Clinical Presentation

Common Symptoms:

• Dyspnea, especially on exertion
• Orthopnea
• Paroxysmal nocturnal dyspnea
• Exercise intolerance
• Fatigue
• Peripheral edema (sacral, ankle, abdominal)
• Cough
• Nocturia
• Nausea, poor appetite, early satiety

Less Common:

• Wheezing
• Dizziness, syncope
• Depression

Signs Specific for HF:

• Jugular venous distension
• Displaced apical impulse
• S3 gallop
• Hepatojugular reflux
• Cheyne-Stokes respiration (advanced HF)

Less Specific Signs:

• Peripheral edema
• Pulmonary rales
• Tachycardia
• Tachypnea
• Hepatomegaly, ascites
• Cardiomegaly on exam or imaging
• Pleural effusions

HF can be caused by abnormalities in cardiac contraction (HFrEF) or relaxation (HFpEF). Patients usually present with dyspnea and fatigue from congestion or poor perfusion. However, there is often a disconnect between symptoms and ejection fraction. Risk factors like hypertension, previous MI, valvular disease, cardiomyopathies, etc. provide clues, but natriuretic peptide levels and echocardiography are needed for confirmation. Misdiagnosis can occur if HF is not considered alongside other potential causes of dyspnea (e.g. COPD, pulmonary embolism).