Feature Article

Chronic heart failure. Part 1: pathophysiology and patient assessment

Kiran Swaraj, Peter MacDonald
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Significant advances in our understanding of the pathophysiology and treatment of chronic heart failure (CHF) have led to improved survival and quality of life for CHF sufferers; however, this condition remains a major cause of death and disability in our community.

Key Points

  • Clinically, chronic heart failure (CHF) is a syndrome of dyspnoea, fatigue or exercise intolerance due to systolic or diastolic cardiac dysfunction.
  • It is associated with a complex pattern of neurohormonal activation that results in fluid retention and vasoconstriction.
  • While dyspnoea and fatigue are the cardinal symptoms of CHF, orthopnoea, paroxysmal nocturnal dyspnoea and ankle swelling strengthen the clinical suspicion of heart failure.
  • Many patients with CHF have few clinical signs; a displaced apex beat is probably the single most reliable physical abnormality indicating cardiomegaly.
  • All patients with suspected heart failure should undergo standard investigations comprising blood tests, ECG and chest x-ray; those with a clinical diagnosis of heart failure should have an echocardiogram.