: #F5F5F5; padding: 5px;" |✔
| style="background: #F5F5F5; padding: 5px;" |✔
| style="background: #F5F5F5; padding: 5px;" |✔
| style="background: #F5F5F5; padding: 5px;" | -
| style="background: #F5F5F5; padding: 5px;" |✔
| style="background: #F5F5F5; padding: 5px;" |✔
| style="background: #F5F5F5; padding: 5px;" | -
| style="background: #F5F5F5; padding: 5px;" | -
| style="background: #F5F5F5; padding: 5px;" | -
| style="background: #F5F5F5; padding: 5px;" |
*Ill-contact
*Travelling
*[[Smoking]]
*[[Diabetes mellitus|Diabetic]]
*Recent hospitalization
*[[Chronic obstructive pulmonary disease]]
| style="background: #F5F5F5; padding: 5px;" |
*Requires [[Sputum|sputum stain]] and culture for diagnosis
*[[Empiric therapy|Empiric management]] usually started before [[Culture collection|culture]] results
|-
| style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Vasculitis]]
| style="background: #F5F5F5; padding: 5px;" |
*On [[Computed tomography|CT scan]]: ([[Takayasu's arteritis|Takayasu arteritis]])
**[[Blood vessel|Vessel]] wall thickening
**Luminal narrowing of [[pulmonary artery]]
**Masses or nodules ([[Anti-neutrophil cytoplasmic antibody|ANCA]]-associated granulomatous vasculitis)
*On [[Magnetic resonance imaging|MRI]]:


