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 (UWDA) Pathological transudate within one or more tissues.
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_NCI-GLOSS) Swelling caused by excess fluid in body tissues.
Definition (NCI) Accumulation of an excessive amount of 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, 158247007, 161979002, 139241006, 158241008, 158244000, 161988006, 139250008, 155375008, 266308000, 79654002, 20741006, 267038008
LNC MTHU019803, LA17263-7, LA19035-7
English Dropsy, Edema, Hydrops, EDEMA NOS, OEDEMA, OEDEMA NOS, Edema NOS, Oedema NOS, [D]Dropsy, [D]Edema, [D]Edema NOS, [D]Oedema, [D]Oedema 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), Edema (NOS), Edema [Disease/Finding], oedemas, excess fluid, dropsies, interstitial edema, edema interstitial, watery swelling, swelling due to excess fluid, swells, interstitial oedema, swelled, swellings, edematous, edemas, swell, oedema, oedematous, swelling, Oedema - symptom, [D]Oedema NOS (situation), [D]Oedema (situation), Edema - symptom, [D]Dropsy (situation), Edema NOS (finding), Oedema NOS (finding), [D]Edema NOS (situation), [D]Edema (situation), Waterlogged, EDEMA, Edematous, Interstitial edema, Interstitial oedema, Oedema, Oedematous, Edema - lesion, Oedema - lesion, Edema (finding), Edema (morphologic abnormality), Hydrops (morphologic abnormality), hydrops, Dropsy, NOS, Edema, NOS, Hydrops, NOS, Oedema, NOS, 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), EDEMA SE, Edema NOS, [D]edema (situación), Oedema NOS, [D]edema, SAI, edema, SAI, [D]hidropesía (situación), edema, SAI (hallazgo), [D]hidropesía, [D]edema, [D]edema, SAI (situación), edema (anomalía morfológica), edema (hallazgo), edema - lesión, edematoso, edema, hidropesía (anomalía morfológica), hidropesía, Edema, Hidropesía, Hidropsia
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, hydrops
Finnish Turvotus
Russian VODIANKA, OTEK, ВОДЯНКА, ОТЕК
Korean 상세불명의 부종
Croatian EDEM
Polish Obrzęk
Hungarian Oedema, Ödéma (k.m.n.), Oedema k.m.n., Ödéma, Ödéma k.m.n.
Norwegian Hevelser, Vattersott, Ødemer, Vannsott, Væskeansamling, Ødem, Hevelse, Hydrops

Ontology: Heart failure (C0018801)

Definition (MEDLINEPLUS)

Heart failure is a condition in which the heart can't pump enough blood to meet the body's needs. 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. It can affect one or both sides of the heart.

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

Common causes of heart failure are coronary artery disease, high blood pressure and diabetes. It is more common in people who are 65 years old or older, African Americans, people who are overweight, and people who have had a heart attack. Men have a higher rate of heart failure than women.

Your doctor will diagnose heart failure by doing a physical exam and heart tests. Treatment includes treating the underlying cause of your heart failure, medicines, and heart transplantation if other treatments fail.

NIH: National Heart, Lung, and Blood Institute

Definition (NCI_CDISC) Inability of the heart to pump blood at an adequate rate to meet tissue metabolic requirements. Clinical symptoms of heart failure include: unusual dyspnea on light exertion, recurrent dyspnea occurring in the supine position, fluid retention; or rales, jugular venous distension, pulmonary edema on physical exam, or pulmonary edema on chest x-ray presumed to be cardiac dysfunction.
Definition (NCI_FDA) 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. Clinical symptoms of heart failure include: unusual dyspnea on light exertion, recurrent dyspnea occurring in the supine position, fluid retention or rales, jugular venous distension, pulmonary edema on physical exam, or pulmonary edema on chest x-ray presumed to be cardiac dysfunction.
Definition (NCI_CTCAE) 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 (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 (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, 155375008, 266308000, 155377000, 266248006, 195117009, 84114007
French INSUFFISANCE CARDIAQUE, Défaillances cardiaques, Défaillance cardiaque SAI, Défaillance de la fonction cardiaque, Insuffisance cardiaque SAI, Défaillance cardiaque, non précisée, Insuffisance cardiaque, Fonction cardiaque défaillante, Défaillance du coeur, Défaillance cardiaque, DEFAILLANCE CARDIAQUE
English CARDIAC FAILURE, Heart failure, unspecified, Cardiac failure NOS, Heart Failure, Cardiac Failure, cardiac failure, cardiac failure (diagnosis), Cardiac function failed, Cardiac failure (NOS), Cardiac function failure, Insufficiency cardiac, Failure heart, Heart failure (NOS), Heart insufficiency, myocardial failure, heart insufficiency, failure cardiac, failures heart, Failure;cardiac, Insufficiency;cardiac, heart failure, hearts weak, Failure;heart, cardiac insufficiency, Weakness;heart, cardiac failures, insufficiency heart, heart failures, heart weakness, heart weaknesses, insufficiency cardiac, Heart failures, Insufficiency - cardiac, Heart failure NOS (disorder), Heart: [weak] or [failure NOS] (disorder), Heart: [weak] or [failure NOS], Cardiac insufficiency, INSUFFICIENCY, CARDIAC, CARDIAC INSUFFICIENCY, FAILURE, HEART, HEART FAILURE, Cardiac failure, HF - Heart failure, Weak heart, Heart failure (disorder), cardiac; failure, cardiac; insufficiency, failure; cardiac, failure; heart, heart; insufficiency, heart; weakness, insufficiency; cardiac, insufficiency; heart, weak; heart, Cardiac failure, NOS, Heart failure, NOS, Weak heart, NOS, Heart failure, Heart failure NOS, 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, Insuficiencia Cardíaca, Falencia Cardíaca, FALLO CARDIACO, INSUFICIENCIA CARDIACA, insuficiencia cardíaca, SAI (trastorno), insuficiencia cardíaca, SAI, Heart failure NOS, Insuficiencia Cardíaca Congestiva, Fallo Cardíaco Congestivo, corazón débil, fallo cardíaco, insuficiencia cardíaca (trastorno), 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, INSUFICIENCIA CARDIACA, Insuficiência Cardíaca Congestiva, Falência 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
Finnish Sydämen vajaatoiminta
Russian СЕРДЕЧНАЯ НЕДОСТАТОЧНОСТЬ ЗАСТОЙНАЯ, SERDECHNAIA NEDOSTATOCHNOST' ZASTOINAIA, СЕРДЕЧНАЯ НЕДОСТАТОЧНОСТЬ, SERDECHNAIA NEDOSTATOCHNOST'
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)
Polish Niewydolność serca lewostronna, Niewydolność serca prawostronna, Ostra niewydolność serca, Niewydolność krążenia, Niewydolność serca, Dekompensacja serca, Niewydolność mięśnia sercowego, Przewlekła niewydolność serca
Hungarian Elégtelen szívműködés, Cardialis decompensatio, Szívelégtelenség (k.m.n.), Cardialis elégtelenség, Szívelégtelenség k.m.n., Cardialis funkció elégtelenség, Szívelégtelenség, Szívelégtelenség, nem meghatározott, Szívelégtelenségek, Cardialis insuffitientia
Norwegian Hjerteinsuffisiens, Hjertesvikt
Croatian SRČANO ZATAJIVANJE, SRČANA INSUFICIJENCIJA