cardiac failure

Last edited 10/2021 and last reviewed 09/2022

Heart failure is a complex clinical syndrome of symptoms and signs that suggest the efficiency of the heart as a pump is impaired (1)

• caused by structural or functional abnormalities of the heart
• around 920,000 people in the UK today have been diagnosed with heart failure
• the incidence and prevalence of heart failure increase steeply with age, and the average age at diagnosis is 77
• overall prevalence of heart failure is rising because of population ageing and increasing rates of obesity

Heart failure (HF) is a syndrome and not a single pathological process in which there is impairment of the heart as a pump supporting physiological circulation (1,2). Patients with heart failure will have the following features:

• symptoms typical of heart failure e.g. - breathlessness and exhaustion at rest or with less than the normal degree of exertion, fatigue  and
• signs of fluid retention e.g. - pleural effusion, increased JVP, peripheral oedema  and
• objective evidence of an abnormality of the structure or function of the heart at rest e.g. - cardiac murmurs, third heart sound (3)

The functional reserve of the heart is grossly reduced and there are associated changes in many organ systems.

Heart failure may be described as acute or chronic:

• acute heart failure - a rapid onset or change in the following signs and symptoms:
  • dyspnoea
• oedema, either pulmonary or peripheral
• organ underperfusion
• tachycardia

• chronic heart failure may be more insidious:
  • chronic exercise limitation

Due to the confusion in the rate of onset and duration of symptoms in acute and chronic HF, the European Society of Cardiology suggested that HF could more accurately be described as new onset, transient, or chronic (2).

A syndrome which may present similarly to heart failure is seen in patients with normal hearts who have extreme pressure or volume stresses.

Reference:

• (1) NICE (September 2018).Chronic heart failure in adults: diagnosis and management
• (2) NICE 2010. Chronic heart failure. National clinical guideline for diagnosis and management in primary and secondary care  
• (3) European Society of Cardiology (ESC) 2008. ESC guidelines for the diagnosis and treatment of acute and chronic heart failure 2008