=====Inflammations=====
Homogeneous, circumferential [[Blood vessel|vessel]] wall [[swelling]]
*[[Viral Myocarditis]]
| style="background: #F5F5F5; padding: 5px;" |
*[[Rickettsial Myocarditis]]
*[[Bundle branch block|Right or left bundle-branch block]] ([[Churg-Strauss syndrome]])
*[[Bacterial Myocarditis]]
*[[Atrial fibrillation]] ([[Churg-Strauss syndrome]])
*Spirochetal Infections
*Non-specific [[ST interval|ST segment]] and [[T wave]] changes
*[[Myocarditis|Protozoal Myocarditis]]: [[Trypanosomiasis]] ([[Chagas Disease]])
| style="background: #F5F5F5; padding: 5px;" |
*[[Fungal myocarditis]]
*[[Nodule (medicine)|Nodules]]
*[[Giant Cell Myocarditis]]
*[[Cavitation]]
*[[Sarcoidosis]]
| style="background: #F5F5F5; padding: 5px;" |✔
| style="background: #F5F5F5; padding: 5px;" |✔
| style="background: #F5F5F5; padding: 5px;" |✔
| style="background: #F5F5F5; padding: 5px;" |✔
| style="background: #F5F5F5; padding: 5px;" |✔
| style="background: #F5F5F5; padding: 5px;" |✔
| style="background: #F5F5F5; padding: 5px;" | -
| style="background: #F5F5F5; padding: 5px;" |✔
| style="background: #F5F5F5; padding: 5px;" |✔
| style="background: #F5F5F5; padding: 5px;" |✔
| style="background: #F5F5F5; padding: 5px;" |
*[[Takayasu's arteritis|Takayasu arteritis]] usually found in persons aged 4-60 years with a mean of 30
*[[Giant-cell arteritis]] usually occurrs in persons aged > 60 years
*[[Churg-Strauss syndrome]] may present with [[asthma]], [[sinusitis]], transient [[pulmonary]] infiltrates and neuropathy alongwith [[cardiac]] involvement
*Granulomatous vasculitides may present with [[nephritis]] and [[upper airway]] ([[nasopharyngeal]]) destruction
| style="background: #F5F5F5; padding: 5px;" |
|-
| style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Chronic obstructive pulmonary disease]] (COPD)
| style="background: #F5F5F5; padding: 5px;" |
*On [[Computed tomography|CT scan]]:
**[[Chronic bronchitis]] may show [[bronchial]] wall thickening, scarring with bronchovascular irregularity, [[fibrosis]]
**[[Emphysema]] may show [[alveolar]] septal destruction and airspace enlargement (Centrilobular- upper lobe, panlobular- lower lobe)
**Giant bubbles
*On [[MRI]]:
**Increased diameter of [[pulmonary arteries]]
**Peripheral [[pulmonary]] [[vasculature]] attentuation
**Loss of retrosternal airspace due to right ventricular enlargement
**Hyperpolarized Helium MRI may show progressively poor ventilation and destruction of lung
| style="background: #F5F5F5; padding: 5px;" |
*[[Multifocal atrial tachycardia]] (atleast 3 distinct [[P waves|P wave]] morphologies)
| style="background: #F5F5F5; padding: 5px;" |
*Enlarged [[lung]] shadows ([[emphysema]])
*Flattening of [[diaphragm]] ([[emphysema]])
| style="background: #F5F5F5; padding: 5px;" |✔
| style="background: #F5F5F5; padding: 5px;" |✔
| style="background: #F5F5F5; padding: 5px;" | -
| style="background: #F5F5F5; padding: 5px;" | -
| style="background: #F5F5F5; padding: 5px;" | -
| style="background: #F5F5F5; padding: 5px;" |✔
| style="background: #F5F5F5; padding: 5px;" |✔
| style="background: #F5F5F5; padding: 5px;" | -
| style="background: #F5F5F5; padding: 5px;" | -
| style="background: #F5F5F5; padding: 5px;" | -
| style="background: #F5F5F5; padding: 5px;" |
*[[Smoking]]
*[[Alpha 1-antitrypsin deficiency|Alpha-1 antitrypsin deficiency]]
*Increased [[sputum]] production ([[chronic bronchitis]])
*[[Cough]]
| style="background: #F5F5F5; padding: 5px;" |
*[[Alpha 1-antitrypsin deficiency|Alpha 1 antitrypsin deficiency]] may be associated with [[hepatomegaly]]
|-
| style="background: #DCDCDC; padding: 5px; text-align: center;" |[[COVID-19-associated heart failure]]
| style="background: #F5F5F5; padding: 5px;" |
*CT: [[Cardiomegaly]], [[Pulmonary edema]]
*CMR: Signs of underlying [[myocarditis]] may be seen.
| style="background: #F5F5F5; padding: 5px;" |
*[[Left ventricular hypertrophy]]
*[[Low-voltage]] QRS
*Non-specific ST-T change
| style="background: #F5F5F5; padding: 5px;" |
*[[Cardiomegaly]]
*[[Pulmonary edema]] (interstitial, alveolar)
| style="background: #F5F5F5; padding: 5px;" |✔
| style="background: #F5F5F5; padding: 5px;" |✔
| style="background: #F5F5F5; padding: 5px;" | -
| style="background: #F5F5F5; padding: 5px;" | -
| style="background: #F5F5F5; padding: 5px;" |✔
| style="background: #F5F5F5; padding: 5px;" |✔
| style="background: #F5F5F5; padding: 5px;" | -
| style="background: #F5F5F5; padding: 5px;" | -
| style="background: #F5F5F5; padding: 5px;" | -
| style="background: #F5F5F5; padding: 5px;" | -
| style="background: #F5F5F5; padding: 5px;" | -
| style="background: #F5F5F5; padding: 5px;" |
*Increased [[NT-proBNP]] and cardiac [[troponin]]s levels
|}


===Congestive Heart Failure as a Consequence of Valvular Heart Disease===
=====Other Conditions that Cause Dyspnea that are Emergencies=====
*[[Aortic stenosis with Left Ventricular Systolic Dysfunction]]
The following emergency conditions should be excluded when diagnosing a patient with heart failure:
*[[Chronic aortic regurgitation]]
*[[Mitral Stenosis]]
*[[Chronic mitral regurgitation]]
*[[Acute aortic regurgitation]]
*[[Acute mitral regurgitation]]


