What type of heart failure is usually associated with dyspnea

Help fund lifesaving research and prevent heart failure in communities like yours nationwide. Right-sided heart failure The heart's pumping action moves "used" blood that returns to the heart through the veins through the right atrium into the right ventricle. The right ventricle then pumps the blood back out of the heart into the lungs to be replenished with oxygen.

Right-sided or right ventricular RV heart failure usually occurs as a result of left-sided failure. When the left ventricle fails, increased fluid pressure is, in effect, transferred back through the lungs, ultimately damaging the heart's right side. When the right side loses pumping power, blood backs up in the body's veins.

This usually causes swelling or congestion in the legs, ankles and swelling within the abdomen such as the GI tract and liver causing ascites. Congestive heart failure CHF is a type of heart failure which requires seeking timely medical attention, although sometimes the two terms are used interchangeably.

As blood flow out of the heart slows, blood returning to the heart through the veins backs up, causing congestion in the body's tissues. Often swelling edema results. Most often there's swelling in the legs and ankles, but it can happen in other parts of the body, too. The DLCO is used to indirectly measure the gas exchange of oxygen and carbon dioxide across the alveolar surface. Reduced diffusing capacity can occur in a variety of alveolar or interstitial abnormalities, such as edema, inflammation, infection, infiltration and malignancy.

Reduced oxygen diffusion can markedly contribute to dyspnea; however, it usually occurs with some spirometric abnormality. Exercise treadmill testing can target ischemia as a cause of dyspnea. A patient's ability to perform a treadmill test can be limited by poor aerobic conditioning, by lower extremity pathology such as arthritis, claudication or edema, or by coincidental pulmonary disease. Exercise treadmill testing is relatively safe and has few risks: only one in 10, patients dies of malignant arrhythmia or acute myocardial infarction, and only two in 10, have serious but nonfatal arrhythmia or another complication.

The normal physiologic response to exercise testing is an increase in blood pressure and heart rate. To achieve maximal effort, the heart rate should reach at least 85 percent of the target heart rate for the patient's age. Underlying heart disease may be signified by ST-segment changes, by arrhythmias or by inappropriate blood pressure changes during exercise. There are limitations to the sensitivity and specificity of treadmill testing, however, and interpretation of the results may vary.

Negative results on treadmill exercise testing in a patient who has dyspnea but no chest pain or other cardiac risk factors suggest that dyspnea is caused by something other than coronary artery disease. When the results are equivocal or difficult to interpret, further diagnostic testing or consultation should be considered. Echocardiography can detect a valvular abnormality and may be diagnostically helpful in patients with questionable murmurs in the context of dyspnea.

Chamber size, hypertrophy and left ventricular ejection fraction can also be assessed. A multigated cardiac acquisition MUGA scan or radionucleotide ventriculography can also be used to quantify the ejection fraction. Cardiopulmonary exercise testing quantifies cardiac function, pulmonary gas exchange, ventilation and physical fitness. Cardiopulmonary exercise testing may be used in selected cases when the diagnosis is still unclear after the inital examination.

It can be particularly useful in cases where obesity, anxiety, deconditioning, exercise-induced asthma or other problems preclude standard exercise treadmill testing. The test is usually performed on a treadmill or bicycle ergometer and requires that the patient breathe into a mouthpiece during exercise. The patient performs progressively more difficult exercise to the point of exhaustion.

During exercise, oxygenation is measured by using either a pulse oximeter or an arterial line, and interpretation of the complete test requires analysis of oxygen consumption, carbon dioxide production, anaerobic threshold, heart rate and rhythm, blood pressure, minute ventilation, continuous monitoring of gas exchange, severity of perceived exertion, dyspnea, chest pain and leg discomfort.

Cardio-pulmonary exercise testing can help define whether an abnormality lies in the pulmonary, cardiac or skeletal muscle systems. In most patients, the cause or causes of dyspnea can be determined in a straightforward fashion by using the history and physical examination to identify common cardiac or pulmonary etiologies.

