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Insuficiência cardíaca com fração de ejeção reduzida

Last reviewed: 12 Aug 2025
Last updated: 03 Apr 2025

Summary

Definition

History and exam

Key diagnostic factors

  • presença de fatores de risco
  • dispneia
  • distensão jugular
  • B3 em galope
  • cardiomegalia
  • refluxo hepatojugular
  • estertores
  • ortopneia e dispneia paroxística noturna
  • noctúria
Full details

Other diagnostic factors

  • taquicardia (frequência cardíaca >120 batimentos por minuto)
  • desconforto torácico
  • hepatomegalia
  • edema de tornozelos
  • tosse noturna
  • sinais de derrame pleural
  • fadiga, fraqueza muscular ou cansaço
  • palpitações, pré-síncope ou síncope
  • letargia/confusão
Full details

Risk factors

  • doença arterial coronariana (DAC)
  • infarto do miocárdio
  • hipertensão
  • diabetes mellitus
  • dislipidemia
  • idade avançada
  • sexo masculino
  • obesidade
  • exposição a agentes cardiotóxicos
  • disfunção ventricular esquerda
  • hipertrofia ventricular esquerda
  • insuficiência renal
  • valvopatia cardíaca
  • apneia do sono
  • homocisteína elevada
  • uso de cocaína
  • história familiar de IC
  • fibrilação atrial
  • distúrbios da tireoide
  • anemia
  • fator de necrose tumoral alfa (TNF-alfa) e interleucina-6 (IL-6) elevados
  • proteína C-reativa elevada
  • fator de crescimento semelhante à insulina-1 (IGF-1) diminuído
  • peptídeos natriuréticos aumentados
  • dilatação do ventrículo esquerdo
  • massa ventricular esquerda aumentada
  • enchimento diastólico ventricular esquerdo anormal
  • síndrome metabólica ou síndrome cardiovascular-renal-metabólica
  • baixa condição socioeconômica
  • tabagismo
  • abuso de álcool
  • ingestão excessiva de sódio
  • taquicardia
  • depressão/estresse
  • microalbuminúria
  • uso de aspirina
  • deficiências de micronutrientes
Full details

Diagnostic investigations

1st investigations to order

  • ecocardiografia transtorácica
  • eletrocardiograma (ECG)
  • radiografia torácica
  • níveis de peptídeo natriurético do tipo B (PNB)/fragmento N-terminal do peptídeo natriurético tipo B (NT-proBNP)
  • Hemograma completo
  • urinálise
  • eletrólitos séricos (incluindo cálcio e magnésio)
  • ureia, creatinina sérica
  • glicemia
  • testes de função hepática
  • testes de função tireoidiana (especialmente hormônio estimulante da tireoide [TSH])
  • lipídeos séricos
Full details

Investigations to consider

  • ferritina sérica
  • saturação de transferrina
  • exame de imagem não invasivo sob estresse (RNM cardiovascular, ecocardiograma sob estresse, SPECT, PET)
  • teste ergométrico padrão (bicicleta ou esteira)
  • angiografia coronariana
  • angiotomografia cardíaca
  • teste ergométrico cardiopulmonar com VO₂ máx
  • teste de exercício de marcha em 6 minutos
  • cateterismo cardíaco direito
  • biópsia endomiocárdica
  • ensaio de imunoadsorção enzimática (ELISA) sérico para HIV
  • ressonância nuclear magnética (RNM) cardíaca
  • outros biomarcadores
  • tomografia computadorizada (TC) com múltiplos cortes
Full details

Treatment algorithm

ONGOING

IC sintomática: FEVE ≤40%

IC sintomática: FEVE 41% a 49%

IC avançada

Contributors

Authors

Syed Wamique Yusuf, FACC, FRCPI
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.

Acknowledgements

Dr Syed Wamique Yusuf would like to gratefully acknowledge Dr Andrew R.J. Mitchell, Dr Grigorios Giamouzis, Dr Sonjoy Raja Laskar, and Dr Javed Butler, the previous contributors to this topic.

Disclosures

ARJM, GG, SRL, and JB declare that they have no competing interests.

Peer reviewers

David Leaf, MD, MPH

Professor of Medicine

VA Greater Los Angeles Healthcare System

UCLA School of Medicine

Los Angeles

CA

Disclosures

DL declares that he has no competing interests.

Brian Griffin, MD

Director

Cardiovascular Training Program

Cleveland Clinic

Cleveland

OH

Disclosures

BG declares that he has no competing interests.

Abdallah Al-Mohammad, MD, FRCP(Edin.), FRCP(Lond.)

Consultant Cardiologist and Heart Failure Lead

Sheffield Teaching Hospitals NHS Foundation Trust (Northern General Hospital)

Sheffield

UK

Disclosures

AAM has accepted hospitality by NOVARTIS in 2008 to attend the American College of Cardiology meeting in Chicago, and had received honoraria for delivering educational talks before 2008. AAM is the co-author of the NICE chronic heart failure partial update of the guideline in 2010, and of several related articles.

Peer reviewer acknowledgements

BMJ Best Practice topics are updated on a rolling basis in line with developments in evidence and guidance. The peer reviewers listed here have reviewed the content at least once during the history of the topic.

Disclosures

Peer reviewer affiliations and disclosures pertain to the time of the review.

References

Our in-house evidence and editorial teams collaborate with international expert contributors and peer reviewers to ensure that we provide access to the most clinically relevant information possible.

Key articles

Bozkurt B, Coats AJ, Tsutsui H, et al. Universal definition and classification of heart failure: a report of the Heart Failure Society of America, Heart Failure Association of the European Society of Cardiology, Japanese Heart Failure Society and Writing Committee of the Universal Definition of Heart Failure. J Card Fail. 2021 Apr 1;27(4):387-413.Full text  Abstract

Groenewegen A, Rutten FH, Mosterd A, et al. Epidemiology of heart failure. Eur J Heart Fail. 2020 Aug;22(8):1342-56.Full text  Abstract

Heidenreich PA, Bozkurt B, Aguilar D, et al. 2022 AHA/ACC/HFSA guideline for the management of heart failure: a report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines. Circulation. 2022 May 3;145(18):e895-1032.Full text  Abstract

McDonagh TA, Metra M, Adamo M, et al; ESC Scientific Document Group. 2021 ESC guidelines for the diagnosis and treatment of acute and chronic heart failure. Eur Heart J. 2021 Sep 21;42(36):3599-726.Full text  Abstract

McKee PA, Castelli WP, McNamara PM, et al. The natural history of congestive heart failure: the Framingham study. N Engl J Med. 1971 Dec 23;285(26):1441-6. Abstract

National Institute for Health and Care Excellence. Chronic heart failure in adults: diagnosis and management. Sep 2018 [internet publication].Full text

McDonagh TA, Metra M, Adamo M, et al. 2023 Focused update of the 2021 ESC guidelines for the diagnosis and treatment of acute and chronic heart failure. Eur Heart J. 2023 Oct 1;44(37):3627-39.Full text  Abstract

Reference articles

A full list of sources referenced in this topic is available to users with access to all of BMJ Best Practice.
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