===Congestive Hert Failure Secondary to Congenital Heart Disease===
*[[Asthma]] or [[bronchospasm]]
*[[Foreign body aspiration]]
*[[H. influenza epiglottitis]]
*[[Spontaneous pneumothorax]]


'''A. Causes of Congestive Heart Failure in Adults with Unoperated Congenital Heart Diseases'''
=====Non Cardiac Causes of Dyspnea=====
*[[Eisenmenger's syndrome]]
*Fibrocalcific degeneration of abnormal [[aortic valve]]
*Systemic ventricular dysfunction and/or [[tricuspid regurgitation]] in congenitally corrected transposition of the great arteries
*[[Atrial septal defect]] with [[mitral regurgitation]]] secondary to myxomatous mitral valve
*[[Congenital mitral regurgitation]]
*[[Arrhythmia]]
*[[Endocarditis]]
*Other degenerative diseases ([[coronary artery disease]], [[hypertension]])
*[[Drug abuse]], [[alcohol abuse]]
*[[Pregnancy]]


'''B. Causes of Congestive Heart Failure in Adults with Operated Congenital Heart Diseases'''
*[[Abdominal masses]]
*Myocardial dysfunction
*[[Acute bronchitis]]
*Valvular regurgitation
*[[Acute Chest Syndrome]]
*Persistent left-to-right shunt
*[[Acute myeloid leukemia]]
*Pulmonary vascular disease  
*[[Acute promyelocytic leukemia]]
*Prosthetic valve dysfunction
*[[Acute tracheobronchitis]]
*Status post [[Fontan operation]]
*[[AIDS]]
*[[Arrhythmia]]  
*[[Air pollution]]
*[[Endocarditis]]  
*[[Air-conditioner lung]]
*Other degenerative diseases ([[coronary artery disease]], [[hypertension]])
*[[Allergy]]
*[[Alpha 1-antitrypsin deficiency]]
*[[Altitude sickness]]
*[[Amniotic fluid embolism]]
*[[Amphotericin B]]
*[[Amyl nitrite]]
*[[Amyotrophic Lateral Sclerosis]] ([[ALS]])
*[[Anaphylactoid reactions]]
*[[Anaphylaxis]]
*[[Anemia]]
*[[Anthrax]]
*[[Anxiety]]
*[[Asbestosis]]
*[[Aspergillus clavatus]]
*[[Aspiration]]
*[[Asthma]]
*[[Atelectasis]]
*[[Atypical pneumonia]]
*[[Barium]]
*[[Beta-blockers]]
*[[Betazole]]
*[[Bird breeder's lung]]
*[[Bird fancier's lung]]
*[[Bland-White-Garland Syndrome]]
*[[Bleomycin]] in [[ABVD]]
*[[Blood transfusion]]
*[[Brain stem infarction]]
*[[Bronchial asthma]]
*[[Bronchial tumors]]
*[[Bronchiolitis]]
*[[Bronchiolitis obliterans]]
*[[Bronchiolitis obliterans organizing pneumonia]]
*[[Bronchitis]]
*[[Bronchogenic carcinoma]]
*[[Bronchoscopy]]
*[[Cardiovascular syphilis]]
*[[Caspofungin]]
*[[Cheese worker's lung]]
*[[Chemical worker's lung]]
*[[Chest trauma]]
*[[Chest tube]]
*[[Cholesterol pericarditis]]
*[[Bronchitis|Chronic bronchitis]]
*[[Chronic fatigue syndrome]]
*[[Chronic Obstructive Pulmonary Disease]] (COPD)
