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Condition/Disorder Synonyms

  • Heart failure (HF)

  • Systolic heart failure

  • Diastolic heart failure

ICD-9-CM Code

  • 428 Heart failure

ICD-10-CM Codes

  • I50 Heart failure

  • I50.2 Systolic (congestive) heart failure

  • I50.3 Diastolic (congestive) heart failure

  • I50.9 Heart failure, unspecified

Preferred Practice Pattern

Key Features


  • Heart is unable to produce sufficient cardiac output (CO) to meet demands of the body

  • Heart failure (HF) is a syndrome caused by several pathophysiologic conditions, resulting in left ventricular and/or right ventricular dysfunction (cardiac pump dysfunction)

Essentials of Diagnosis

  • EKG/ECG2

  • Echocardiogram

  • Chest x-ray

  • Elevated brain natriuretic peptide (BNP) levels

  • Elevated pulmonary artery catheter readings

General Considerations

  • HF is a result of cardiac muscle dysfunction or damage

  • Education on disease management reduces hospitalization

  • Vital signs should be monitored before, during, and after exercise

  • Both aerobic and resistive exercise have shown positive benefits

  • Signs and symptoms should be monitored

  • Emphasis on wellness and prevention

  • Physiologic changes associated with HF 3


  • Affects 3 million people in the United States3

  • 400,000 new cases annually3

Clinical Findings

Signs and Symptoms

  • Left-sided HF

    • Dyspnea on exertion

    • Shortness of breath3

    • Paroxysmal nocturnal dyspnea3

    • Orthopnea3

    • Fatigue weakness3

    • Crackles

    • S3 heart sound

    • Cold, pale, cyanotic extremities

  • Right-sided HF

    • Weight gain

    • Peripheral edema

    • Jugular venous distention3

    • Hepatomegaly

    • Ascites

    • Fatigue3

    • Cyanosis

Functional Implications

  • New York Heart Association functional status 4

    • Class I: normal physical activity not limited by symptoms

    • Class II: ordinary physical activity results in fatigue, dyspnea, other symptoms

    • Class III: marked limitation in normal physical activity

    • Class IV: symptoms present at rest or with any physical activity

  • Depending on the severity of HF

    • Decreased activity tolerance

    • Decreased exercise tolerance

    • Dyspnea on exertion

    • Hypoxia

    • Muscle weakness

    • Cardiac arrhythmia

Possible Contributing Causes

  • Causes of left ventricular failure 3

  • Causes of right ventricular failure 3

  • Myocardial damage

  • Coronary artery disease

  • Autoimmune diseases

  • Alcohol abuse

  • Cardiac arrhythmias

  • Fluid overload

  • Cardiogenic shock

  • Hypertension

  • Cor pulmonale

  • Cardiac valve abnormalities

  • Pulmonary hypertension

  • Renal insufficiency

  • Myocarditis

  • Spinal cord injury

  • Pulmonary embolism

  • Older age

Differential Diagnosis

  • Cardiac pump dysfunction

    • Cardiac muscle dysfunction produces slight-to-moderate reduction in CO

    • Mild-to-moderate activity limitation

    • Functional capacity of ⩽ 5 to 6 metabolic equivalents (METS)

  • Cardiac pump failure

    • Cardiac muscle dysfunction produces moderate-to-severe reduction in CO

    • Marked activity limitation

    • Functional capacity of ⩽ 4 to 5 METS

Means of Confirmation or Diagnosis

Laboratory Tests

  • Elevated ...

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