II. Epidemiology

  1. Prevalence: 5.2 Million with CHF in the United States
  2. Incidence: 400,000 cases CHF diagnosed per year
  3. Morbidity: 870,000 hospitalizations (estimates in 2013 approach 1 Million)
    1. Re-hospitalization rate within 30 days approaches 20%
  4. Mortality: 200,000 patients die from CHF per year
  5. CHF costs
    1. Accounts for 5-10% of all hospital admissions
    2. Annual U.S. Cost: $38.1 billion ($44.6 billion by 2015)

III. Pathophysiology

  1. Heart Failure is a syndrome, not a disease
    1. Heart Failure is a final common pathway
    2. Maximize treatment of the underlying causes
    3. Control the causes and prevent end organ damage

IV. Precautions

  1. Heart Failure is a clinical diagnosis best made by an astute clinician with history and exam
  2. Labs (e.g. BNP) and diagnostics (e.g. Echocardiogram) should be adjunctive only to confirm and follow the diagnosis

VI. Causes

VII. Types

  1. Systolic Dysfunction (60-70% of Heart Failure cases)
    1. Decreased contractility
    2. Decreased Left Ventricular Ejection Fraction
  2. Diastolic Dysfunction (30-40% of Heart Failure cases)
    1. Decreased compliance
    2. Decreased filling
    3. Variable Left Ventricular Ejection Fraction

VIII. Labs

X. Classification: Congestive Heart Failure

XII. Resources

  1. American Heart Association CHF Website
    1. http://www.americanheart.org/chf

XIII. Associated Conditions

  1. Central Sleep Apnea (60% pretest probability)

Images: Related links to external sites (from Google)

Ontology: Edema (C0013604)

Definition (MEDLINEPLUS)

Edema means swelling caused by fluid in your body's tissues. It usually occurs in the feet, ankles and legs, but it can involve your entire body.

Causes of edema include

To keep swelling down, your health care provider may recommend keeping your legs raised when sitting, wearing support stockings, limiting how much salt you eat or taking a medicine called a diuretic - also called a water pill.

Definition (NCI) Swelling caused by excess fluid in body tissues.
Definition (UWDA) Pathological transudate within one or more tissues.
Definition (NCI) Accumulation of an excessive amount of watery fluid in cells or intercellular tissues.
Definition (CSP) swelling from excessive accumulation of serous fluid in tissue.
Definition (MSH) Abnormal fluid accumulation in TISSUES or body cavities. Most cases of edema are present under the SKIN in SUBCUTANEOUS TISSUE.
Concepts Pathologic Function (T046)
MSH D004487
ICD9 782.3
ICD10 R60.9
SnomedCT 206891002, 206888002, 206894005, 423666004, 158244000, 158247007, 139250008, 158241008, 161988006, 20741006, 267038008, 79654002, 155375008, 266308000, 139241006, 161979002
English Edemas, Dropsy, Edema, Hydrops, EDEMA, EDEMA NOS, OEDEMA, OEDEMA NOS, SWELLING, Dropsy, NOS, EDEMAS, Edema NOS, Edema, NOS, Hydrops, NOS, Oedema NOS, Oedema, NOS, [D]Dropsy, [D]Edema, [D]Edema NOS, [D]Oedema, [D]Oedema NOS, EDEMA (NOS), Edema, unspecified, Oedema, unspecified, [D]Dropsy (context-dependent category), [D]Edema (context-dependent category), [D]Edema NOS (context-dependent category), Edema (observable entity), edema (diagnosis), edema, edema (physical finding), 363-364 EDEMAS, [D]Dropsy (situation), [D]Oedema NOS (situation), Oedema NOS (finding), [D]Oedema (situation), Edema (NOS), EDEMATOUS, [D]Edema NOS (situation), [D]Edema (situation), Edema NOS (finding), Edema [Disease/Finding], oedemas, dropsi, excess fluid, dropsies, interstitial edema, dropsys, edema interstitial, hydrop, watery swelling, swelling due to excess fluid, swells, interstitial oedema, swelled, swellings, edematous, edemas, swell, oedema, oedematous, swelling, Edematous, Interstitial edema, Interstitial oedema, Oedema, Oedematous, Edema - lesion, Oedema - lesion, Edema (finding), Edema (morphologic abnormality), Hydrops (morphologic abnormality), hydrops, Edema - symptom, Oedema - symptom, dropsy
French OEDEME, Oedèmes SAI, Oedème SAI, OEDEME SAI, Oedème
Portuguese EDEMA, Edema NE, Edema, Hidropisia, Hidropsia
Spanish EDEMA, Edema NEOM, Edema (NEOM), [D]edema (categoría dependiente del contexto), edema (entidad observable), [D]hidropesía (categoría dependiente del contexto), [D]edema, SAI (categoría dependiente del contexto), Oedema NOS, [D]Edema NOS, [D]Oedema, Oedema - symptom, Dropsy, [D]Edema, [D]Oedema NOS, Edema, Edema - symptom, [D]Dropsy, Oedema, EDEMA SE, [D]edema, SAI (situación), [D]edema, SAI, [D]hidropesía (situación), [D]edema (situación), [D]edema, [D]hidropesía, Edema NOS, edema (anomalía morfológica), edema (hallazgo), edema - lesión, edema, SAI (hallazgo), edema, SAI, edematoso, edema, hidropesía (anomalía morfológica), hidropesía, Hidropesía, Hidropsia, Hidropesia
German OEDEM, Oedem NNB, Oedem (NNB), OEDEM NNB, Oedem, nicht naeher bezeichnet, Oedem, Hydrops, Wassersucht, Ödem
Dutch oedeem (NAO), oedeem NAO, Oedeem, niet gespecificeerd, oedeem, Hydrops, Oedeem, Oedema, Waterzucht
Italian Edema (NAS), Edema NAS, Anasarca, Idropi, Edema
Japanese 浮腫NOS, 浮腫(NOS), フシュ, フシュNOS, 浮腫, 水症
Swedish Svullnad
Czech otok, edém, Otok, Edém (NOS), Edém, Edém NOS
Finnish Turvotus
Korean 상세불명의 부종
Croatian EDEM
Polish Obrzęk
Hungarian Oedema, Ödéma (k.m.n.), Oedema k.m.n., Ödéma, Ödéma k.m.n.