*[[Chylothorax]]
*[[Cirrhosis]]
*[[Cladosporium]]
*[[CMV Pneumonitis]]
*[[Community-acquired pneumonia]]
*[[Croup]]
*[[Cystic Fibrosis]]
*[[Daptomycin]]
*[[Decompression sickness]]
*Decreased thoracic or [[diaphragm]]atic excursion
*[[Diabetic coma]]
*[[Diffuse panbronchiolitis]]
*[[Diverticulosis]]
*[[Drugs]]
*[[Ehrlichiosis (canine)]]
*[[Empty nose syndrome]]
*[[Empyema, pleural]]
*[[Encephalitis]]
*[[Eosinophilic pneumonia]]
*[[Ephedrine]]
*[[Epidemic dropsy]]
*[[Erdheim-Chester disease]]
*[[Esophageal cancer]]
*Esophageal diseases with [[trachea]]l compression
*[[Exercise-induced asthma]]
*[[Extrinsic allergic alveolitis]]
*[[Fat embolism]]
*[[Fibrosing alveolitis, cryptogenic]]
*[[Gamma-Hydroxybutyric acid]]
*[[Gastroesophageal reflux]]
*[[Gemeprost]]
*[[Glatiramer acetate]]
*Glottal edema
*[[Goiter]]
*[[Goodpasture syndrome]]
*[[Grain handler's lung]]
*Gram-negative [[sepsis]]
*[[Guillain-Barre Syndrome]]
*[[Hemochlyothorax]]
*[[Hemothorax]]
*[[Histiocytosis X]]
*[[Hoose (disease)]]
*[[Humidifier lung]]
*[[Hydrochlyothorax]]
*[[Hypersensitivity Pneumonitis]]
*[[Hyperthyroidism]]
*[[Hypoxia]]
*[[Hysteria]]
*[[Idiopathic pulmonary fibrosis]]
*[[Iloprost]]
*[[Interstitial lung disease]]
*[[Intoxication]] ([[carbon monoxide]], [[cyanide]])
*Intrapulmonary receptor stimulation
*[[Intussusception (medical disorder)]]
*[[Iron deficiency anemia]]
*[[Irregular Heart Rhythms]]
*[[Ketorolac]]
*[[Kyphoscoliosis]]
*[[Laryngeal]]/[[bronchospasm]]
*[[Leukemia]]
*[[Lung cancer]]
*[[Lymphangitic metastases]]
*[[Lymphocytic interstitial pneumonia]]
*[[Lymphoma]]
*[[Malignant Mesothelioma]]
*[[Malt worker's lung]]
*[[Mediastinal tumors]]
*[[Megaloblastic Anemias]]
*[[Mercury (element)]]
*[[Metabolic acidosis]]
*[[Methyl isocyanate]]
*[[Micropolyspora faeni]]
*[[Miliary tuberculosis]]
*[[Mollusk shell hypersensitivity]]
*[[Mucor stolonifer]]
*Multiple [[rib fractures]]
*[[Myasthenia Gravis]]
*[[Myxoma]]
*[[Neuromuscular disease]]
*[[Obesity]]
*[[Phrenic nerve paralysis]]
*Pleural callosity
*[[Pneumoconiosis]]
*[[Pneumonia]]
*[[Pneumochlyothorax]]
*[[Pneumothorax]]
*[[Pleural Effusion]]
*Pleural fibrosis
*[[Polyradiculitis]]
*Pulmonary [[arteriovenous malformation]]
*[[Pulmonary Emphysema]]
*[[Pulmonary fibrosis]]
*[[Quincke's Edema]]
*[[Radiation]] pneumonitis
*[[Respiratory tract infection]]
*[[Sarcoidosis]]
*[[Shock]]
*[[Shock lung]]
*[[Sleep Apnea Syndrome]]
*[[Trauma]]
*[[Tracheal stenosis]]
*[[Tracheal tumors]]
*[[Tracheomalacia]]
*[[Tracheobronchial collapse]]
*[[Uremia]]


