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Congestive heart failure pain: Heart failure – Symptoms and causes


Chronic Pain in Chronic Heart Failure: A Review Article


Heart failure (HF) is one of the main causes of death and disability in the world. The prevalence of HF in developed countries is between 1% and 2% of the adult population and approximately between 6% and 10% in the elderly, giving rise to high costs of care and treatment. Indeed, in the United States, the direct and indirect costs exceeded 23 billion dollars in 2002. HF is typically characterized by periods of acute symptoms followed by returns to nearly asymptomatic periods. As dyspnea and fatigue are considered the signature symptoms of HF, other symptoms such as pain go unnoticed. Awareness of the burden of pain, however, is growing in patients with chronic HF. The past 2 decades have witnessed remarkable technical headway in cardiology and many patients have survived despite the progressive impairment of their cardiovascular function. It is, therefore, of great value to investigate the prevalence and management of pain in patients with HF. To that end, we undertook a comprehensive search using the MEDLINE database for studies and guidelines on the subject of pain and HF and the complications and considerations and finally selected 65 studies for review.

Key Words: Heart failure, Pain, Chronic disease, Review


Chronic diseases are now considered the leading cause of morbidity and mortality worldwide. The progression of chronic end-stage organ failure, especially heart failure (HF), is typically marked by a gradual decline punctuated by acute deteriorations in health status and daily functioning.1 The deterioration of organ failure can be life-threatening and increase the risk of hospital admission and need for intensive treatment.13 HF is one of the principal causes of death in the world; the prevalence of this chronic disease in developed countries is from 1% to 2% of the adult population and approximately between 6% and 10% in the elderly. About 15 million people the world over and more than 4.9 million people in the United States suffer from HF, and the direct and indirect costs of the health care and treatment of these patients are very high.1, 3 HF is progressive in nature; accordingly, treatment is mainly focused on slowing the progression of the disease and palliating the symptoms of the patients.4, 5

Dyspnea and fatigue are deemed the hallmark symptoms of HF, and other symptoms such as pain are liable to go unnoticed.6, 7 Nonetheless, awareness of the burden of pain and symptoms is growing in patients with HF.8, 9 Pain in patients suffering from HF may be of different origins by different mechanisms such as ischemia, inflammation, and neuropathy. The experience of pain may diminish cognitive functioning and increase anxiety, sleeplessness, depression, and hopelessness.1012 Thus, it is highly beneficial to investigate the prevalence of pain and its source and management in patients with HF.


We undertook a comprehensive search using the MEDLINE database for studies and guidelines on the subject of pain and HF and the complications and considerations thereof. Our search comprised the MeSH headings of heart failure, cardiac failure, congestive heart failure, and heart decompensation, as well as pain and chest pain. We also sought additional articles by performing the same search strategy in the databases of EMBASE, ScienceDirect, and Google Scholar. Subsequently, we combined all the searches and removed the duplicates. The total number of potential articles in our primary search was 245 studies. We thereafter excluded irrelevant articles by reading their title and abstract and finally chose 65 studies for this review article.

Chronic Pain Syndrome in Chronic Diseases

Pain is one of the most common symptoms among individuals seeking medical attention and is identified as the chief complaint on presentation to the emergency department. 1315 Patients tend to seek health care for pain not only for diagnostic evaluation and symptom relief but also for the interference of pain with personal performance and the resultant anxiety and emotional distress. When pain persists for weeks or months, the influence of the broader effects of pain on well-being becomes more palpable. Chronic pain can exert negative effects on psychological health and performance of social responsibilities in work and family life.16 The major challenge in chronic pain is its unusual nature. In this syndrome, the etiology of pain is difficult to identify and the symptoms of pain do not usually respond to the common medical managements. Regardless of its etiology, the chronic pain syndrome affects many aspects of the patient’s personal and medical life. The presence of the chronic pain syndrome in the setting of a chronic disease renders patients anxious, frustrated, and depressed-which may have deleterious effects on their therapies. 16

Importance of Pain in Patients with Heart Failure

Patients with HF commonly experience pain in any part of their body. The pain is an important and frequent symptom, particularly during the time of exacerbation and hospitalization.17 Much as pain has been recognized as the most common identifiable reason for clinical deterioration prior to admission to the hospital, the importance of pain in patients with HF is frequently underestimated by physicians.18 It has been shown that patients with HF suffering from pain are older, enjoy lower levels of general health, have more comorbidities, and are even more likely to have a history of cancer than those without HF.19 The experience of pain may weaken cognitive functioning and increase anxiety, sleeplessness, depression, and hopelessness.1012 Furthermore, the presence of pain, particularly when accompanied by fatigue and depression (common findings in HF), may lead to compromised functional performance. 20 Moreover, individuals experiencing depression and anxiety tend to have a lower rate of medication adherence, which is an essential component of self-management in patients with HF.21 Pain may constitute an important symptom in patients with HF referring to the emergency department. It has been shown that the incidence rate of the acute coronary syndrome among patients with HF presenting to the emergency department with chest pain is 32%. These patients have more prolonged hospital stays, require higher levels of care, and have a higher incidence of death. Given the considerable importance of pain and its management in the setting of HF, we aimed to determine the prevalence of pain and evaluate its management and its impact on the quality of life of patients with HF.

Prevalence of Pain in Patients with Heart Failure

The prevalence of pain in HF varies between 23% and 85% in different studies (). Although shortness of breath and fatigue are regarded as the most common symptoms of HF, there is a great deal of evidence indicating that pain is a significant symptom in patients with HF (). 2233 A remarkable number of studies show that the majority of patients with HF, particularly those with advanced HF, suffer from pain.22, 23 Interestingly, patients with a lower left ventricular ejection fraction (LVEF) may have significantly higher pain scores than those with a higher LVEF.24, 25

Table 1

Prevalence of pain in patients with heart failure in different studies

Study Patient and Study Design Pain Prevalence Outcome of Pain Findings Associated with Increase in Pain
Blinderman et al. , 20084 Outpatients with end-stage CHF
Longitudinal observational study
29% (chest pain or pressure)
37% (other types of pain)
High symptom-associated distress being seen in 26.7% of the patients with chest pain and in 54.1% of those with other types of pain —-
Lip et al., 199714 Hospitalized patients (acute HF)
23.1% (chest pain) —- —-
Whelan et al., 20047 In hospitalized patients and in a period of 30 days after discharge
Prospective cohort study
Number of all the patients: 5605
Number of the patients with HF: 428
59% of the total patients
(no specific reporting for patients with HF)
Nordgren and Sörensen, 200315 In hospitalized patients (patients with end-stage HF) and in a period of the last 6 months of life)
Descriptive retrospective design
75% —- —-
Godfrey et al. , 200717 Patients with HF at hospital discharge and at 2 and 6 weeks post discharge
Part of a larger randomized controlled trial
At hospital discharge (68%; n: 115)
68% (n: 78/115) at 2 weeks
Post discharge
72% (n: 83/115) at 6 weeks post discharge
Decrease in health-related QOL
Goebel et al., 200919 Veterans with HF
Secondary data analysis of a cohort study
(37.5% reporting moderate-to-severe pain)
Conley et al., 2015   20  Outpatients with stable HF
Secondary data analysis of a cross-sectional study
57% Pain, fatigue, and depression being associated with decreased functional performance —-
Goodlin et al. , 201222 Outpatients with advanced HF
Descriptive multisite study
(39.5% reporting pain at more than 1 site)
Rustøen et al., 200823 Hospitalized patients with HF
Part of a larger descriptive study
(42.5% reporting severe or very severe pain)
80% of the patients with HF reporting that pain interfered with their normal work
In conjunction with the severity of disease and exacerbated mental health, pain having a negative impact on QOL
Higher number of chronic conditions
Shah et al. , 201324 Hospitalized patients (acute decompensation of HF)
Cross-sectional study
60% —- Lower LVEF (≤ 40%)
Udeoji et al., 201225 Outpatients with stable HF
Cross-sectional study
52% —-
Gan et al., 201226 Chronic HF at a mean follow-up of 22 months
Cohort study (not defined in the paper)
25.6% An increase in MACE (patients with moderate-to-severe pain having higher MACE)
Decrease in QOL
  • Increase in NYHA functional class

  • Female gender

  • More comorbidities

  • Lower LVEF

  • Shorter distance during the 6-minute walking test

  • Increase in MLHFQ scores

  • Increase in TNF-α levels

Pantilat et al. , 2016 Patients with HF (classes II and III)
Survey at baseline and at 3–6 months’ follow-up
57% (class III)
32% (class II)
—- Depression (even in mild stage)
Evangelista et al., 200928 Chronic HF
Cross-sectional, correlational study
67% Decrease in physical and overall QOL Worsening functional class
Bekelman et al., 200729 Outpatients with HF
Cross-sectional study
(42% reporting severe pain)
Number of the symptoms being strongly inversely associated with health status as measured by the KCCQ overall score —-
Levenson et al. , 200030 Patients with HF during the last 6 months of life
A retrospective analysis of data from a prospective cohort study
41% of the patients’ carers reporting that their patient was in severe pain during the last 3 days before death Increase in the rate of severe pain in the last 6 months of life Approach of death
Desbiens et al., 199731 Seriously ill hospitalized patients
Cross-sectional study
Number of all the patients: 1556
Number of the patients with HF: 420
51.2% of all the patients (not defined as HF) —-
Desbiens et al. , 199732 Survivors of serious illnesses at 2 and 6 months after discharge
Observational cohort study
Number of all the patients: 5652
Number of the patients with HF: 104
63% of the patients having reported pain in the hospital also reporting pain at 6 months post discharge Level of hospital pain being most strongly associated with later pain During the post-discharge period:

