Congestive Heart Failure Definition and Diagnosis

Core Components of CHF Definition

The European Society of Cardiology defines congestive heart failure as a clinical syndrome characterized by typical symptoms and signs caused by a structural and/or functional cardiac abnormality, resulting in reduced cardiac output and/or elevated intracardiac pressures at rest or during stress 1
Heart failure is a syndrome in which patients have symptoms of heart failure and signs of fluid retention, along with objective evidence of an abnormality of the structure or function of the heart at rest, as stated by the European Heart Journal 2
The American College of Cardiology notes that the cardinal manifestations of heart failure are dyspnea and fatigue, which may limit exercise tolerance, and fluid retention, which may lead to pulmonary congestion and peripheral edema 3
The European Heart Journal recommends that demonstration of an underlying cardiac cause is central to the diagnosis of heart failure, as the precise pathology determines specific treatment approaches 1, 4
The American College of Cardiology prefers the term "heart failure" over the older term "congestive heart failure" because not all patients have volume overload at the time of initial or subsequent evaluation 3

The American College of Cardiology states that heart failure results from any structural or functional cardiac disorder that impairs the ability of the ventricle to fill with or eject blood 3
The European Heart Journal notes that the syndrome can result from disorders of the pericardium, myocardium, endocardium, heart valves, great vessels, or abnormalities of heart rhythm and conduction 1, 4
Common causes include coronary artery disease, hypertension, and dilated cardiomyopathy, with as many as 30% of dilated cardiomyopathy cases having a genetic cause, according to the American College of Cardiology 3

The European Heart Journal classifies heart failure based on left ventricular ejection fraction (LVEF) into three categories: heart failure with reduced ejection fraction (HFrEF): LVEF <40%, heart failure with mid-range ejection fraction (HFmrEF): LVEF 40-49%, and heart failure with preserved ejection fraction (HFpEF): LVEF ≥50% 1
The American College of Cardiology notes that both systolic and diastolic dysfunction often coexist in heart failure patients, regardless of ejection fraction 3
Diastolic heart failure is more common in elderly patients and women, and is frequently associated with systolic hypertension and myocardial hypertrophy with fibrosis, as stated by the European Heart Journal 5, 6

Typical symptoms include breathlessness, ankle swelling, and fatigue, according to the European Heart Journal 1, 4
Common signs include elevated jugular venous pressure, pulmonary crackles, and peripheral edema, as noted by the European Heart Journal and the American College of Cardiology 1, 7
Pulmonary rales are hallmark lung sounds in CHF and indicate pulmonary congestion requiring prompt treatment, according to the European Heart Journal 7
Some patients may have exercise intolerance with little evidence of fluid retention, while others may present primarily with edema and minimal dyspnea, as stated by the American College of Cardiology 3, 7

The European Heart Journal states that the diagnosis of heart failure is primarily clinical, based on a careful history and physical examination, supported by appropriate investigations 5, 6
A clinical response to treatment directed at heart failure alone is not sufficient for diagnosis, though patients should generally show improvement in symptoms and signs with appropriate therapy, as noted by the European Heart Journal 2, 5
Heart failure should never be the only diagnosis - the underlying cause should always be identified, according to the European Heart Journal 5, 6
Asymptomatic structural or functional abnormalities of the heart are considered precursors of symptomatic heart failure and are associated with high mortality, as stated by the European Heart Journal 2

Acute heart failure refers to rapid onset or worsening of symptoms and signs of heart failure, often requiring urgent treatment, according to the European Heart Journal 5, 6
Chronic heart failure is the persistent state, often punctuated by acute exacerbations, as noted by the European Heart Journal 5, 6
The terms "right heart failure" and "left heart failure" refer to syndromes presenting predominantly with congestion of the systemic or pulmonary veins, respectively, but do not necessarily indicate which ventricle is most severely damaged, as stated by the European Heart Journal 6