Signs And Symptoms Of Heart Failure

Heart failure symptoms are traditionally and somewhat arbitrarily divided into "left" and "right" sided, recognizing that the left and right ventricles of the heart supply different portions of the circulation. There are several other exceptions to a simple left-right division of heart failure symptoms. Left sided forward failure overlaps with right sided backward failure. Additionally, the most common cause of right-sided heart failure is left-sided heart failure. The result is that patients commonly present with both sets of signs and symptoms.

Symptoms of HF;
The cardinal symptoms of HF are: Fatigue & Tiredness WHY IT HAPPENS?
Heart cant pump enough blood to meet needs of bodies tissues Body diverts blood away from less vital organs (muscles in limbs) and sends it to the heart and brain

Ventricular dysfunction limits a patient's ability to perform the routine activities of daily living

SYMPTOMS
Constant tired feeling Difficulty with everyday activities

Cont:
Shortness Of Breath (Dyspnea)
WHY IT HAPPENS?
Blood "backs up" in the pulmonary veins (the vessels that return blood from the lungs to the heart) because the heart can't keep up with the supply. This causes fluid to leak into the lungs

SYMPTOMS
Dyspnea on exertion or at rest Difficulty breathing when lying flat Waking up short of breath

Cont:
Orthopnea
IT is dyspnea occurring in the recumbent position

WHY IT HAPPENS?
It results from the redistribution of fluid from the splanchnic circulation and lower extremities into the central circulation during recumbency, with a resultant increase in pulmonary capillary pressure.

SYMPTOMS
Nocturnal cough is a frequent manifestation of this this process

NOTE - Orthopnea is generally relieved by sitting upright or by sleeping with additional pillows

Cont:
Paroxysmal Nocturnal Dyspnea
Acute episodes of shortness of breath and coughing that generally occur at night and awaken the patient from sleep , usually 1-3 h after the patient retires.

Why It Happens?
Because of increased pressure in the bronchial arteries leading to airway compression, along with interstitial pulmonary edema leading to increased airway resistance.

Cont:
Buildup of excess fluid in the body (Edema)
WHY IT HAPPENS?
As blood flow out of the heart slows, blood returning to the heart through the veins backs up, causing fluid to build up in the tissues. The kidneys are less able to dispose of sodium and water, also causing fluid retention in the tissues.

Symptoms
Swelling in feet, ankles, legs or abdomen Weight gain The patient may find that his shoes feel tight.

Note: Edema caused by CHF is always "pitting", that is, if you press the swollen tissue with your finger, you will leave an imprint

Cont:
Persistent Cough or Wheezing
WHY IT HAPPENS?
Fluid backs up in the lungs

SYMPTOMS
Coughing that produces white or pink blood-tinged sputum

 Increased heart rate Why It Happens

To "make up for" the loss in pumping capacity, the heart beats faster.

SYMPTOMS
heart palpitations, which feel like your heart is racing or throbbing.

 Lack of appetite/ Nausea

WHY IT HAPPENS?
The digestive system receives less blood causing problems with digestion

SYMPTOMS
Feeling of being full or sick to your stomach

 Confusion/ Impaired thinking

WHY IT HAPPENS?
Changing levels of substances in the blood ( sodium) can cause confusion

SYMPTOMS
Memory loss or feeling of disorientation Relative or care giver may notice this first

Sings of HF
PHYSICAL EXAMINATION
A careful physical examination is always warranted in evaluation of patients with HF. The purpose of examination is help determine the cause of HF ,as well as to assess the severity of the syndrome.

 General Appearance And Vital Signs

In mild or moderately severe HF, the patient appears in no distress at rest, except for feeling uncomfortable while lying flat for more than a few minutes. In more severe heart failure the patient must sit upright, may have labored breathing, and may not be able to finish a sentence because of shortness of breath. Systolic BP maybe reduced in advance HF because of severe LV dysfunction. The pulse pressure maybe diminished, reflecting a reduction in stroke volume.

 Pulmonary Examination
Pulmonary crackles (rales or crepitations) result from the transudation of fluid from the intravascular space into the alveoli. Pulmonary effusions from the elevation of pleural capillary pressure and the resulting transudation of fluid into the pleural cavities. Pleural effusions occur most commonly in biventricular failure.

Cardiac Examination
Displaced and sustained apical impulses Third heard sound (S3) low pitched sound that is heard during rapid filling of the ventricle Mechanism of S3 sudden deceleration of blood as elastic limit of the ventricles are reached Vibration of ventricular wall by blood filling

 Forth heart sound (S4) - usually at the end of diastole - exact mechanism is not known - could be due to contraction of atrium against stiff ventricle.

Jugular veins
Increased Jugular Venous Pressure Jugular venous distention JVD Abdomino - jugular reflux

Abdomen And Extremities

Hepatomegaly Ascites Jaundice Peripheral edema usually symmetric and dependent in HF.