  • Level of pain during hospitalization

  • Increasing age from 18 to 50 years

  • Depression

  • Increased dependencies in ADLs

  • Comorbidity disorders

  • Poor QOL

  • Anxiety

Desbiens et al., 199633 Seriously ill hospitalized patients
Prospective cohort study
Number of all the patients: 5176
Number of the patients with HF: 854
49. 9% of the total study population
43.3% of the patients with HF
Dissatisfaction with pain control being more likely reported by the patients with:

Pathophysiology and Source of Pain in Heart Failure

Although the etiology of pain is clear in some instances such as trauma or surgery, the issue of pain in HF is controversial. Pain in chronic illnesses is multifactorial with physiological, sensory, sociocultural, affective, cognitive, and behavioral components. Nevertheless, in patients with HF, the causes of pain or altered pain perception have not been fully explained. Moreover, pain perception may vary from patient to patient and may be altered by other symptoms allied to HF such as shortness of breath, fatigue, depression, and anxiety.34

Approximately 80% of patients with HF are elderly.35 Multiple sources of pain such as physical, psychological, and neurological have been described in the elderly and they may be the sources of pain in HF. Increase in age has been defined as a marker of increase in pain levels among patients with HF in previous studies.15, 32 Moreover, comorbid conditions such as cancers and other chronic illnesses increase by age. As a result, the presence of these conditions and the age-related increase in pain are frequently found in patients suffering from HF. The comorbidities presenting with HF that may be the source of pain in these patients include coronary artery disease, chronic obstructive pulmonary disease, cancers, depression, anxiety disorder, peripheral vascular disease, pneumonia, diabetes mellitus, osteoarthritis, and low back pain.30

About one-third of patients with HF suffer from depression and the same proportion of them suffer from anxiety. A meta-analysis showed that major depression after HF was a predictor for subsequent all-cause mortality. Also, depressive mood in the wake of HF is a predictor of cardiovascular mortality.36 There is a strong association between increasing depression and anxiety and greater levels of pain. Also, there is a correlation between dissatisfaction with pain control and level of pain, depression, and anxiety.33 When death approaches, a significant trend toward an increase in anxiety and depression, as well as increasing rates of severe pain and dyspnea, is observed.30 presents the factors contributing to pain in patients with HF.

Table 2

Factors associated with pain and increased level of pain in patients with heart failure

1 Physical problems and disabilities
2 Depression, anxiety, and affective disorders
3 Ischemia (impaired circulation and oxygenation)
4 Increase in age
5 Worsening NYHA functional class
6 Increased dependencies in ADLs
7 Female gender
8 Neurohormonal derangement
9 Sensation and neurological conduction
10 Cognition and central nervous system processing
11 Behavior and health literacy
12 Social support and relationships
13 Religious, spiritual, and cultural beliefs
14 Increase in comorbid disorders
15 Poor QOL
16 Approach of death

Cytokines and inflammatory markers may participate in the generation of pain or influence the central processing of pain stimuli. 37, 38 Gan et al.26 evaluated the effects of serum levels of creatinine, NT-proBNP, high-sensitivity C-reactive protein, tumor necrosis factor-alpha (TNF-α), interleukin (IL)-6, and IL-10 on the symptoms of pain in patients with HF and found that only TNF-α levels were higher in those with pain. In the myocardium, the increased expression of TNF-α is associated with reversible and irreversible ischemia/reperfusion injury, post-myocardial infarction remodeling, fetal gene expression, myocyte hypertrophy or apoptosis, and altered endothelial and vascular smooth muscle cell function-contributing to the development and progression of HF.39

End-of-life HF is a painful condition influenced by various factors. The theory of “total pain” was defined by Dr. Cicely Saunders in 1984 to conceptualize pain at the end of life.40

This theory can be extended to a chronic life-limiting, highly symptomatic disease such as advanced HF. Physical, emotional, social or interpersonal, and spiritual or existential facets contribute to the experience of “total pain”.41 Murray et al.42 described the end-of-life trajectories of social, psychological, and spiritual needs associated with patients with end-stage HF during their last year of life. The authors reported that in advanced HF, the decline in social and psychological well-being runs in parallel with physical deterioration and that spiritual distress fluctuates more than other factors in advanced HF. Additionally, they concluded that spiritual distress is modulated by various other influences, including a perceived lack of understanding of these issues by health care professionals.

Heart Failure | Johns Hopkins Medicine

What is heart failure?

Heart failure is a condition in which the heart can’t pump enough
oxygenated blood to meet the body’s needs. The heart keeps pumping, but not
as efficiently as a healthy heart. Heart failure does not mean the heart
stops. Rather, it means the heart fails to pump as well as it should. Heart
failure generally results from some other underlying condition.

What causes heart failure?

Heart failure may result from any or all of the following:

A number of medications and supplements
may worsen heart failure or interfere with heart failure medicines. Be sure
to tell your physician about all medications and supplements you are
taking, including over-the-counter remedies.

What are the symptoms of heart failure?

The following are the most common symptoms of heart failure. However, each person may experience symptoms differently. Symptoms may include:

  • shortness of breath during rest or exercise, or while lying flat

  • weight gain

  • visible swelling of the legs, ankles and sometimes the abdomen, due to a buildup of fluid

  • fatigue and weakness

  • nausea, abdominal pain, loss of appetite

  • persistent cough that can cause blood-tinged sputum

Broadly speaking, some people will develop symptoms because they can’t get blood to the body (fatigue and weakness, shortness of breath with activity), and some will develop symptoms because blood and fluid become congested prior to reaching the heart (shortness of breath lying down, weight gain, persistent cough, abdominal congestion, nausea, abdominal pain, poor appetite, leg swelling). Some may have symptoms from both groups. And yet some may not have any symptoms at all.

The severity of the condition and symptoms depends on how much of the heart’s pumping capacity has been affected.

Symptoms of heart failure may resemble those of other conditions or medical problems. Always consult your health care provider for a diagnosis.

How is heart failure diagnosed?

In addition to a complete medical history and physical examination, diagnostic procedures for heart failure may include some combination of the following:

  • chest X-ray : a process that produces pictures of internal tissues, bones and organs

  • echocardiogram (also called echo): an ultrasound of the heart

  • electrocardiogram (ECG or EKG): wires taped to various parts of your body to create a graph of your heart’s electrical rhythm

  • BNP testing: B-type natriuretic peptide (BNP) is a hormone released from the ventricles in response to increased wall tension (stress) that occurs with heart failure. BNP levels rise as wall stress increases. BNP levels are useful in the rapid evaluation of heart failure. In general, the higher the BNP levels, the worse the heart failure.

How is heart failure treated?

The goal of heart failure treatment is to improve quality of life by addressing the underlying causes, reducing symptoms and managing overall health. Education plays a crucial role. Patients and their families who learn to recognize and respond to small changes, such as swelling or weight gain, can help slow the progression of heart failure.

Treatments include:

  • Treating underlying conditions

  • Controlling risk factors

    • quitting smoking

    • losing weight (if overweight) and increasing moderate exercise

    • switching to a heart-healthy diet

    • avoiding alcohol

    • getting proper rest

    • controlling blood sugar (if diabetic)

    • controlling blood pressure — which also means controlling the amount of sodium (salt) in your diet

    • limiting fluids

  • Medications

  • Implanted devices that help the heart function more effectively

    • biventricular pacing/cardiac resynchronization therapy : This new type of pacemaker paces both sides of the left ventricle simultaneously to coordinate contractions and improve the heart’s function. Some heart failure patients are candidates for this therapy.

    • implantable cardioverter defibrillator (ICD) : A device similar to a pacemaker, it senses when the heart is beating too fast and delivers an electrical shock to convert the fast rhythm to a normal rhythm.

    • ventricular assist device (VAD) : This mechanical device takes over the pumping function for one or both of the heart’s ventricles, or pumping chambers. A VAD may be necessary when heart failure progresses to the point that medications and other treatments are no longer effective.

    • heart transplantation : For select patients, replacing the heart with a donated heart is a last resort for those who do not improve despite all other treatments.

Congestive Heart Failure: Symptoms, Causes & Treatments

Congestive heart failure, also called CHF or heart failure, is a serious and complex disease in which the heart muscle has been damaged or has to work too hard because of heart disease and other conditions, such as obesity. Although the heart continues to beat, the damaged heart muscle is too weak to efficiently pump enough oxygen-rich blood to and from the body, resulting in potentially life-threatening congestion in the lungs and other tissues of the body.

