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Congestive Heart Failure

Heart failure is a syndrome that develops when cardiac output becomes insufficient to meet systemic metabolic demands. Left ventricular systolic dysfunction can be recognized by the presence of a left ventricular ejection fraction less than or equal to 40%. Chronic left ventricular systolic dysfunction is almost always accompanied by evidence by

Clinical Evaluation of Heart Failure

All patients who complain of paroxysmal nocturnal dyspnea, orthopnea, or new-onset dyspnea on exertion should undergo evaluation for heart failure unless the history and physical examination clearly indicate a

Chest pain may indicate that ischemia is the cause of heart failure; however, ischemia can also occur

Past history of a heart murmur, prior viral illness, hypertension, myocardial infarction, alcohol or drug use, congestive heart failure, thyroid disease, or lung disease should be sought.

Precipitating Cause. The most common precipitating cause of CHF is lack of compliance with dietary and medical regimens. Atrial fibrillation sometimes exacerbates CHF without the patient being aware of any change in heart rhythm. Nonsteroidal anti-inflammatory agents, alcohol, hyperthyroidism, and beta blockers (including eyedrops) can exacerbate CHF. Underlying causes should be sought and treated.

Assessment of functional capacity reflects on the effectiveness of therapy. Capacity to perform activities, such as climbing one or two flights of stairs or walking 50 or 100 feet should be assessed at each visit. Congestive Heart Failure