=== Right Ventricular Failure ===
===Other Causes of Fatigue===
Factors affected right ventricle and to be eliminated during management of congestive heart failure.
There are numerous non-cardiac causes of [[fatigue]]. Again, these non-cardiac causes are not associated with [[dyspnea]] and edema.
A. Right ventricular myocardial dysfunction
#[[Right ventricular myocardial infarction]]
#[[Dilated cardiomyopathy]]  
#[[Arrhythmogenic right ventricular dysplasia|Right ventricular dysplasia]]
B. Primary right ventricular pressure overload
#[[Left ventricular failure]]
#[[Mitral valve]] disease
#[[Atrial myxoma]]
#[[Pulmonary veno-occlusive disease]]
#[[Cor pulmonale]]
#:*[[Chronic obstructive pulmonary disease]]
#:*[[Primary pulmonary hypertension]]
#:*[[Pulmonary embolism]]
#[[Pulmonic stenosis]]
#:*[[Supravalvular pulmonic stenosis]]
#:*[[Valvular pulmonic stenosis]]
#:*[[Subvalvular pulmonic stenosis]]
#[[Ventricular septal defect]]
#Aortopulmonary communication
C. Primary right ventricular volume overload
#[[Pulmonic regurgitation]]
#[[Tricuspid regurgitation]]
#[[Atrial septal defect]]
#[[Partial anomalous pulmonary venous return]]
D. Impediment to right ventricular inflow
#[[Tricuspid stenosis]]
#[[Cardiac tamponade]]
#[[pericarditis |Constrictive pericarditis]]
#[[cardiomyopathy|Restrictive cardiomyopathy]]


== Differential Diagnosis of Causes of Heart Failure==
===Other Causes of Edema===
Other non cardiac causes of [[pedal edema]] are listed below.  Obviously, the majority of these disorders do not also cause dyspnea and fatigue, and that distinguishes them form heart failure.


===A. Left Ventricular Failure===
*[[ACE inhibitor]]
 
*[[Aceon]]
====Most Common Causes:====
*[[Acquired C1-esterase inhibitor deficiency]]
* [[Aortic Regurgitation|Aortic regurgitation]]
*[[Actos]]
* [[Aortic Stenosis|Aortic stenosis]]
*[[Acute glomerulonephritis]]
* [[Hypertension]]
*[[Addison's Disease]]
* [[Mitral Regurgitation|Mitral regurgitation]]
*[[Aldomet]]
* [[Myocardial ischemia]]
*[[Amlodipine]]
 
*Amniotic band
====Expanded List of Causes:====
*[[Angioneurotic edema]]
* [[Atrial fibrillation]]
*[[Angiotensin converting enzyme inhibitor]]
* [[Alcoholism]]
*[[Anemia]]
* [[Anemia]]
*[[Anorexia Nervosa]]
* [[Angina]]
*[[AV fistula]]
* [[Aortic Regurgitation|Aortic regurgitation]]
*[[Avandia]]
* [[Aortic Stenosis]]
*[[Bartter's Syndrome]]
* [[Arteriovenous fistula]]
*[[Beta blockers]]
* [[Beriberi]]
*[[Boils]]
* [[aneurysm|Cardiac aneurysm]]
*[[Bruise]]
* [[Cardiomyopathy]]
*[[Bulimia Nervosa]]
* [[pericarditis|Constrictive pericarditis]]
*[[Burn]]
* [[Drugs]], [[toxin]]s
*[[Cachexia]]
* [[Hypertension]]
*[[Carbuncle]]
* [[Hyperthyroidism]]
*[[Cardura]]
* [[Hypovolemia]]
*[[Cellulitis]]
* [[Hypoxia]]
*[[Chemotherapy]]
* Mediastinal tumors
*[[Cisplatin]]
* [[Mitral Regurgitation]]
*Cold (physical stimuli)
* [[Myocardial Infarction]]
*[[Contact dermatitis]]
* [[Paget's Disease]]
*[[Contusion]]
* [[Pancoast's Tumor]]
*[[Cushing's Syndrome]]
* [[Pericardial effusion]]
*[[Diltiazem]]
* [[Pericardial tamponade]]
*[[Drugs]]
* [[Perimyocarditis]]
*[[Docetax]]
* [[Protein deficiency]]
*[[Erysipelas]]
* [[Restrictive cardiomyopathy]]
*[[Exudative enteropathy]]
* [[Papillary muscle rupture|Rupture of the papillary muscles]]
*[[Filariasis]]
* [[Sepsis]]
*[[Fracture]]
* Vena Cava Superior Thrombosis
*[[Frostbite]]
 