Congestive heart failure is a common complication of heart attack and other types of heart disease that damage the heart muscle. These diseases include hypertension, heart valve disorders, arrhythmias, and cardiomyopathy. Congestive heart failure can also be caused by anemia.

In general, congestive heart failure affects both the left and right sides of the heart, but it can affect one side more than the other, depending on the location and severity of damage.

In left-sided CHF, the left side of the heart is damaged and unable to effectively pump blood from the heart to the body. This results in blood backing up into the lungs and increasing blood pressure in the lungs. The increase in pressure causes a buildup of fluid in the lungs, which can lead to a life-threatening condition called acute pulmonary edema.

In right-sided CHF, the right side of the heart is damaged and unable to effectively relax to permit blood flowing from the body back into the heart. This results in a backup of blood and an increase in pressure in the veins that carry blood from the body to the heart. In turn, this leads to swelling (edema) of the lower extremities and sometimes of other areas of the body.

Acute CHF, in which fluid builds up rapidly in the lungs and causes pulmonary edema, is an immediately life-threatening condition that can quickly lead to respiratory failure, cardiac arrest and death. Immediate emergency treatment best minimizes the risk of these and other serious complications of heart failure. Seek immediate medical care (call 911) if you, or someone you are with, have symptoms of acute congestive heart failure, such as shortness of breath, difficulty breathing, congested cough, and chest pain. If you do not have the above symptoms, but have swelling in the extremities, abdomen or face, seek prompt medical care.

Warning Signs of Heart Failure

Heart Failure Warning Signs and Symptoms

By themselves, any one sign of heart failure may not be cause for alarm. But if you have more than one of these symptoms, even if you haven’t been diagnosed with any heart problems, report them to a healthcare professional and ask for an evaluation of your heart. Congestive heart failure is a type of heart failure which requires seeking timely medical attention, although sometimes the two terms are used interchangeably.

View an animation of heart failure.

If you have been diagnosed with heart failure, it’s important for you to manage and keep track of symptoms and report any sudden changes to your healthcare team.

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This table lists the most common signs and symptoms, explains why they occur and describes how to recognize them.

Sign or Symptom People with Heart Failure May Experience… Why It Happens
Shortness of breath (also called dyspnea) …breathlessness during activity (most commonly), at rest, or while sleeping, which may come on suddenly and wake you up. You often have difficulty breathing while lying flat and may need to prop up the upper body and head on two pillows. You often complain of waking up tired or feeling anxious and restless. Blood “backs up” in the pulmonary veins (the vessels that return blood from the lungs to the heart) because the heart can’t keep up with the supply. This causes fluid to leak into the lungs.
Persistent coughing or wheezing …coughing that produces white or pink blood-tinged mucus. Fluid builds up in the lungs (see above).
Buildup of excess fluid in body tissues (edema) …swelling in the feet, ankles, legs or abdomen or weight gain. You may find that your shoes feel tight. As blood flow out of the heart slows, blood returning to the heart through the veins backs up, causing fluid to build up in the tissues. The kidneys are less able to dispose of sodium and water, also causing fluid retention in the tissues.
Tiredness, fatigue …a tired feeling all the time and difficulty with everyday activities, such as shopping, climbing stairs, carrying groceries or walking. The heart can’t pump enough blood to meet the needs of body tissues. The body diverts blood away from less vital organs, particularly muscles in the limbs, and sends it to the heart and brain.
Lack of appetite, nausea …a feeling of being full or sick to your stomach. The digestive system receives less blood, causing problems with digestion.
Confusion, impaired thinking …memory loss and feelings of disorientation. A caregiver or relative may notice this first. Changing levels of certain substances in the blood, such as sodium, can cause confusion.
Increased heart rate …heart palpitations, which feel like your heart is racing or throbbing. To “make up for” the loss in pumping capacity, the heart beats faster.

Heart failure – NHS

Heart failure means that the heart is unable to pump blood around the body properly. It usually occurs because the heart has become too weak or stiff.

It’s sometimes called congestive heart failure, although this name is not widely used nowadays.

Heart failure does not mean your heart has stopped working. It just needs some support to help it work better.

It can occur at any age, but is most common in older people.

Heart failure is a long-term condition that tends to get gradually worse over time.

It cannot usually be cured, but the symptoms can often be controlled for many years.


Coronavirus advice

Get advice about coronavirus and heart failure from the British Heart Foundation

Symptoms of heart failure

The main symptoms of heart failure are:

  • breathlessness after activity or at rest
  • feeling tired most of the time and finding exercise exhausting
  • swollen ankles and legs

Some people also experience other symptoms, such as a persistent cough, a fast heart rate and dizziness.

Symptoms can develop quickly (acute heart failure) or gradually over weeks or months (chronic heart failure).

When to get medical advice

See a GP if you experience persistent or gradually worsening symptoms of heart failure.

Call 999 for an ambulance or go to your nearest A&E department as soon as possible if you have sudden or very severe symptoms.

A number of tests can be used to help check how well your heart is working, including blood tests, an ECG and an echocardiogram.

Find out more about how heart failure is diagnosed

Causes of heart failure

Heart failure is often the result of a number of problems affecting the heart at the same time.

Conditions that can lead to heart failure include:

Sometimes anaemia, drinking too much alcohol, an overactive thyroid or high pressure in the lungs (pulmonary hypertension) can also lead to heart failure.

Treatments for heart failure

Treatment for heart failure usually aims to control the symptoms for as long as possible and slow down the progression of the condition.

Common treatments include:

  • lifestyle changes – including eating a healthy diet, exercising regularly and stopping smoking
  • medicine – a range of medicines can help; many people need to take 2 or 3 different types
  • devices implanted in your chest – these can help control your heart rhythm
  • surgery – such as a bypass operation or a heart transplant

Treatment will usually be needed for life.

A cure may be possible when heart failure has a treatable cause. For example, if your heart valves are damaged, replacing or repairing them may cure the condition.

Outlook for heart failure

Heart failure is a serious long-term condition that’ll usually continue to get slowly worse over time.

It can severely limit the activities you’re able to do and is often eventually fatal.

But it’s very difficult to tell how the condition will progress on an individual basis.

It’s very unpredictable. Lots of people remain stable for many years, while in some cases it may get worse quickly.


Social care and support guide

If you:

  • need help with day-to-day living because of illness or disability
  • care for someone regularly because they’re ill, elderly or disabled (including family members)

Our guide to care and support explains your options and where you can get support.

Page last reviewed: 26 October 2018
Next review due: 26 October 2021

11 signs you might have heart and circulatory disease

Will that pain wear off, or is it time to see your doctor or even call an ambulance? BHF Professor David Newby highlights the 11 symptoms that you need to take seriously.

Around 11 per cent of men and nine per cent of women in the UK have been diagnosed with some form of heart or circulatory disease. But what symptoms can we look out for that might indicate a potential heart problem? David Newby, BHF John Wheatley Professor of Cardiology at the BHF Centre of Research Excellence at the University of Edinburgh, tells us more about 11 signs that could mean it’s time to see a doctor.

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1. Chest pain

It’s the classic sign of a heart attack, yet many people don’t realise this could be a medical emergency.

Professor Newby says: “If you have chest pain and you feel extremely unwell, you should dial 999 and get an ambulance as soon as possible. If it’s a heart attack, it’s usually described as a heaviness, tightness or pressure in the chest; people will often describe it as ‘an elephant sat on my chest’ or ‘it felt like a tight band around my chest,’ that sort of constricting feeling.

“If chest pains occur when you are exerting yourself, but go away when you stop, that would suggest it’s more likely to be angina. That would still mean you should go and see a doctor, but you don’t have to call 999.”

Professor Newby advises that chest pains accompanied by feeling extremely unwell, mean it is probably the right time to call 999 and request an ambulance.

2. Feeling sick

Obviously not every bout of nausea equals a heart attack – but if you’re getting pain as well, alarm bells should ring. Professor Newby says: “If you experience intense chest pain even when you are just sitting around doing nothing and you are also feeling sick, that is the time to call for an ambulance.”  

If you’re getting some discomfort, but not intense pain, as well as feeling sick, call NHS 111 for advice.

3. Stomach pain or indigestion

An indigestion-type pain or a burning sensation in your chest or stomach can be a sign of a heart attack or related heart problem. Professor Newby says: “Because the heart, the gullet [the passage between your mouth and stomach] and the stomach are all lying right next to each other, the challenge, for both members of the public and doctors, is that a burning or indigestion-type pain and heart pain can be difficult to disentangle. You could call NHS 111 for advice – they have certain algorithms they apply, but they aren’t perfect as there are no hard and fast rules that apply to everyone.”

4. Feeling sweaty

Working up a sweat when you’ve been to the gym or because it’s a really hot day, is nothing to worry about. But feeling hot and clammy along with chest pains is a sign that you should call an ambulance.

5. Leg pain

Professor Newby says: “If you get a gripping, cramping sensation in your calves when you are walking, it might be worth seeing your doctor, as that can be a marker of PAD (peripheral arterial disease). It’s most common in smokers and people who have diabetes.” Make an appointment with your GP.

