What is Chronic heart failure - Meaning and definition

Published by Roberto Wenk. Reviewed by Alison Ramsey. Last updated date: October 29, 2018.

Clinical manifestation
The cardinal manifestations of heart failure (HF) are dyspnea and fatigue, which may limit exercise tolerance, and fluid retention, which may lead to pulmonary congestion and peripheral edema. Both abnormalities can impair the functional capacity and quality of life of affected individuals, but they do not necessarily dominate the clinical picture at the same time. Some patients have exercise intolerance but little evidence of fluid retention, whereas others complain primarily of edema and report few symptoms of dyspnea or fatigue

The approach that is most commonly used to quantify the degree of functional limitation imposed by HF is one first developed by the New York Hearth Association. This system assigns patients to 1 of 4 functional classes, depending on the degree of effort needed to elicit symptoms: patients may have symptoms of HF at rest (class IV), on less-than-ordinary exertion (class III), on ordinary exertion (class II), or only at levels of exertion that would limit normal individuals (class I).

The development of HF can be appropriately characterized by considering 4 stages of the disease.
This staging system has established risk factors and structural prerequisites — that the development of HF has asymptomatic and symptomatic phases, and that specific treatments targeted at each stage can reduce the morbidity and mortality of HF.

American College of Cardiology–American Heart Association classification of chronic heart failure
Stage A: High risk for developing heart failure. Description: hypertension, diabetes mellitus, coronary artery disease, family history of cardiomyopathy.
Stage B: Asymptomatic heart failure. Description: previous myocardial infarction, left ventricular dysfunction, valvular heart disease.
Stage C: Symptomatic heart failure. Description: structural heart disease, dyspnea and fatigue, impaired exercise tolerance.
Stage D: Refractory end-stage heart failure. Description: marked symptoms at rest despite maximal medical therapy.

See reference for more information.

Hobbs R, Boyle A. Disease management project. Cleveland Clinic. Heart failure. Internet. Accessed on June 16, 2016.

Published by Roberto Wenk. Last updated date: June 16, 2016.

Heart failure is a complex clinical syndrome of symptoms and signs that suggest the efficiency of the heart as a pump is impaired.

Causes:
It is caused by structural or functional abnormalities of the heart.
Coronary artery disease is one of the most common causes of heart failure. Other causes include valvular heart disease, cardiomyopathy, rheumatic heart disease, infective endocarditis, congenital heart disease, etc.

Management:
Includes a multidisciplinary approach with lifestyle modifications, rehabilitation, pharmacotherapy and interventional therapy as appropriate.

Prognosis:
Heart failure has a poor prognosis: 30–40% of patients diagnosed with heart failure die within a year – but thereafter the mortality is less than 10% per year.

Palliative care in chronic heart failure:
• The palliative needs of patients and carers should be identified, assessed and managed at the earliest opportunity.
• Issues of sudden death and living with uncertainty are pertinent to all patients with heart failure. The opportunity to discuss these issues should be available at all stages of care.
• Patients with heart failure and their carers should have access to professionals with palliative care skills within the heart failure team.
• The diagnosis of anxiety and depression should be considered in all patients with heart failure.

Adapted from NICE guidelines 2010. Chronic heart failure. Internet. Accessed on June 12, 2012.

Chronic heart failure

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