Clinical Presentation

CHF is divided into two main categories: systolic and diastolic dysfunction. Systolic dysfunction exists when there is a dilated left ventricle with impaired contractility. Diastolic dysfunction occurs in a normal or intact left ventricle that has an impaired ability to relax, fill, and eject blood. Table 27-1 lists the findings frequently associated with CHF.

Dyspnea 011 exertion is the most sensitive symptom for the diagnosis of CHF, but its specificity is much lower. Other symptoms, which are common but less sensitive for the diagnosis, include dyspnea at rest, anxiety, orthopnea, paroxysmal nocturnal dyspnea, and cough productive of pink, frothy sputum. Nonspecific symptoms sometimes reported are weakness, lightheadedness, abdominal pain, malaise, wheezing, and nausea. Patients may have a medical history of hypertension, coronary artery disease, or other heart diseases (cardiomyopathy, valvular disease). Histories of cigarette smoking and alcohol abuse may also be found.

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