6. Arm pain

You might not associate arm pain with your heart, but it can be a sign of a heart attack. Professor Newby says: “If your pain is going down the arm, especially the left arm, or into the neck that makes it more likely to be heart-related than indigestion. If it doesn’t go away, or if you know you have heart disease and have used your GTN (glyceryl trinitrate) spray two or three times to no discernible effect, you should be seeking emergency medical advice.” Call 999 for an ambulance.

7. Jaw or back pain

Professor Newby says: “With heart attacks, it can even happen that the pain is felt in the jaw, or the back. Again, if it doesn’t go away, call 999 and ask for an ambulance.” There is some evidence that women’s symptoms are more likely to vary from ‘classic’ chest pain, and we know that women are less likely to seek medical attention and treatment.

8. Choking sensation

Professor Newby says: “The word ‘angina’ actually means ‘choking’, and sometimes the tightness or pain can be up in the throat. People tend to describe a ‘restricting’ or ‘choking’ sensation.” If the feeling continues, and you haven’t previously been diagnosed with heart problem, you should call NHS 111 – but if you have some of the other signs listed here as well, it might be safer to call an ambulance.

9. Swollen ankles

Professor Newby says: “This shouldn’t be ignored, especially if the ankles get really big, as it can be a marker of heart failure, but it is also very common and has lots of other causes. It could just as easily be from tablets you are taking – for example, blood pressure medication can lead to swollen ankles.”

If you’re getting swollen ankles, it’s worth making an appointment with your GP.

10. Extreme fatigue

Feeling tired all the time can be a symptom of heart failure, as well as of other conditions. Professor Newby says: “Many of my patients tell me they’re tired, whether they’ve got heart failure or not, whether they’ve got angina or not! It’s a difficult one, because it’s so non-specific.”

If you’re tired and you’ve been working long hours or staying up late, it’s probably not your heart – but if you start experiencing extreme tiredness and your lifestyle hasn’t changed, it’s a good idea to chat to your GP.

11. Irregular heartbeat 

Professor Newby says: “This is a hot topic at the moment, there’s a lot of focus on diagnosing irregular heartbeats. I did an audit of the heart monitors we give out to people for investigation and from about 700 people, we found only about 20 that had atrial fibrillation [which can increase your risk of stroke].

Left-Sided Congestive Heart Failure

The heart is a large muscle that pumps blood throughout the body. Blood carries oxygen to all the organs including the brain, plus the muscles and skin. After the body takes the oxygen out of the blood, the blood returns to the heart. The right side of the heart collects that blood. It pumps the blood to the lungs to get fresh oxygen. This oxygen-rich blood from the lungs then returns to the left side of the heart. There it is pumped back out to the brain and rest of the body, starting the process all over. 

Heart failure occurs when the heart muscle does not function normally, leading to fluid retention and reduced blood flow. This can be caused by heart muscle weakness or stiffness, or a heart valve problem.

When the left side of the heart is failing, it can’t handle the blood it is getting from the lungs. Pressure then builds up in the veins of the lungs, causing fluid to leak into the lung tissues. This may be referred to as congestive heart failure. This causes you to feel short of breath, weak, or dizzy. These symptoms are often worse with exertion, such as climbing stairs or walking up hills. Lying flat is uncomfortable and can make your breathing worse. This may make sleeping difficult and force you to use extra pillows to elevate your upper body to help you sleep well. You may also feel weak or tired and have less energy during exertion.

Causes of heart failure include:


Heart failure is usually a chronic condition. The purpose of medical treatment is to improve the pumping action of the heart, and remove excess water and fluids from the body. A number of medicines can help reach this goal, improve symptoms and keep the heart from becoming weaker. In some cases of severe heart failure, a mechanical device will be placed in the heart to help the heart pump. Another major goal is to better treat the causes of heart failure, such as diabetes, high blood pressure, and your lifestyle.

Home care

  • Check your weight every day. A sudden increase in weight gain could mean worsening heart failure.

    • Use the same scale every day.

    • Weigh yourself at the same time every day.

    • Make sure the scale is on the floor, not on a rug.

    • Keep a record of your weight every day, so your healthcare provider can see it. If you are not given a log sheet for this, keep a separate journal for this purpose. 

  • Cut back on how much salt (sodium) you eat:

    • Your provider will tell you how much salt to have daily, usually 2,000 mg or less.

    • Limit high-salt foods. These include olives, pickles, smoked meats, processed foods, and salted potato chips.

    • Don’t add salt to your food at the table. Use only small amounts of salt when cooking.

    • Don’t binge on salt-heavy meals.

  • Follow your healthcare provider’s recommendations about how much fluid you should have.

  • Stop smoking.

  • Cut back on the amount of alcohol you drink.

  • Lose weight if you are overweight. The excess weight adds a lot of stress on the workload of the heart.

  • Stay active. Talk to your provider about an exercise program that is safe for your heart.

  • Keep your feet elevated to reduce swelling. Ask your provider about support hose as a preventive treatment for daytime leg swelling.

  • Follow your healthcare provider’s instructions closely.

Besides taking your medicine as instructed, an important part of treatment includes lifestyle changes. These include diet, physical activity, stopping smoking, and weight control.

Improve your diet. Often in the hospital, people are given a heart healthy diet. This includes more fresh foods, lower saturated fat, less processed foods, and lower salt.

Follow-up care

Follow up with your healthcare provider, or as advised. Make sure to keep any appointments that were made for you. This can help better control heart failure.

If an X-ray was done, you will be told of any new findings that may affect your care.



Call 911 if you:

  • Become severely short of breath

  • Feel lightheaded, or feel like you might pass out or faint

  • Have chest pain or discomfort that is different than usual, the medicines your provider told you to use for this don’t help, or the pain lasts longer than 10 to 15 minutes

  • Develop a rapid heart rate suddenly

When to seek medical advice

Call your healthcare provider right away if you have any of these signs of worsening heart failure:

  • Sudden weight gain. This means more than 2 pounds in 1 day, or 5 pounds in 1 week, or whatever weight gain you were told to report by your provider

  • Trouble breathing not related to being active

  • New or increased swelling of your legs or ankles

  • Swelling or pain in your abdomen

  • Breathing trouble at night, waking up short of breath or needing more pillows to elevate your upper body to help you breathe

  • Frequent coughing that doesn’t go away

  • Feeling much more tired than usual

Acquired heart disease


Acquired heart defects lesions of the heart valve (s), the cusps of which are unable to fully open (stenosis) of the valve opening or to close (valve insufficiency) or both (combined defect).

Etiology and pathogenesis

Etiology stenosis and combined defect rheumatic, valve insufficiency – usually rheumatic, rarely septic, atherosclerotic, traumatic, syphilitic. Stenosis is formed as a result of cicatricial adhesion or cicatricial rigidity of the valve leaflets, subvalvular structures; insufficiency of the valve – due to their destruction, damage or cicatricial deformation. The affected valves form an obstacle to the passage of blood – anatomical with stenosis, dynamic with insufficiency. The latter lies in the fact that part of the blood, although it passes through the hole, returns back to the next phase of the cardiac cycle. The “parasitic” volume is added to the effective volume, making a pendulum-like movement on both sides of the affected valve.Significant valvular insufficiency is complicated by relative stenosis (due to an increase in blood volume). Obstruction of the passage of blood leads to overload, hypertrophy and expansion of the overlying chambers of the heart. Difficulty in the work of the heart due to improper functioning of the valve and dystrophy of the hypertrophied myocardium leads to the development of heart failure.

Clinical picture

Mitral defect defeat of the mitral valve, accompanied by difficulty in the passage of blood from the small circle to the large one at the level of the left atrioventricular opening. Manifested by heart failure. With an increase in pressure in a small circle, there are complaints of shortness of breath (more pronounced with stenosis), palpitations, cough, with an increase in right ventricular failure – for fluid retention and pain in the right hypochondrium. On examination, in severe cases, a characteristic cyanotic blush of the cheeks and lips is noticeable. Often there is extrasystole.

Mitral stenosis . With a slight narrowing of the left atrioventricular opening (the area of ​​the opening is more than 1.5 cm2), shortness of breath appears only with significant exertion.With moderate stenosis (the area of ​​the atrioventricular opening is from 1 to 1.5 cm2), shortness of breath appears with less significant exertion. Progressive heart failure can develop with moderate stenosis, but not as quickly and inevitably as with a sharp one. For a sharp stenosis (the area of ​​the atrioventricular opening is 1 cm2 or less), shortness of breath is characteristic at light and minimal loads, attacks of suffocation, orthopnea. A sharp mitral stenosis predetermines the development of progressive heart failure.

Insufficiency of the mitral valve. No complaints with minor deficiencies. With moderate insufficiency, complaints of palpitations, increased fatigue, moderate shortness of breath, fluid retention may appear. Episodic tibia is noted. With significant mitral valve insufficiency, symptoms of heart failure can be pronounced up to signs of an edematous dystrophic stage, but they can remain subtle.

