Summary

• A complex clinical syndrome that can result from any structural or functional cardiac disorder that impairs the ability of the ventricle to fill with or eject blood.
• It is a major and growing public health problem. It is the only cardiovascular disease that is increasing in incidence and prevalence, partly because the population is ageing, but also because of improved cardiovascular interventions for disease processes that reduce early mortality but may result in cardiac changes that lead to heart failure.
• The key manifestations are dyspnoea and fatigue, which may limit exercise tolerance, and fluid retention, which may lead to pulmonary congestion and peripheral oedema.
• Diagnosis is largely clinical; a thorough history and physical examination should be obtained to identify cardiac and non-cardiac disorders or behaviours that might cause CHF or accelerate progression.
• The single most useful diagnostic test in the evaluation of patients is the comprehensive 2-dimensional echocardiogram coupled with Doppler flow studies. Measurement of B-type natriuretic peptide (BNP) can be useful in the evaluation of patients at initial presentation.
• Interventions that have a proven beneficial impact on patient survival include ACE inhibitors, angiotensin receptor blockers, beta-blockers, aldosterone antagonists, hydralazine and nitrate, cardiac re-synchronisation therapy, and implantable cardioverter defibrillators.