*[[Gas gangrene]]
===B. Right Ventricular Failure ===
*[[Glitazones]]
 
*[[Gout]]
====Most Common Causes:====
*[[Hyperthyroidism]]
* [[Cardiomyopathy]]
*[[Hypoalbuminemia]]
* [[Cor pulmonale]]
*[[Hypoplasia]]
* [[myocarditis|Diffuse myocarditis]]
*[[Hypothyroidism]]
* Left heart failure
*[[Ibuprophen]]
 
*Idiopathic edema
====Other Causes:====
*[[Insect bite]]
* After [[left ventricular failure]]
*[[Irritant]]
* After pulmonary resection
*Ligamentous sprain
* [[Alveolitis|Allergic alveolitis]]
*[[Liver failure]]
* [[asthma|Bronchial asthma]]
*[[Lymph node]] mass
* [[bronchitis|Chronic bronchitis]]
*[[Malabsorption]]
* [[Alveolitis|Honeycomb lung]]
*[[Malnutrition]]
* [[Hyperglobulia]]
*Mediastinal cancer
* [[Emphysema]]
*[[Milroy's Disease]]
* [[Mitral Stenosis]]
*[[Minipress]]
* [[Right ventricular myocardial infarction]]
*[[Motrin]]
* [[Pickwickian Syndrome]]
*Musculoskeletal [[trauma]]
* Pleural fibrosis
*[[Neoplasm]]
* [[Pneumoconiosis]]
*[[Nephrotic Syndrome]]
* [[Pulmonary fibrosis]]
*[[ Nifedipine]]
* [[Pulmonic regurgitation]]
*[[Norvasc]]
* [[Pulmonic stenosis]]
*[[Osteomyelitis]]
* [[Sarcoidosis]]
*Peripheral nerve lesion
* [[pulmonary emboli|Severe relapsing pulmonary emboli]]
*[[Premenstrual]] edema
* [[Silicosis]]
*[[Scleroderma]]
* [[Tachycardia]]
*[[Sepsis syndrome]]
* [[Tricuspid insufficiency]]
*[[Snakebites]]
 
*[[Starvation]] [[edema]]
===C. Others ===
*[[Sunburn]]
* [[Ascorbic acid deficiency]]
*Surgical excision
* [[Cardiac amyloidosis]]
*[[Tendon]]ous strain
* [[Carnitine deficiency]]
*[[Thrombophlebitis]]
* Cervical vein stasis of non-cardiac genesis
*[[Thrombosis]]
* [[Congenital heart disease]]
*Tight clothing
* [[Cyanosis]] of non-cardiac genesis
*[[Trentinion]]
* [[Diabetes Mellitus]]
*[[Trichinosis]]
* [[Ddx:Dyspnea|Dyspnea]] of non-cardiac genesis
*[[Tumor]]s
* [[Edema]] of non-cardiac genesis
*[[Univasc]]
* [[Hemochromatosis]]
*[[Valproic acid]]
* [[Pleural effusion]] of non-cardiac genesis
*[[Varicose veins]]
* [[Pulmonary edema]] of non-cardiac genesis
*[[Vesinoid]]
* [[Thiamine deficiency]]
*[[vytorin]]
* [[Thyroid disease]]


==References==
==References==
{{Reflist|2}}
{{Reflist|2}}
{{WikiDoc Help Menu}}
{{WikiDoc Sources}}


{{SIB}}
[[Category:DiseaseState]]
[[Category:Cardiology]]
[[Category:Cardiology]]
[[Category:Disease]]
[[Category:Emergency medicine]]
[[Category:Emergency medicine]]
[[Category:Intensive care medicine]]
[[Category:Medicine]]
[[Category:Up-To-Date]]
[[Category:Up-To-Date cardiology]]

Latest revision as of 14:10, 8 September 2020



Resident
Survival
Guide

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1];Associate Editor(s)-in-Chief: Seyedmahdi Pahlavani, M.D. [2]Syed Hassan A. Kazmi BSc, MD [3]

Overview

Congestive heart failure should be distinguished from other conditions that cause dyspnea, fatigue and edema.