Aortic defect .Symptoms and course are determined by the form of the defect (aortic stenosis or aortic valve insufficiency) and the severity of hemodynamic disorders. Aortic stenosis can be rheumatic (atherosclerotic) or congenital. Insufficient ejection of blood into the aorta can lead to insufficiency of cerebral and coronary circulation (primarily during exercise and transition to an upright position), which is manifested by both subjective and objective signs. Symptoms depend on the degree of stenosis and hemodynamic disturbances.The stage of the defect is determined by the presence of at least one of the following “sufficient” signs of a more severe stage.

Stage I: only acoustic signs of defect.

Stage II: no subjective disorders yet. The presence of noise.

Stage III: subjective disorders may appear – dizziness, darkening of the eyes, angina pectoris during physical exertion.

Stage IV: severe disorders of cerebral or coronary circulation with light exertion.Mitralization of the defect with the appearance of at least one of the following signs of congestive left ventricular failure: severe shortness of breath with moderate physical exertion, episodes of cardiac asthma. Some patients have atrial fibrillation. Death usually occurs at this stage, often at the previous stage.

Stage V (terminal) has time to develop only in some patients. Its signs are cardiomegaly, right ventricular failure, frequent (repeated within a week) attacks of cardiac asthma, severe angina pectoris.
Insufficiency of the aortic valve. The etiology is usually rheumatic. Rarely – subacute septic endocarditis, atherosclerosis of the aorta, etc. A characteristic feature is a specific blowing diastolic murmur.

Stage I: Diastolic murmur only. In the following stages, the following signs of a more severe degree of hemodynamic disturbance are found.

Stage II: no subjective disorders.

Stage III: subjective disorders are absent or moderately expressed (palpitations, moderate angina pectoris, dizziness, a feeling of pulsation in the head, in other areas).

Stage IV: severe angina pectoris, left ventricular failure with dyspnea with moderate exertion. Atrial fibrillation and other heart rhythm disturbances are possible.

Stage V: severe angina. Severe congestive left ventricular failure with frequent (repeated within a month) attacks of cardiac asthma. Many patients have shortness of breath with light exertion.


Electrocardiography. Echocardiographic examination allows you to detect stenosis and assess its degree; in the sectoral scanning mode, the degree of mitral stenosis (the area of ​​the left atrioventricular opening) is determined with great accuracy.Doppler cardiographic examination reveals reverse blood flow (valve insufficiency). Radiographically, an increase in the boundaries of the heart and congestive changes in the lungs are found. Angiographic examination helps to determine the size of the left ventricular cavity, the thickness of its walls, the site of narrowing, the degree of deformity and mobility of the valve cusps.


Treatment of the defect itself can only be surgical. To clarify the indications for such treatment, timely consultation of a specialist – a cardiac surgeon is required.Conservative therapy is reduced to the prevention and treatment of recurrence of the main process and complications, to the treatment and prevention of heart failure, as well as cardiac arrhythmias.

Treatment of heart failure requires the use of diuretins and cardiac glycosides. Vasodilators are also used. Antianginal drugs and vasodilators are used as needed.

Timely and adequate professional orientation towards the patient’s employment is of great importance.


Forecast and work capacity is determined by the degree of heart failure.

90,000 Heart cough: how to tell? | Heart failure cough: symptoms

Most people are used to the fact that cough is a companion of colds or allergies. Could there be a cough from the heart? Yes, because in case of cardiac pathologies, the synchronous work of the ventricles of the heart can be disrupted. The right one actively fills the lung tissue with blood, while the left one pumps it out more slowly.This provokes a deterioration in blood circulation and an increase in pressure in the lungs, which causes hypoxia. The patient constantly wants to cough up and breathe in more air, while most often the cough is dry in nature. In such cases, they speak of a heart cough.

Causes of heart cough

Shortness of breath is one of the common symptoms of heart disease associated with lung function. It can be felt already in the early stages of the disease. It is often possible to notice that people with shortness of breath begin to cough during physical or emotional stress.This is the so-called “cough from the heart.”

This type of cough owes its origin to functional disorders of the heart muscle. Coughing in heart disease is a fairly common phenomenon, because the heart muscle and its main vessels are closely related to the lungs and bronchi.

Violations of blood flow in the small (pulmonary) circulation can manifest themselves to varying degrees: at an early stage, cause a slight cough, and in a neglected state – pulmonary edema.This is the most severe manifestation of heart failure associated with coughing. In this case, the patient needs urgent medical attention. Now you have a unique opportunity to undergo a free specialist consultation and a set of preparatory examinations when registering for a course of enhanced external counterpulsation or shock wave therapy of the heart:


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How does a cough occur in heart disease?

Weak work of the left ventricle and the pathological processes occurring in it are the main cause of heart cough. In this case, they speak of left ventricular failure. It leads to deterioration of blood circulation in the pulmonary arteries, sclerosis of small vessels, increased pressure in the lungs. Their tissues lack oxygen, which is why the patient experiences shortness of breath and suffocation.In turn, problems in the pulmonary circulation aggravate the condition of the heart muscle.

One of the symptoms of a cough in heart failure is hemoptysis. This phenomenon also has its own reason: since the volume of blood in the lungs exceeds the normal rate, its excess accumulates and when coughing comes out of the bronchi. After all, a cough is a natural reaction of the body when the lungs, bronchi, alveoli overflow with fluid or a foreign body enters them.

Cardiac cough almost always manifests itself at moments when the patient is exposed to physical activity.However, in case of severe enough disturbances in the work of the heart, the patient, in order to begin to choke from coughing, only needs to take a lying position. In this case, excess fluid begins to intensively fill the lungs, causing irritation and continuous coughing.

What diseases accompany a heart cough?

This is a frequent companion of such pathologies as:

  • heart failure;
  • ischemic heart disease;
  • arrhythmias;
  • cardiomyopathy;
  • hypertension.

There is a high probability of its occurrence in case of problems in the work of the heart valves, heart defects. Often, cardiac cough is seen in heart attack survivors.

Cough with heart failure

Heart failure is an extremely common disease associated with blood congestion due to disturbances in its circulation in large vessels. In most patients, this pathology is accompanied by shortness of breath and cough of the above-described origin.

The nature of the cough can be different:

  • paroxysmal and dry;
  • exhausting and loud;
  • irritating dry;
  • is sharp and short.

Heart cough can be a constant concern for people with chronic heart failure . It occurs at the time of physical or emotional stress and is usually characterized as dry and jerky.

With acute heart failure , the cough can begin with shortness of breath at night, which turns into choking due to the overflow of fluid in the lungs.When breathing, the lungs begin to emit bubbling sounds. The patient may cough up bloody, frothy sputum due to the rapid increase in its volume in the lungs.

Symptoms of a heart cough

Most often, patients in the early stages of the development of heart pathologies are alarmed by a dry cough, which lasts a long time and is not associated with colds. Pain in the heart when coughing is a clear sign of problems in the work of this organ and a signal to start treatment.

Subsequently, coughing attacks begin to overwhelm the patient even with minimal physical exertion and at night, often accompanied by the release of foamy sputum with traces of blood.That is why many “cores” sleep while sitting.

Other common symptoms include:

  • increased heart rate;
  • weakness and loss of consciousness;
  • lack of air;
  • swelling of the veins in the neck;
  • Bubbling audible in the lungs at a distance.

As already mentioned, a heart cough almost always accompanies shortness of breath. Unlike bronchitis, phlegm is rarely produced with a heart cough.It also differs with a smoker’s cough, which has a barking character.

Symptoms of a heart cough in a child

The appearance of a cough in a child at night, accompanied by the above symptoms, should alert parents.

Often this symptom indicates a congenital heart defect, and the severity of the cough indicates the degree of damage to the heart tissue. Children also experience pain in the region of the heart when they cough, may choke and become extremely agitated.

Cardiac cough treatment

To prescribe effective therapy, it is necessary to diagnose the cause of the symptoms of cardiac cough. Treatment is prescribed depending on the identified problems in the work of the heart. This can be both drug therapy and surgery.

In the treatment, drugs are also used to suppress coughing attacks, and diuretics to reduce fluid in the body.

Cardiac Cough Diagnosis and Consultation at CBCP

To learn how to treat a heart cough, including heart failure and heart conditions that caused it, or where heart pain comes from, undergo an examination with expert-class equipment at the CBCP clinic.At your service are the latest methods of diagnostics of the functionality of the heart, consultations of experienced cardiologists, highly qualified cardiac surgeons.

You can make an appointment with a doctor right now on the website or by phone: +7 (495) 640-57-56.

Postpartum cardiomyopathy with thromboembolic complications

U.N. Ibebuogu, J.W. Thornton, G.L. Reed, Division of Cardiology, Medical College of Georgia, Augusta, Georgia, USA

Postpartum cardiomyopathy is a rare form of heart failure (HF), occurring in 1 case out of 3-4 thousand.normal delivery. As a rule, clinical manifestation occurs between the last month of pregnancy and the fifth month after delivery in previously healthy women; the frequency of deaths is 20-50%. Although viral, autoimmune, and idiopathic factors may be predisposing, the etiology of this condition is not fully understood.

