Differential Diagnosis of Heart Failure Based on Clinical Presentation

Introduction

Heart failure (HF) is a complex clinical syndrome resulting from structural or functional cardiac disorders that impair the ability of the heart to pump blood efficiently. Accurate differential diagnosis is crucial for effective management.

Clinical Presentation and Differential Diagnosis

Heart Failure with Reduced Ejection Fraction (HFrEF)

• Characterized by an ejection fraction (EF) ≤40%
• Common causes: Ischemic heart disease, hypertension, myocarditis
• Symptoms: Dyspnea, fatigue, fluid retention

Heart Failure with Preserved Ejection Fraction (HFpEF)

• EF ≥50%, often associated with diastolic dysfunction
• Common causes: Hypertension, obesity, diabetes
• Symptoms: Exercise intolerance, pulmonary congestion

Right-Sided Heart Failure

• Often secondary to left-sided HF or pulmonary hypertension
• Symptoms: Peripheral edema, hepatomegaly, ascites

Management Considerations

Pharmacologic Approaches

• ACE inhibitors/ARBs: Reduce afterload and improve cardiac function
• Beta-blockers: Improve survival in HFrEF
• Diuretics: Symptomatic relief of fluid overload
• SGLT2 inhibitors: Emerging role in HF management

Non-Pharmacologic Approaches

• Dietary sodium restriction
• Regular physical activity tailored to patient tolerance
• Cardiac rehabilitation programs
• Device therapy: Implantable cardioverter-defibrillators (ICDs), cardiac resynchronization therapy (CRT)

Conclusion

Heart failure requires a nuanced approach to diagnosis and management. Understanding the clinical presentation aids in selecting appropriate pharmacologic and non-pharmacologic interventions to optimize patient outcomes.