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  • Heart failure (HF)
  • Systolic heart failure
  • Diastolic heart failure

  • 428 Heart failure

  • I50 Heart failure
  • I50.2 Systolic (congestive) heart failure
  • I50.3 Diastolic (congestive) heart failure
  • I50.9 Heart failure, unspecified


  • 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 HF3


  • Affects 3 million people in the United States3
  • 400,000 new cases annually3

Signs and Symptoms

Functional Implications

  • New York Heart Association functional status4
    • 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

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

Laboratory Tests

  • Elevated Brain Natriuretic Peptide (BNP)
    • Hormone is released with stretch on the myocardium


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