Differentiating Congestive Heart Failure from other Diseases

Heart failure is a clinical syndrome of dyspnea, fatigue and edema. There are several disorders that cause heart failure and should not be confused with the syndrome of heart failure.


Organ System Disease Symptoms Signs Laboratory findings Diagnostic modality Management
Cardiac HFpEF (Heart Failure with preserved Ejection Fraction Exertional dyspnea, reduced exercise tolerance, orthopnea, paroxysmal nocturnal dyspnea, edema Elevated JVP, fine crackles, edema Increased BNP Echocardiography (EF ≥ 50 %) Control of volume overload and hypertension,

treatment of underlying condition (obesity, AF, coronary artery disease, anemia)

HFrEF (Heart Failure with reduced Ejection Fraction) Exertional dyspnea, reduced exercise tolerance, orthopnea, paroxysmal nocturnal dyspnea, edema Elevated JVP, fine crackles, edema Increased BNP Echocardiography (EF ≤ 40 %) Diuretics, ACE inhibitors, ARBs, beta blockers, nitrates
Pericardial disease Exercise intolerance, dyspnea, fatigue Elevated JVP, pericardial knock, kussmaul's sign, pulsus paradoxus - Echocardiography, ECG Diuretics, pericardiectomy
Hypertrophic cardiomyopathy Dyspnea, chest pain, palpitation, lightheadedness Systolic murmur - Echocardiography, ECG Beta blockers, verapamil
Valvular disease (MR, TR) Edema, fatigue, exercise intolerance, dyspnea, lightheadedness Cardiac murmur - Echocardiography, ECG Valve repair or replacement, diuretics, beta blockers
Arrhythmia Palpitation, lightheadedness, chest tightness Tachycardia, abnormal pulse - Echocardiography, ECG, holter monitoring Pharmacological cardioversion (anti arrhythmics), electrical cardioversion, ablation
Pulmonary Chronic airway disease Cough, dyspnea, chest pain, exercise intolerance Tachypnea, respiratory distress, cyanosis, edema, rhonchi and crackles Hypoxemia, hypercapnea, polycythemia, PFT, chest imaging Bronchodilators, corticosteroids, anticholinergics
Interstitial lung diseaee Exercise intolerance, cough Crackles, clubbing, cyanosis Hypoxemia PFT, Chest imaging, lung biopsy Corticosteroids, bronchodilators
Pulmonary hypertension Dyspnea, fatigue, chest pain, syncope, palpitation Edema, clubbing, elevated JVP, TR murmur Elevated BNP, elevated d-dimer Echocardiography, cardiac cathaterization Diuretics, calcium channel blockers, endothelin receptor antagonist, phosphodiesterase 5 inhibitor
Sleep apnea Snoring, somnolence, headache, fatigue, irritability tachypnea, hypertension, tachycardia Hypoxemia, polycythemia Polysomnography Weight reduction, CPAP
High output status Anemia Palpitation, lightheadedness, fatigue Cheilosis, delayed capillary refill Decreased Hb and HCT CBC, Iron study, bone marrow aspiration and biopsy Iron replacement, nutritional support
Thyrotoxicosis Palpitation, sweating, weight loss Proptosis, tachycardia Decreased TSH, increased T3,T4 Thyroid function test Thyrostatics, beta blockers, ablation
Others Liver disease Fatigue, edema, jaundice Ascites, palmar erythema, gynecomastia Increased AST and ALT, decreased albumin, increased Br Liver function test, Liver biopsy Diuretics, treatment of underlying disease
Chronic kidney disease Fatigue, anorexia, nausea, edema, decreased exercise tolerance Edema, hypertension, crackles Increased BUN and Cr BUN, Cr Control of blood pressure, anemia, dialysis, kidney transplant