Ontology: Heart failure (C0018801)

Definition (NCI) A disorder characterized by the inability of the heart to pump blood at an adequate volume to meet tissue metabolic requirements, or, the ability to do so only at an elevation in the filling pressure.
Definition (NCI) Inability of the heart to pump blood at an adequate rate to fill tissue metabolic requirements or the ability to do so only at an elevated filling pressure.
Definition (MEDLINEPLUS)

Heart failure is a condition in which the heart can't pump enough blood throughout the body. Heart failure does not mean that your heart has stopped or is about to stop working. It means that your heart is not able to pump blood the way it should.

The weakening of the heart's pumping ability causes

  • Blood and fluid to back up into the lungs
  • The buildup of fluid in the feet, ankles and legs - called edema
  • Tiredness and shortness of breath

The leading causes of heart failure are coronary artery disease, high blood pressure and diabetes.

Treatment includes treating the underlying cause of your heart failure, medicines, and heart transplantation if other treatments fail.

Heart failure is a serious condition. About 5 million people in the U.S. have heart failure. It contributes to 300,000 deaths each year.

NIH: National Heart, Lung, and Blood Institute

Definition (CSP) inability of the heart to pump blood at an adequate rate to fill tissue metabolic requirements or the ability to do so only at an elevated filling pressure.
Definition (NCI) Inability of the heart to pump blood at an adequate rate to meet tissue metabolic requirements or the ability to do so only at an elevated filling pressure.
Definition (MSH) A heterogeneous condition in which the heart is unable to pump out sufficient blood to meet the metabolic need of the body. Heart failure can be caused by structural defects, functional abnormalities (VENTRICULAR DYSFUNCTION), or a sudden overload beyond its capacity. Chronic heart failure is more common than acute heart failure which results from sudden insult to cardiac function, such as MYOCARDIAL INFARCTION.
Concepts Disease or Syndrome (T047)
MSH D006333
ICD9 428.9, 428
ICD10 I50 , I50.9
SnomedCT 155374007, 195117009, 155377000, 266248006, 84114007, 155375008, 266308000
French INSUFFISANCE CARDIAQUE, Défaillances cardiaques, Défaillance cardiaque SAI, Insuffiance cardiaque, Défaillance de la fonction cardiaque, Insuffisance coronarienne, Insuffisance cardiaque SAI, Défaillance cardiaque, non précisée, Insuffisance cardiaque, Fonction cardiaque défaillante, Défaillance du coeur, Défaillance cardiaque, DEFAILLANCE CARDIAQUE, Decompensation cardiaque
English CARDIAC FAILURE, FAILURE HEART, HEART FAILURE, HEART FAILURE (NOS), INSUFFICIENCY CARDIAC, Cardiac failure, NOS, HEART FAILURE AND OTHER FUNCTIONAL DISORDERS, Heart failure, NOS, Myocardial failure, NOS, Weak heart, NOS, Heart failure NOS, Heart failure, unspecified, Cardiac failure NOS, Heart Failure, Cardiac Failure, cardiac insufficiency (diagnosis), cardiac failure, cardiac failure (diagnosis), 3-16 HEART FAILURE AND OTHER FUNCTIONAL DISORDERS, cardiac insufficiency, Heart: [weak] or [failure NOS] (disorder), Heart failure NOS (disorder), Cardiac function failed, Cardiac failure (NOS), Cardiac function failure, Cardiac insufficiency, Insufficiency cardiac, Failure heart, Heart failure (NOS), Heart insufficiency, INSUFFICIENCY, CARDIAC, CARDIAC INSUFFICIENCY, FAILURE, HEART, myocardial failure, heart insufficiency, failure cardiac, failures heart, Failure;cardiac, Insufficiency;cardiac, hearts weak, Failure;heart, Weakness;heart, cardiac failures, insufficiency heart, heart failures, heart weakness, heart weaknesses, insufficiency cardiac, Heart failures, Cardiac failure, HF - Heart failure, Weak heart, Heart failure (disorder), heart failure, cardiac; failure, cardiac; insufficiency, failure; cardiac, failure; heart, heart; insufficiency, heart; weakness, insufficiency; cardiac, insufficiency; heart, weak; heart, Heart: [weak] or [failure NOS], Insufficiency - cardiac, Heart failure, weak heart