Clinical case
A 24-year-old woman with an uncomplicated history at 5 months after normal delivery (fifth birth) complained of severe pain in the epigastrium and upper right abdomen, nausea and vomiting.An objective study showed only pain in the sections indicated by the patient without peritoneal symptoms. All vital functions are preserved. On ultrasound of the abdominal cavity, a thickened wall of the gallbladder without pathological neoplasms. Liver tests without abnormalities. The pain was relieved with analgesics. The patient showed no symptoms at discharge. Three days later, she was re-hospitalized with complaints of progressive pain in the upper abdomen, epigastrium, lower extremities and lower back, nausea and shortness of breath.Blood pressure indicators – 130/100 mm Hg. Art., heart rate – 100 beats / min. With auscultation, bilateral weakening of breathing, the appearance of a third tone at the apex of the heart, the heart rhythm is correct. On palpation, tenderness in the right upper abdomen, epigastrium and in the area of ​​the costovertebral angles. Murphy’s symptom is negative. Radiography in the abdominal cavity revealed no pathological formations, moderate cardiomegaly and shadows in the basal regions in the chest (Fig. 1). On the ECG, the normal electrical axis of the heart with diffuse changes in the form of inversion of the T wave (Fig.2). Transthoracic echocardiography: ventricular dilatation, end-diastolic size of the left ventricle (LV) – 65 mm, decrease in ejection fraction by 9%, thrombus in the region of the anterior LV wall (Fig. 3). Diagnosis: postpartum cardiomyopathy, congestive heart failure, congestive changes in the liver, intramural LV thrombus. The patient was prescribed strict bed rest with telemetric monitoring, therapeutic doses of low molecular weight heparin, nitrates, diuretics, ACE inhibitors. In dynamics, the severity of symptoms of congestive heart failure decreased, but the pain increased.Increased indicators of lactic acid (3.3 mmol / l), leukocytes (12 200 / mm 3 ). Decreased liver congestion. With catheterization of the right heart, the normal functional state, the pressure level indicates the absence of blood discharge, the cardiac index – 2.6 l / min / m 2 . Computed tomography showed the presence of thrombi in the ventricles of the heart, an 8 mm formation in the right lobe of the liver (Fig. 4), multiple formations in both kidneys (Fig. 5), partially obstructing thrombi in the area of ​​the common iliac and right external iliac arteries.An arteriogram subsequently confirmed the presence of blood clots on both sides in the iliac and femoral arteries. Tests for HIV, hepatitis B and C, syphilis, IgG and anticardiolipin IgM (6.8 GPL and 4.0 MPL, respectively) were negative. Ferritin within normal limits, rheumatoid factor <20 IU / ml. The woman underwent bilateral thrombectomy of the lower extremities well. During the entire stay in the department, the state of renal function was stable. Against the background of HF treatment and anticoagulant therapy, the patient's clinical condition improved and repeated transthoracic echocardiography 5 days after admission did not confirm the presence of thrombi in the ventricles.The lactic acid level returned to normal, the woman was discharged 2 weeks later under the supervision of a cardiologist.

Postpartum cardiomyopathy is a rare form of dilated cardiomyopathy with a complicated course and high mortality. This pathology can be characterized by the following features:
• development of HF from the last month of pregnancy up to and including the fifth month after childbirth;
• lack of a clearly established etiology of heart failure;
• absence of heart disease until the last month of pregnancy;
• echocardiography diagnoses impaired LV systole.
Death can occur as a result of the progression of heart failure, arrhythmias, or as a result of thromboembolic complications, the development of which is caused by LV dysfunction and increased coagulation. As a result of stagnant processes in the liver, discomfort appears in the right abdomen (in 50% of cases).
Initially, the patient complained of severe abdominal pain. After the diagnosis of postpartum cardiomyopathy, pain was associated with liver congestion and heart failure. Due to the fact that the pain did not decrease with the cessation of HF symptoms and the determination of normal pressure in the right heart during catheterization, it was decided to conduct a contrast computed tomography.Multiple thrombi of the heart, kidneys, common iliac and right external iliac arteries were identified. They were the cause of severe pain. Anticoagulant therapy was started against the background of severe LV dysfunction, confirmed by echocardiography (LV ejection fraction
≤ 35%). Thus, persistent abdominal pain with the disappearance of symptoms of congestive heart failure may indicate the presence of blood clots in the abdominal organs and be an indication for anticoagulant therapy. Timely diagnosis and treatment is the key to a successful outcome of postpartum cardiomyopathy.The prognostic factors of this pathology can be several births in the anamnesis, pregnancy with twins, age after 30 years, late manifestation of pathological changes after delivery. In this case, the patient had several births in the anamnesis, the first complaints were presented in the fifth month after delivery. Identification of cardiomegaly and severe heart failure helped to establish the correct diagnosis and therapy. In patients with postpartum cardiomyopathy, restoration of normal LV size and functioning by the fifth month after delivery is a good prognostic sign (in 50% of cases).In the patient described above, LV dysfunction persisted for 6 months after discharge from the hospital. At the moment she is waiting for her turn for a heart transplant.

References are being revised.

heart failure in obstructive pulmonary disease – UniMedica

The heart and lungs work together. The lungs receive oxygen through breathing and transport it to the bloodstream, the heart. The heart then delivers oxygen to other tissues and organs of the body, which use it to produce energy to support all the vital functions of our body.

Chronic obstructive pulmonary disease (COPD) is a series of diseases affecting the lungs and mainly in people over the age of 40. This includes diseases such as emphysema (the gradual destruction of lung tissue) and chronic bronchitis (associated with persistent coughing and shortness of breath as a result of the accumulation of mucus in the bronchi). COPD and heart problems share similar symptoms and signs, causes, and risk factors. In addition, patients with COPD are more likely to develop cardiovascular disease.

Heart failure (decreased heart function) and COPD share one serious common symptom – difficulty breathing. Often people with COPD and heart failure have difficulty exercising – walking, climbing stairs … If you have COPD and heart problems, it can be difficult to determine which condition is causing your shortness of breath.

Both diseases are chronic progressive with complicated exacerbations. Unfortunately, many people with both diseases do not realize this, as the symptoms can be similar.The combination (comorbidity) of these pathologies is a very common phenomenon. Both conditions can cause shortness of breath, exercise intolerance and fatigue. Independently coexisting with each other, they share some common risk factors and symptoms, including cigarette smoking, old age, and systemic inflammation. Over time, both diseases progress, which cannot be ignored, as this worsens overall well-being and makes treatment difficult.

Studies show that the prevalence of COPD among people with heart failure ranges from 20% to 32% of cases, and 10% of hospitalized patients with heart failure also have COPD.On the other hand, heart failure predominates in more than 20% of patients with COPD. In addition, adjusted for age and other factors that provoke cardiovascular disease, the risk ratio of developing heart failure among patients with COPD is 4.5 times higher than in people from the control group without this pathology.

These diseases are often related and the symptoms they cause can be strikingly similar. For example, shortness of breath is a hallmark that is often associated with both conditions.

  • Shortness of breath due to heart failure

Congestive heart failure is a condition that occurs when the heart becomes too weak to efficiently pump blood to the rest of the body. The level of fluid in the circulatory system rises and blood can return to both the heart and lungs, leading to fluid buildup and, as a result, shortness of breath. In most patients with CHF, difficulty breathing does not occur at rest, but even a slight effort can cause these symptoms to appear.

  • Shortness of breath with COPD

Patients with COPD tend to maintain a normal respiratory rate at rest, as in heart failure. Patients with CHF and COPD most often notice shortness of breath during physical activity. Conditions that cause COPD, such as chronic bronchitis and emphysema, irritate and damage the airways or air sacs in the lungs, where oxygen and carbon dioxide are exchanged. On inhalation, this injury prevents oxygen from being completely released before the next inhalation is taken.The result is shortness of breath.

Comorbidity of COPD and heart failure

COPD and CHF are two different conditions that can present with similar symptoms. However, there are two other forms of heart failure, left-sided and right-sided, that can be directly related to the presence of COPD or worsened by COPD. There are three main types of heart failure: right-sided, left-sided, and congestive.

  • Chronic heart failure

When blood flow from the heart is slowed down, congestive heart failure occurs.As a result, the blood returning to the heart accumulates in the veins, causing congestion throughout the body, including the respiratory system. This can lead to swelling or swelling of the legs and ankles. Sometimes fluid also collects in the lungs, which is called pulmonary edema.

  • Left-sided heart failure

Pumping oxygen-rich blood throughout the body to the organs is the prerogative of the left side of the heart. There is no direct link between COPD and left-sided heart failure.However, these diseases can coexist and aggravate each other.

COPD is not directly related to left-sided heart failure, but the two conditions can exacerbate each other. When the blood is not oxygenated properly due to COPD, the heart is put on extra stress, which worsens the symptoms of left-sided heart failure. Conversely, excess fluid in the lungs as a result of left-sided heart failure can make it difficult for someone with COPD to breathe.High blood pressure and coronary artery disease often lead to left-sided heart failure.