In selected cases, specific diagnostic testing or consultation may be needed to confirm the diagnosis or to provide assistance with therapeutic management. Already a member or subscriber? Log in. Interested in AAFP membership? Learn more. He received his medical degree from the University of Washington School of Medicine, Seattle, and completed a residency in family medicine at San Bernardino Calif. County Medical Center. Morgan has a certificate of added qualification in geriatric medicine.

HODGE, m. Address correspondence to Walter C. Morgan, M. Reprints are not available from the authors. Mahler DA, ed. Mount Kisco, N. Principles of ambulatory medicine. Tobin MJ. Pathophysiologic basis, clinical presentation, and management. Arch Intern Med. Evaluation of dyspnea in the elderly patient. Clin Chest Med. Assessment of breathlessness. Q J Med. Discriminating causes of dyspnea through clinical examination.

J Gen Intern Med. Braunwald E, ed. Heart disease: a textbook of cardiovascular medicine. Philadelphia: Saunders, Fauci AS, ed. Harrison's Principles of internal medicine. Heart failure can affect the right or left side of your heart or both at the same time. It can be either an acute short-term or chronic ongoing condition. In acute heart failure, the symptoms appear suddenly but go away fairly quickly.

This condition often occurs after a heart attack. It may also be a result of a problem with the heart valves that control the flow of blood in the heart. The vast majority of heart failure cases are chronic.

About 6. Most of these people are male. However, females are more likely to die from heart failure when the condition goes untreated. Heart failure is a serious medical condition that requires treatment.

Early treatment increases your chances of long-term recovery with fewer complications. Heart failure is most often related to another condition. The most common cause of heart failure is coronary artery disease CAD , a disorder that causes narrowing of the arteries that supply blood and oxygen to the heart.

Other conditions that may increase your risk for developing heart failure include:. Heart failure can occur in either the left or right side of your heart. The left heart ventricle is located in the bottom left side of your heart. This area pumps oxygen-rich blood to the rest of your body. This prevents your body from getting enough oxygen-rich blood.

The blood backs up into your lungs instead, which causes shortness of breath and a buildup of fluid. The right heart ventricle is responsible for pumping blood to your lungs to collect oxygen. The accumulation of blood in the lungs caused by left-sided heart failure makes the right ventricle work harder. This can stress the right side of the heart and cause it to fail. Right-sided heart failure can also occur as a result of other conditions, such as lung disease.

Right-sided heart failure is marked by swelling of the lower extremities. This swelling is caused by fluid backup in the legs, feet, and abdomen. Diastolic heart failure occurs when the heart muscle becomes stiffer than normal. This is known as diastolic dysfunction. It leads to a lack of blood flow to the rest of the organs in your body. Systolic heart failure occurs when the heart muscle loses its ability to contract.

Top of the page. Topic Overview If you have heart failure , symptoms start to happen when your heart cannot pump enough blood to the rest of your body. Shortness of breath While shortness of breath is the most common symptom of heart failure, it may be difficult or impossible to distinguish it from shortness of breath caused by other health problems such as emphysema or severe anemia.

You might feel that: You can't catch your breath. You feel tightness in your chest. You feel tired when you walk. You need to stop a lot when you walk. It gets worse when you lie flat, and it may wake you up at night. Being very tired fatigue You might feel that: You have less energy and feel more tired than usual.

You can't exert yourself like you could before. Swelling in ankles or feet People with heart failure often experience swelling in their ankles or feet. You might notice that: It gets worse at the end of the day or after you stand for long periods. It hurts. Pressure leaves impressions in your skin. Shoes no longer fit. Sudden weight gain Weight gain may be the first noticeable sign that you have developed heart failure or that your heart failure is getting worse. Credits Current as of: August 31, Top of the page Next Section: Related Information.

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