Heart failure
Posted by dkwinter

See also: Cough/shortness of breath Ddx
Hx
     Cough that is exacerbated by lying down at night
     Cough is improved by propping up on pillows
     Exertional dyspnea

Workup
     CBC
     CXR
     ECG
     Echocardiography
     PFTs
     BNP

CHF, unspecified
     Etiologies
          Myocarditis (the most likely precipitant in young patient with acute-onset sx and limited risk factors)
     Tx
          Diuretic

CHF without preserved EF (left heart failure/systolic heart failure)
     Sx
          Pulmonary edema
          Shortness of breath
          Paroxysmal nocturnal dyspnea
          Dyspnea on exertion
          Bilateral pleural effusions
          Third heart sound
          Cardiomegaly
     Complications
          Diastolic dysfunction
          Right heart failure
     Tx
          IV diuretics
          ACE-inhibitor or ARB

CHF with diastolic dysfunction (impaired ventricular relaxation)     
     Ddx
          Constictive pericarditis also causes impaired filling
     Sx
          Pulmonary edema
     Tx (rapid)
          Rapidly reduce preload with
               Nitroglycerin (IV, SL, or topical)
     Tx (mainstay)
          Loop diuretics
          Beta-blocker
          ACE inhibitor or ARB
          Aldosterone antagonist

CHF with preserved EF (right heart failure)
     Sx
     PE


CHF, with pulmonary hypertension, RV hypertropy, and RV failure (right heart failure/Cor pulmonale)
     Etiologies
          COPD (the most common cause)
          Pneumoconiosis
          Pulmonary fibrosis
          Kyphoscoliosis
          Primary pulmonary hypertension
          Repeated episodes of pulmonary embolism
     Sx
          No evidence of pulmonary congestion
          Jugular venous distention
          Ascites
          Lower extremity edema
          Hepatosplenomegaly
          Hepatojugular reflux