Last reviewed: November 2017
Last updated: November  2017

Summary

Definition

History and exam

Key diagnostic factors

  • presence of risk factors (previous cardiovascular disease, age >70 years)
  • dyspnoea
  • pulmonary crepitations
  • peripheral oedema
  • cool peripheries
  • chest pain
  • third heart sound (S3)

Other diagnostic factors

  • fatigue and weakness
  • hypotension
  • tachycardia
  • elevated jugular venous pressure (JVP)
  • displaced apex beat (point of maximal impulse)
  • dullness to percussion and decreased air entry in lung bases
  • wheezing
  • palpitations
  • cough
  • fever
  • syncope
  • murmur
  • ascites
  • hepatomegaly
  • central cyanosis

Risk factors

  • age >70 years
  • prior episode of congestive heart failure
  • coronary artery disease
  • hypertension
  • valvular heart disease
  • pericardial disease
  • myocarditis
  • atrial fibrillation
  • diabetes mellitus
  • non-compliance with medications
  • excessive salt intake
  • excessive catecholamine stimulation
  • abnormal thyroid function
  • excessive alcohol intake

Diagnostic investigations

1st investigations to order

  • ECG
  • CXR
  • Hb
  • TFT
  • troponin
  • B-type natriuretic peptide (BNP)
Full details

Investigations to consider

  • echocardiography
  • cardiac catheterisation
  • endomyocardial biopsy
Full details

Treatment algorithm

Contributors

Authors VIEW ALL

Syed Wamique Yusuf

Professor of Medicine

Department of Cardiology

University of Texas

MD Anderson Cancer Center

Houston

TX

Disclosures

SWY declares that he has no competing interests.

Dr Syed Wamique Yusuf would like to gratefully acknowledge Dr Daniel Lenihan, a previous contributor to this monograph. DL declares that he has no competing interests.

Peer reviewers VIEW ALL

Assistant Professor of Medicine

Jefferson Medical College

Philadelphia

PA

Disclosures

DW declares that he has no competing interests.

Assistant Professor of Medicine

Johns Hopkins University School of Medicine

Baltimore

MD

Disclosures

KCW declares that she has no competing interests.

Consultant Cardiologist

King's College Hospital London

London

UK

Disclosures

SS declares that he has no competing interests.

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