Sections View Full Chapter Figures Tables Videos Annotate Full Chapter Figures Tables Videos Supplementary Content ++ Heart failure (HF)Systolic heart failureDiastolic heart failure ++ 428 Heart failure ++ I50 Heart failureI50.2 Systolic (congestive) heart failureI50.3 Diastolic (congestive) heart failureI50.9 Heart failure, unspecified ++ Pattern 6D: Impaired Aerobic Capacity/Endurance Associated With Cardiovascular Pump Dysfunction or Failure1 +++ Description ++ Heart is unable to produce sufficient cardiac output (CO) to meet demands of the bodyHeart 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/ECG2EchocardiogramChest x-rayElevated brain natriuretic peptide (BNP) levelsElevated pulmonary artery catheter readings +++ General Considerations ++ HF is a result of cardiac muscle dysfunction or damageEducation on disease management reduces hospitalizationVital signs should be monitored before, during, and after exerciseBoth aerobic and resistive exercise have shown positive benefitsSigns and symptoms should be monitoredEmphasis on wellness and preventionPhysiologic changes associated with HF3 +++ Demographics ++ Affects 3 million people in the United States3400,000 new cases annually3 +++ Signs and Symptoms ++ Left-sided HFDyspnea on exertionShortness of breath3Paroxysmal nocturnal dyspnea3Orthopnea3Fatigue weakness3CracklesS3 heart soundCold, pale, cyanotic extremitiesRight-sided HFWeight gainPeripheral edemaJugular venous distention3HepatomegalyAscitesFatigue3Cyanosis +++ Functional Implications ++ New York Heart Association functional status4Class I: normal physical activity not limited by symptomsClass II: ordinary physical activity results in fatigue, dyspnea, other symptomsClass III: marked limitation in normal physical activityClass IV: symptoms present at rest or with any physical activityDepending on the severity of HFDecreased activity toleranceDecreased exercise toleranceDyspnea on exertionHypoxiaMuscle weaknessCardiac arrhythmia +++ Possible Contributing Causes ++ Causes of left ventricular failure3Causes of right ventricular failure3Myocardial damageCoronary artery diseaseAutoimmune diseasesAlcohol abuseCardiac arrhythmiasFluid overloadCardiogenic shockHypertensionCor pulmonaleCardiac valve abnormalitiesPulmonary hypertensionRenal insufficiencyMyocarditisSpinal cord injuryPulmonary embolismOlder age +++ Differential Diagnosis ++ Cardiac pump dysfunctionCardiac muscle dysfunction produces slight-to-moderate reduction in COMild-to-moderate activity limitationFunctional capacity of ⩽ 5 to 6 metabolic equivalents (METS)Cardiac pump failureCardiac muscle dysfunction produces moderate-to-severe reduction in COMarked activity limitationFunctional capacity of ⩽ 4 to 5 METS +++ Laboratory Tests ++ Elevated Brain Natriuretic Peptide (BNP)Hormone is released with stretch on the myocardium +++ Imaging ++ Chest x-rayCardiomegalyAcute pulmonary edema resulting in ventricular failure3EKGLeft ventricular hypertrophy ... Your Access profile is currently affiliated with '[InstitutionA]' and is in the process of switching affiliations to '[InstitutionB]'. Please click ‘Continue’ to continue the affiliation switch, otherwise click ‘Cancel’ to cancel signing in. Get Free Access Through Your Institution Learn how to see if your library subscribes to McGraw Hill Medical products. Subscribe: Institutional or Individual Sign In Username Error: Please enter User Name Password Error: Please enter Password Forgot Password? Forgot Username? Sign in via OpenAthens Sign in via Shibboleth You already have access! Please proceed to your institution's subscription. Create a free a profile for additional features.