Symptoms / clinical features of the heart failure

Respiratory disturbances

DYSPNEA

In early HF, dyspnea is observed only during exertion, when it may simply represent an aggravation of the breathlessness that occurs normally. As HF advances, dyspnea occurs with progressively less strenuous activity and ultimately it is present even at rest.

The principal difference between exertional dyspnea occurs with progressively less strenuous activity and ultimately it is present even at rest. The principal difference between exertional dyspnea in normal persons and in patients.

With HF is the degree of exertion necessary to induce this symptom. Cardiac dyspnea is observed most frequently in patients with elevations of pulmonary vessels and interstitial accumulation of interstitial fluid.

The activation of receptors in the lungs results in the rapid, shallow breathing characteristic of cardiac dyspnea. The oxygen cost of breathing is increased by the excessive work of the respiratory muscles required to move air into and out of the congested lungs.

This is coupled with the diminished delivery of oxygen to these muscles, a consequence of a reduced cardiac output. This imbalance may contribute to fatigue of the respiratory muscles and the sensation of shortness of breath.

Orthopnea

This symptom, i.e. dyspnea in the recumbent position, is usually a later manifestation of HF than exertional dyspnea. Orthopnea results form the redistribution of fluid from the abdomen and lower extremities into the chest during recumbency,

Which increase the pulmonary capillary pressure, combined with elevation of the diaphragm. Patients with orthopnea must elevate their head on several pillows at night and frequently awaken short of breath and coughing if their head slips off the pillows.

Orthopnea is usually relieved by sitting upright, and some patients reports that they find relief from sitting in front of an open window. In advanced HF, patients cannot lie down at all and must spend the entire night in a sitting position.

Paroxysmal (nocturnal) dyspnea

This term refers to attacks of severe shortness of breath and coughing that generally occurs at night, usually awaken the patient from sleep, and may be quite frightening.

Though simple orthopnea may be relived by sitting upright at the side of the bed with legs dependent, in the patients with paroxysmal nocturnal dyspnea, coughing and wheezing often persist even in this position.

Paroxysmal nocturnal dyspnea may be caused in part by the depression of the respiratory center during sleep, which may reduce ventilation. Sufficiently to lower arterial oxygen tension, particularly in patients with interstitial lungs edema and reduced pulmonary compliance.

Cardiac asthma is closely related to paroxysmal nocturnal dyspnea and nocturnal cough and is characterized by wheezing secondary to bronchospasm-most prominent at night.

Acute pulmonary edema is a severe form of cardiac asthma due to marked elevation of pulmonary capillary pressure leading to alveolar edema, associated with extreme shortness of breath, rales over the lungs fields, and the expectoration of blood –tinged fluid. If not treated promptly, acute pulmonary edema may be fatal.

Cheyne-stokes respiration

Also known as periodic respiration or cyclic respiration, Cheyne - Stokes respiration is characterized by diminished sensitivity of the respiratory center to arterialpco2. There is an apneic phase, during which the arterial po2 falls and the arterial pco2 rises.

These changes in the arterial blood stimulate the depressed respiratory center, resulting in hyperventilation and hypocapian, followed in turn by recurrence of apnea.

Cheyne - Stokes respiration occurs most often in patients with cerebral atherosclerosis and other cerebral lesions, but the prolongation of the circulation time from the lung to the brain that occurs in HF, particularly in patients with hypertension and coronary artery disease, also appears to contribute to this form of disordered breathing.

Other symptoms

Fatigue and weakness

These nonspecific but common symptoms of HF are related to reduction of skeletal muscle perfusion. Exercise capacity is reduced to the limited ability of the failing heart to increase its output and deliver oxygen to the exercising muscles.

Abdominal symptoms

Anorexia and nausea associated with abdominal pain and failure are frequent complains and may be related to the congested liver and portal venous system.

Cerebral symptoms

Patients with severe HF, particularly elderly patients with cerebral arteriosclerosis, reduced cerebral perfusion, and arterial hypoxemia, may develop alterations in the mental state characterized by confusion, difficulty in concentration, impairment of memory, headache, and anxiety. Nocturia is common in HF and may contribute to insomnia.

What are the symptoms / clinical features of the heart failure