Other Causes of Dyspnea

CHF should be differentiated from other diseases presenting with shortness of breath and tachypnea. The differentials include the following:[1][2][3][4][5][6][7][8][9][10][11][12][13][14][15][16][17][18][19][20]

Diseases Diagnostic tests Physical Examination Symptoms Past medical history Other Findings
CT scan and MRI EKG Chest X-ray Tachypnea Tachycardia Fever Chest Pain Hemoptysis Dyspnea on Exertion Wheezing Chest Tenderness Nasalopharyngeal Ulceration Carotid Bruit
Pulmonary embolism
  • On CT angiography:
    • Intra-luminal filling defect
  • On MRI:
    • Narrowing of involved vessel
    • No contrast seen distal to obstruction
    • Polo-mint sign (partial filling defect surrounded by contrast)
✔ (Low grade) ✔ (In case of massive PE) - - - -
Congestive heart failure
  • Goldberg's criteria may aid in diagnosis of left ventricular dysfunction: (High specificity)
    • SV1 or SV2 + RV5 or RV6 ≥3.5 mV
    • Total QRS amplitude in each of the limb leads ≤0.8 mV
    • R/S ratio <1 in lead V4
- - - - - -
Percarditis
  • ST elevation
  • PR depression
  • Large collection of fluid inside the pericardial sac (pericardial effusion)
  • Calcification of pericardial sac
✔ (Low grade) ✔ (Relieved by sitting up and leaning forward) - - - - -
  • May be clinically classified into:
    • Acute (< 6 weeks)
    • Sub-acute (6 weeks - 6 months)
    • Chronic (> 6 months)
Pneumonia - - - -
Vasculitis

Homogeneous, circumferential vessel wall swelling

-
Chronic obstructive pulmonary disease (COPD)
  • On CT scan:
  • On MRI:
    • Increased diameter of pulmonary arteries
    • Peripheral pulmonary vasculature attentuation
    • Loss of retrosternal airspace due to right ventricular enlargement
    • Hyperpolarized Helium MRI may show progressively poor ventilation and destruction of lung
- - - - - -
COVID-19-associated heart failure - - - - - - -
Other Conditions that Cause Dyspnea that are Emergencies

The following emergency conditions should be excluded when diagnosing a patient with heart failure:

Non Cardiac Causes of Dyspnea

Other Causes of Fatigue

There are numerous non-cardiac causes of fatigue. Again, these non-cardiac causes are not associated with dyspnea and edema.

Other Causes of Edema

Other non cardiac causes of pedal edema are listed below. Obviously, the majority of these disorders do not also cause dyspnea and fatigue, and that distinguishes them form heart failure.

References

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  2. "CT Angiography of Pulmonary Embolism: Diagnostic Criteria and Causes of Misdiagnosis | RadioGraphics".
  3. Bĕlohlávek J, Dytrych V, Linhart A (2013). "Pulmonary embolism, part I: Epidemiology, risk factors and risk stratification, pathophysiology, clinical presentation, diagnosis and nonthrombotic pulmonary embolism". Exp Clin Cardiol. 18 (2): 129–38. PMC 3718593. PMID 23940438.
  4. "Pulmonary Embolism: Symptoms - National Library of Medicine - PubMed Health".
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  16. Stein PD, Dalen JE, McIntyre KM, Sasahara AA, Wenger NK, Willis PW (1975). "The electrocardiogram in acute pulmonary embolism". Prog Cardiovasc Dis. 17 (4): 247–57. PMID 123074.
  17. Warnier MJ, Rutten FH, Numans ME, Kors JA, Tan HL, de Boer A, Hoes AW, De Bruin ML (2013). "Electrocardiographic characteristics of patients with chronic obstructive pulmonary disease". COPD. 10 (1): 62–71. doi:10.3109/15412555.2012.727918. PMID 23413894.
  18. Stein PD, Matta F, Ekkah M, Saleh T, Janjua M, Patel YR, Khadra H (2012). "Electrocardiogram in pneumonia". Am. J. Cardiol. 110 (12): 1836–40. doi:10.1016/j.amjcard.2012.08.019. PMID 23000104.
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