Although heart failure may be asymptomatic in its earliest stages, a variety of symptoms may develop, depending on the severity of ventricular dysfunction. Symptoms may result from inadequate tissue perfusion caused by pump failure or from the failing heart’s inability to empty adequately, leading to edema and fluid accumulation in the lungs, extremities, and other sites. The most frequent symptoms of left ventricular failure are dyspnea with exertion or at rest, orthopnea, paroxysmal nocturnal dyspnea, diaphoresis, generalized weakness, fatigue, anxiety, and lightheadedness. With more severe CHF, the patient may also experience a productive cough; copious pink, frothy sputum; and confusion. Angina may also occur if the CHF results from ischemia. Right-sided heart failure may occur separately from or secondary to chronic left-sided heart failure. Peripheral edema typically develops in patients with right-sided heart failure.
Figure 5-4 Stages in the development of heart failure. ACEI = ACE inhibitors; AF = atrial fibrillation; ARB = angiotensin II receptor blocker; CHD = coronary heart disease; CRT = cardiac resynchronization therapy; DM = diabetes mellitus; EF = ejection fraction; GDMT = guideline-directed medical therapy; HF = heart failure; HFpEF = heart failure with preserved ejection fraction; HFrEF = heart failure with reduced ejection fraction; HRQOL = health-related quality of life; HTN = hypertension; ICD = implantable cardioverter-defibrillator; LV = left ventricular; LVH = left ventricular hypertrophy; MCS = mechanical circulatory support; MI = myocardial infarction.
(Modified with permission from Yancy CW, Jessup M, Bozkurt B, et al. 2013 ACCF/AHA guideline for the management of heart failure: executive summary: a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines. Circulation. 2013;128:1810–1852.)
Excerpted from BCSC 2020-2021 series: Section 1 - Update on General Medicine. For more information and to purchase the entire series, please visit https://www.aao.org/bcsc.