  • Right-sided heart failure

Returning low oxygen blood back to the lungs is the responsibility of the right side of the heart. Usually, right-sided heart failure results from some form of left-sided heart failure. When the left ventricle fails, the right ventricle struggles to do its job of transferring “used” blood back to the lungs for re-oxygenation (oxygenation of the blood).This results in increased fluid pressure and weakness in the right ventricle. Often, people with right-sided heart failure experience symptoms such as swelling of the legs, ankles, and abdomen because blood builds up in the veins.

In severe cases, COPD can cause right-sided heart failure – when low oxygen levels due to COPD cause an increase in blood pressure in the arteries of the lungs (pulmonary hypertension). The increase in pressure puts excessive stress on the right ventricle of the heart as it pumps blood through the lungs.As a result, the heart muscle weakens and right-sided heart failure can occur.

In right-sided heart failure, COPD can have a direct effect on the right ventricle of the heart. Pulmonary hypertension occurs when blood pressure in the pulmonary artery system rises. This may be a response to abnormally low oxygen levels in the blood vessels of the lungs as a result of COPD. Overloading the right ventricle from pulmonary hypertension can lead to heart failure.In right-sided heart failure, fluid builds up in the legs, ankles, and abdomen, as well as in the lungs. It is important to note that diseases other than COPD can also cause right-sided heart failure.

Comparison of symptoms

General characteristics
Symptoms COPD HSN
Dyspnea yes yes
Fatigue yes yes
Cough yes no
Palpitations (sensation of irregular heartbeat) no yes
Frequent respiratory infections yes no
Sleep apnea yes no
Chest pain no yes
Weakness yes yes
Dizziness late stage yes
Frequent urination at night no yes
Loss of appetite no yes
Concentration problems late stage late stage

Shortness of breath and fatigue are the most noticeable consequences of CHF and COPD.In both conditions, shortness of breath usually occurs during exercise in the early stages of the disease, and at rest during the later stages of the disease.

Many of the other effects – even those seen in both conditions – occur at different stages of each disease or have different characteristics in CHF and COPD. For example, COPD is characterized by persistent coughing and wheezing, while CHF is more likely to present with chest pain and swelling in the legs. Orthopnea is shortness of breath that worsens when lying down.This is a common characteristic of CHF that occurs in the very late stages of COPD.


Both conditions can include flare-ups, which are episodes characterized by worsening of symptoms.

  • In general, exacerbations of COPD are characterized by severe shortness of breath and a feeling of suffocation. They can be triggered by infections, smoke and noxious fumes.
  • As a rule, exacerbations of CHF progress more slowly and may be triggered by dietary changes (eg, excessive salt intake).

Both conditions can worsen if you do not take your medications as directed by your doctor. More worryingly, exacerbations of CHF and COPD can occur without an obvious trigger. Both types of exacerbations are life-threatening and require medical attention.

If you have already been diagnosed with CHF or COPD, you may not notice early signs of another disease due to similar symptoms. If you notice a change in your symptoms, be sure to inform your doctor about it – it is possible that you have developed another disease in addition to the diagnosis that you have already been diagnosed with.


Sometimes COPD and CHF occur together. Also, they can develop independently due to overlapping risk factors such as smoking, sedentary lifestyle, and obesity. Regardless, the specific physical damage that leads to each disease is different. Damage to the lungs causes COPD, and damage to the heart causes CHF. In both cases, damage occurs slowly and gradually and is irreversible.

Risk factors COPD HSN
Smoking yes yes
High blood pressure no yes
Heart disease no yes
Genetics yes no
Passive smoking yes no
High fat and cholesterol levels no yes
Recurrent lung infections yes no
Obesity yes yes
Sedentary lifestyle yes yes

How COPD develops

COPD causes pneumonia.This is due to active or passive smoking, exposure to toxins (airborne), and / or recurrent lung infections. Over time, repeated damage to the lungs leads to thickening and narrowing of the airways, making breathing difficult.

Damaged lungs and thickened airways put pressure on blood vessels, resulting in pulmonary hypertension (increased pressure in the pulmonary artery). Pulmonary hypertension is a form of high blood pressure in the lungs.It can be caused by many factors, including sleep apnea and COPD. Pulmonary arterial hypertension (PAH) is a type of pulmonary hypertension in which the walls of the arteries from the right side of the heart to the lungs narrow. As a result, the pressure in the lungs increases, leading to symptoms such as fatigue and shortness of breath.

When the lungs are severely damaged in COPD, the pressure in the pulmonary arteries becomes very high, causing a reserve pressure on the right side of the heart as blood is sent from there to the lungs.This ultimately leads to cor pulmonale, a type of right ventricular failure caused by a disease of the respiratory tract.

How CHF develops

Congestive (chronic) heart failure is a condition that affects the heart’s ability to pump blood around the body. Affecting one or both sides of the heart, the disease can cause:

  • fatigue and shortness of breath;
  • swelling of the feet and ankles on the legs;
  • An accumulation of blood and fluid in the lungs.

Weakened heart muscle, heart valve disease, or chronic hypertension (high arterial blood pressure) are common causes of CHF. The most common cause of weakness in the heart muscle is damage due to myocardial infarction (MI). MI is a life-threatening condition that occurs when an artery that supplies blood to one or more of the heart muscles becomes blocked. The result is damage to the heart muscle and a decrease in the pumping capacity of the heart, which is described as heart failure.

High blood pressure, elevated levels of fat and cholesterol, and smoking damage and block the arteries that supply the heart muscle.

CHF significantly reduces the quality of life of patients with COPD.


The combination of diseases creates many diagnostic problems. Clinical symptoms and signs often overlap. Assessment of cardiac and pulmonary function is often problematic and sometimes misleading. Closer collaboration between cardiologists and pulmonologists is required to better identify and treat concurrent heart failure and COPD.

The diagnosis of COPD and CHF is based on history, physical examination and special diagnostic tests. Physical exam and test results differ in the early stages of these conditions, but begin to show some similarities in the later stages.

Physical examination COPD HSN
Dyspnea yes no
Wheezing in the chest no yes
Heart murmur no yes
Swelling late stage yes
Enlarged veins in the neck late stage yes
Cyanosis (pallor or cyanosis of fingers, toes, lips) yes no
Tachypnea (rapid breathing) yes no
Tachycardia (rapid heart rate) yes no
Bradycardia (slow heartbeat) no yes
High blood pressure no yes

Research methods

  • Spirometry is a lung function test that will show changes characteristic of COPD, and may also show impaired pulmonary function in CHF.
  • Tests such as chest x-rays, computed tomography (CT), or magnetic resonance imaging (MRI) may show signs of CHF or COPD.

Often with CHF, the heart looks enlarged. With an exacerbation of CHF, fluid accumulates in or around the lungs, this can be seen with imaging of the chest.

Imaging tests can show changes in the lungs consistent with COPD, including thickening, inflammation, and bullae (air-filled spaces in the lungs that compress healthy tissue).

  • Echocardiography (ultrasound of the heart) is an ultrasound examination of the structure, structure and mechanical activity of the heart. Using an echo, your doctor can examine the structure of your heart, the blood flow in the coronary (heart) arteries, and the pumping function of the heart muscle itself.

If heart function is reduced (often described as low ejection fraction), this may indicate CHF. Echoes are not part of the diagnosis of COPD.


The most important strategy for treating CHF and / or COPD is quitting smoking.In addition, both conditions require supportive care.

  • Anti-inflammatory drugs and bronchodilators are used to treat COPD.
  • In the long-term treatment of CHF , drugs are used to help normalize the functioning of the heart muscle (for example, beta-blockers), diuretics and drugs to control blood pressure.
  • Oxygen therapy – can be used for exacerbations and late stages of COPD and CHF (using an oxygen concentrator).Sometimes exacerbations of COPD are caused by lung infections that require antibiotic treatment.
  • Non-invasive ventilation (NIV): notes that NIV as an adjunct to conventional therapy improves the condition of patients with acute respiratory failure due to acute pulmonary edema associated with heart failure or hypercapnic exacerbation of COPD.

NIV improves gas exchange and symptoms in COPD patients by reducing the need for tracheal intubation and hospital stay compared to conventional oxygen therapy.NIV also avoids re-intubation and shortens the duration of invasive mechanical ventilation. In acute cardiogenic pulmonary edema, NIV accelerates symptom remission and normalization of blood gas parameters, reduces the need for endotracheal intubation, and is associated with a tendency to reduce mortality.

In patients with cor pulmonale secondary to chronic lung disease such as COPD, the use of BIPAP therapy may improve right ventricular function.Moreover, recent studies have shown that the use of this treatment can play an important role in patients with heart failure associated with muscle fatigue and hypercapnia.


In addition to quitting smoking, lifestyle changes can help prevent the progression of COPD and CHF.

  • For example, if you are overweight, losing weight will reduce the stress on your heart and lungs.
  • Stress contributes to hypertension, which worsens the course of CHF.Also, stress triggers repeated flare-ups of COPD, and repeated flare-ups cause worsening of COPD. Thus, stress management plays an important role in slowing the progression of both conditions.

