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Understanding Heart Failure Types and Symptoms

Apr 10, 2025

Heart Failure Overview

Definition

  • Heart failure: Dysfunction in the heart's ability to pump blood.
  • Congestive heart failure: Heart failure plus fluid overload.

Important Terminology

  • HFrEF: Heart Failure with reduced Ejection Fraction (previously systolic dysfunction).
  • HFpEF: Heart Failure with preserved Ejection Fraction (not solely systolic or diastolic dysfunction).

Types of Heart Failure

Left-Sided Heart Failure

  • Inability of the left ventricle to maintain ejection fraction.
  • Blood backs up in the pulmonary system causing pulmonary symptoms.
  • Key Symptoms:
    • Orthopnea: Shortness of breath when supine due to blood redistribution in the pulmonary vasculature.
    • Paroxysmal Nocturnal Dyspnea: Shortness of breath awakening from sleep.
    • Pulmonary Edema: Pulmonary venous distension. Look for hemosiderin-laden macrophages ("heart failure cells").

Right-Sided Heart Failure

  • Commonly caused by left-sided heart failure.
  • Blood backs up into the systemic circulation rather than the lungs.
  • Key Symptoms:
    • Hepatosplenomegaly: Due to increased portal resistance.
    • Jugular Venous Distension (JVD): Greater than 3 cm above the sternal angle.
    • Peripheral Edema: Due to increased hydrostatic pressure.

Cor Pulmonale

  • Right heart failure due to intrinsic pulmonary disease causing pulmonary hypertension.
  • Increased endothelin-1 (vasoconstrictor), decreased nitric oxide synthase (vasodilator).
  • Signs:
    • Loud P2 sound: Due to distal resistance.
    • Tricuspid regurgitation.

Diagnostic Insights

  • Pulmonary Capillary Wedge Pressure (PCWP): Surrogate of left atrial pressure, indicative of left ventricular output failure if elevated.
  • S3 Gallop: Low pitch sound in early diastole, indicating ventricular overload. Heard at the cardiac apex in the left lateral decubitus position.

Key Points for Exams

  • Recognize symptoms related to specific heart failure (left vs. right).
  • For left-sided failure: Associated with pulmonary issues and increased PCWP.
  • For right-sided failure: Look for systemic issues like JVD and hepatosplenomegaly.
  • Remember cor pulmonale specifics, focusing on pulmonary hypertension.
  • Use symptoms and diagnostic signs (e.g., S3 gallop, heart failure cells) to identify heart failure type and underlying issues.

Conclusion

  • Key symptoms: Shortness of breath, venous overload, JVD, S3 gallop.
  • Understand and differentiate left-sided vs. right-sided heart failure to anticipate symptoms.

These notes are designed to help prepare for USMLE and COMLEX by simplifying concepts related to heart failure. Focus on distinguishing between different types of heart failure and their distinct symptoms and diagnostic markers for exam success.

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