Italian Insufficienza cardiaca, Insufficienze cardiache, Insufficienza cardiaca NAS, Insufficienza della funzione cardiaca, Insufficienza cardiaca non specificata, Funzione cardiaca insufficiente, Insufficienza cardiaca (NAS), Scompenso cardiaco
Spanish Insuficiencia cardiaca, Insuficiencias cardiacas, Insuficiencia cardiaca NEOM, Fallo del corazón, Insuficiencia cardiológica, Insuficiencia cardiaca (NEOM), Fallo cardiaco, Fallo cardiaco (NEOM), Fallo de la función cardiaca, Fracaso de la función cardiaca, Insuficiencia del corazón, Insuficiencia cardiaca no especificada, Heart failure NOS, Insufficiency - cardiac, Heart: [weak] or [failure NOS], Cardiac failure NOS, Heart failure, Weak heart, Fallo Cardíaco Congestivo, Insuficiencia Cardiaca, Falencia Cardiaca, Fallo Cardiaco Congestivo, Insuficiencia Cardíaca, Falencia Cardíaca, FALLO CARDIACO, INSUFICIENCIA CARDIACA, Insuficiencia Cardíaca Congestiva, Insuficiencia Cardiaca Congestiva, corazón débil, fallo cardíaco, insuficiencia cardíaca (trastorno), insuficiencia cardíaca, SAI (trastorno), insuficiencia cardíaca, SAI, insuficiencia cardíaca
Dutch hartfalen (NAO), hartfalen NAO, hartdecompensatie, hartinsufficiëntie, falende hartfunctie, hartfunctiefalen, hartdecompensatie, niet-gespecificeerd, Decompensatio cordis, cardiaal; falen, cardiaal; insufficiëntie, falen; cardiaal, falen; hart, hart; insufficiëntie, hart; zwak, insufficiëntie; cardiaal, insufficiëntie; hart, zwak; hart, Hartdecompensatie, niet gespecificeerd, falen van de hartfunctie, hartfalen, Hartdecompensatie
German Herzversagen (NNB), Herzfunktion versagt, Insuffizienz, Herz, Herzinsuffizienz NNB, kardiales Versagen, Herzversagen, unspezifisch, Herzfunktion, Versagen, Versagen, Herz, Herzversagen, Herzinsuffizienz, HERZINSUFFIZIENZ, HERZVERSAGEN, Herzinsuffizienz, nicht naeher bezeichnet
Portuguese Insuficiência cardíaca NE, Insuficiência da função cardíaca, Função cardíaca insuficiente, Insuficiência Cardíaca, Falência Cardíaca Congestiva, Falência Cardíaca, INSUFICIENCIA CARDIACA, Insuficiencia cardiaca, Insuficiência Cardíaca Congestiva, Insuficiência cardíaca, Insuficiências cardíacas
Japanese 心不全(NOS), 心機能低下, 心不全、詳細不明, 心不全NOS, 心機能不全, シンフゼンNOS, シンフゼン, シンフゼンショウサイフメイ, シンキノウテイカ, シンキノウフゼン, 左心不全, 心不全-うっ血性, 右心不全, うっ血性心不全, 心不全, 心臓機能不全-鬱血性, 鬱血性心不全, うっ血性心臓機能不全, 心不全-鬱血性, 心臓機能不全-うっ血性, 欝血性心不全, 欝血性心臓機能不全
Swedish Hjärtsvikt, HJARTSVIKT
Finnish Sydämen vajaatoiminta, SYDAMEN VAJAATOIMINTA
Danish Hjerteinsufficiens
Hungarian szivelegtelenseg, Elégtelen szívműködés, Cardialis decompensatio, Szívelégtelenség (k.m.n.), Cardialis elégtelenség, Szívelégtelenség k.m.n., Cardialis funkció elégtelenség, Szívelégtelenség, Szívelégtelenség, nem meghatározott, Szívelégtelenségek, Cardialis insuffitientia
Czech Srdeční selhání (NOS), Selhání srdeční funkce, Blíže neurčené srdeční selhání, Srdeční nedostatečnost, Srdeční selhání NOS, Srdeční selhání, Srdeční insuficience, Selhání srdce, Selhání srdeční, Kardiální insuficience, Selhání srdce (NOS), srdce - selhání, selhání srdce, srdeční selhání, SS
Korean 상세불명의 심장기능상실(심부전), 심장기능상실(심부전)
Hebrew i sfikat lev
Polish Niewydolność serca lewostronna, Niewydolność serca prawostronna, Ostra niewydolność serca, Niewydolność krążenia, Niewydolność serca, Dekompensacja serca, Niewydolność mięśnia sercowego, Przewlekła niewydolność serca