COPD and heart failure are dangerous conditions, and although they often occur independently of each other, it is important to understand the relationship between the two. If you have been previously diagnosed with COPD, you should be aware of the increased risk of developing heart failure.And, if you are a smoker, you need to understand that you are at a higher risk of developing both diseases.

Feline Hypertrophic Cardiomyopathy (HCM) | AibiVET

The heart consists of four chambers: the two upper chambers (right and left) are the atria; and two chambers below, respectively, the right and left ventricles. The left ventricle is responsible for receiving oxygenated blood (blood enriched with oxygen) from the lungs, which flows into the aortic valve, the main artery of the body, then oxygenated blood flows to all parts of the body and nourishes them.The valves that are located between the chambers of the heart (tricuspid and mitral) prevent blood flow from returning back.

Feline hypertrophic cardiomyopathy ( H ypertrophic C ardio m yopathy, HCM) – heart disease characterized by regional and diffuse thickening of the walls of the ventricle (primary “pump” of the heart muscle), and, as a consequence, decreased efficiency of the heart and sometimes with symptoms in other parts of the body. The consequences of this disease and the prognosis can vary considerably.Correct diagnosis and treatment can reduce the likelihood that a cat with HCM will experience certain symptoms and may improve its quality of life.

Although the exact cause of the development of hypertrophic cardiomyopathy has not been determined, and this disease is classified as idiopathic, the fact that this pathology is more common in some breeds (including Maine Coon, Ragdoll, British and American Shorthair, Scottish Fold, Persian , Norwegian Woodland, Sphynx and possibly a few others), and that mutations of several cardiac genes have been identified in some cats with this disease, indicate that genetics play a role.

In a cat with HCM, the left ventricle of the heart (its main “pump muscle”) thickens, which leads to a decrease in the volume of the heart chamber and to abnormal relaxation (diastolic function) of the heart muscle. These changes can cause the heart to beat quickly, leading to increased oxygen utilization and possibly oxygen starvation of the heart muscle. This fasting can lead to the death of heart cells, deterioration of heart function, which leads to the development of arrhythmias (when the heart beats too fast, too slow, or with an irregular rhythm).

In addition to these difficulties, less efficient pumping of blood can also lead to accumulation of blood in other chambers of the heart and lungs, which can contribute to the development of congestive heart failure or the formation of blood clots in the heart.

Many cats with HCM appear healthy. Others may show signs of congestive heart failure, including difficulty breathing or rapid breathing, breathing through the mouth, and signs of lethargy. These symptoms occur when fluid builds up in or around the lungs (pulmonary circulation).

A serious and potentially life-threatening consequence of HCM is the formation of blood clots (thrombi) in the heart. These clots can travel through the bloodstream to obstruct flow to other parts of the body (a dangerous complication of thromboembolism). The effect of a blood clot depends on its location, although in cats with HCM, clots most often block blood flow in the hind limbs, causing severe pain or, in extreme cases, paralysis of those limbs. Diagnosing and treating HCM is essential to properly help reduce the severity of clinical symptoms and reduce the likelihood of thromboembolism.And keep in mind the fact that cats with HCM are at risk of sudden death.

HCM is diagnosed using echocardiography, a technology that uses sound waves to create an image of the heart. And we see in this pathology in the image a characteristic thickening of the walls and a decrease in the volume of the left ventricular chamber. Evaluation of the left atrium in dilation (dilation) and the presence of a thrombus is also achieved with this method.

Since hyperthyroidism and hypertension (high blood pressure) can also cause thickening of the left ventricle, these conditions should be ruled out before arriving at a HCM diagnosis.A chest x-ray can be helpful in assessing the condition of the lungs and to rule out pleurisy. An electrocardiogram can be helpful to characterize your heart rate and rule out heart rhythm disturbances.

Genetic tests can also help determine if your cat is at increased risk of developing HCM, but these tests can only be done overseas.

Treatment goals for cats with HCM include controlling heart rate, body temperature, relieving the animal if pulmonary edema is present, removing pleural fluid (if present), and reducing the likelihood of thromboembolism.This is achieved with the help of drugs that are prescribed to the cat (a group of beta-blockers, drugs for the prevention of thromboembolism, diuretics, calcium channel blockers, ACE inhibitors, etc.). The animal should be placed in a calm environment to minimize stress. If the cat is having trouble breathing, oxygen therapy should be given.

The prognosis for cats with HCM is quite variable. Cats without clinical signs can survive for many years, although the disease is most often progressive.Poor prognostic indicators include congestive heart failure, thromboembolism, and hypothermia (low body temperature). Although HCM can shorten the life span of affected cats (sometimes significantly), drug therapy can improve the quality and longevity of cats with this common condition.

The only way to protect animals from HCM is the need for annual tests (ultrasound – heart) for cats over one year old.Animals that react positively should be immediately withdrawn from breeding and the entire line should be checked in order to avoid further spread of the pathology. Every cat that participates in pedigree breeding must be tested once a year for HCMP.

It is in your power to create conditions for a good life for your cat.


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Alcoholic cardiomyopathy: causes, symptoms, consequences

Prolonged alcohol abuse is often accompanied by damage to the myocardium – the middle layer of the heart, which makes up the bulk of its mass. As a result, alcoholic cardiomyopathy is formed – a disease leading to the expansion of the chambers of the heart.The patient has signs of heart failure, which leads to premature death. Every fifth person who abuses alcohol for ten years dies from this disease.


Many diagnostic methods are used to detect alcoholic cardiomyopathy. Some of them are:

  • • Biochemical blood test.
  • • Urinalysis.
  • • Electrocardiography (ECG).
  • • Echocardiography (EchoCG).
  • • Scintigraphy.
  • • Angiography of the vessels of the heart.
  • • Myocardial catheterization followed by endocardial biopsy.
  • • X-ray examination.

In addition to instrumental examinations, complaints and medical history are studied, obvious symptoms are recorded.


The primary signs of alcoholic cardiomyopathy are considered to be irregular heart rate and sleep, the appearance of headaches. In the future, even with a slight load, shortness of breath occurs.Stagnation often manifests itself in the form of edema. Most often, patients do not see the relationship between symptoms and their addiction, or even deny its existence altogether. Their characteristic external features are:

  • • persistent facial redness;
  • • hand tremor;
  • • agitation and talkativeness, not caused by objective circumstances;
  • • a sharp change in body weight – both upward and downward;
  • • a very characteristic blue-purple nose, on which the dilated vessels are clearly visible;
  • • the eyes in general give off redness, and the sclera in particular – yellow.

The characteristic symptoms of this disease are insomnia, heart pain, shortness of breath, rapid heartbeat, cold extremities, a feeling of heat, excessive sweating. Medical examination reveals arrhythmias, tachycardia, increased blood pressure, and liver and kidney malfunctions.


The primary cause of the disease under consideration is systematic intoxication of the body with alcoholic beverages. As the reasons for the second plan, you can specify:

  • • weakened immune system;
  • • damage by infections or viral bacteria;
  • • lack of vitamins and proteins in the diet;
  • • congenital heart disease;
  • • hereditary predisposition to cardiomyopathy;
  • • disturbed work and rest hours;
  • • constant stressful situations.

The risk of developing alcoholic cardiomyopathy is directly proportional to the duration and volume of ethanol consumed. Due to individual sensitivity to this poison in different people, this disease develops under the influence of different doses. It is believed that for the development of a fatal form of cardiomyopathy, it is required to take from 60 to 150 g of pure ethanol per day for 3-10 years.


Alcoholic cardiomyopathy goes through three successive stages in its development:

  1. 1.The first 10 years, the disease is characterized by arrhythmia and is manifested by periodic pain.
  2. 2. With a long experience of alcoholism (usually it is about 10 years or more), cardiomyopathy reveals a number of symptoms characteristic of the pathological development of the disease.
  3. 3. If over time the patient does not give up alcohol and does not seek medical attention, he will develop severe heart failure. The disease affects the structure of many organs, irreversibly disrupting their natural functioning.

Like many other diseases, alcoholic cardiomyopathy is characterized by undulating development. The longer the patient takes alcohol, the further his condition worsens. With each new portion of ethanol, the likelihood of death increases. At the same time, a decrease in this portion or a complete rejection of it leads to an improvement in the patient’s condition. Having got rid of a bad habit, it is quite possible to achieve lasting rehabilitation and elimination of clinical signs.

Treatment and prognosis

Complete and unconditional refusal to drink is a key measure for starting the successful treatment of alcoholic cardiomyopathy.If the patient cannot do this on his own, he is referred to an experienced narcologist. It should be understood that long-term therapy will be needed, which can take a long time. Even partial restoration of the myocardium is a difficult process. Only strict adherence to all medical prescriptions will help the patient to at least partially extend his life.

Let’s single out measures that promote recovery:

  • • Drug therapy recommended for patients with heart failure and administered according to appropriate protocols.
  • • Non-drug therapy, including diuresis control and salt restriction.
  • • Eating a diet rich in protein and vitamins. It is the deficiency of these nutritional components that contributes to the development of the disease.
  • • Shown for outdoor walks and moderate exercise.