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Cardiology1760 papers

Congestive heart failure

Last edited: 4/24/2026

Overview

Congestive heart failure (CHF) is a complex clinical syndrome characterized by the heart's inability to pump blood effectively to meet the body's metabolic demands, leading to symptoms such as dyspnea, fatigue, and fluid retention. It significantly impacts quality of life and is a leading cause of hospitalization and mortality, particularly among older adults and those with preexisting cardiovascular conditions. The condition affects millions globally, with varying prevalence based on demographic and risk factor profiles. Understanding CHF is crucial in day-to-day practice for timely intervention and management to improve patient outcomes and reduce healthcare burdens 1234567891011121314151617181920212223242526272829303132333435363738394041424344454647484950.

Pathophysiology

Congestive heart failure arises from a cascade of molecular, cellular, and organ-level dysfunctions primarily stemming from myocardial injury or dysfunction. Initially, the heart compensates through hypertrophy and neurohormonal activation, including increased sympathetic nervous system activity and renin-angiotensin-aldosterone system (RAAS) engagement, which aim to maintain cardiac output. However, these compensatory mechanisms eventually become maladaptive, leading to further myocardial remodeling, fibrosis, and impaired contractility 1234567891011121314151617181920212223242526272829303132333435363738394041424344454647484950. Over time, these processes result in systemic congestion, reduced perfusion to vital organs, and metabolic disturbances, manifesting clinically as symptoms like dyspnea, edema, and fatigue. Additionally, inflammation and endothelial dysfunction contribute to the progression of CHF, exacerbating organ dysfunction and increasing mortality risk 461424343748.

Epidemiology

Congestive heart failure exhibits significant variability in incidence and prevalence based on demographic factors and underlying risk conditions. Globally, the prevalence is notably higher in older adults, with estimates ranging from 1% to over 5% in individuals aged 65 and older 1234567891011121314151617181920212223242526272829303132333435363738394041424344454647484950. Men are slightly more affected than women in younger populations, though this disparity narrows with age. Risk factors such as hypertension, diabetes, coronary artery disease, and valvular heart disease significantly elevate the likelihood of developing CHF. Trends indicate an increasing prevalence due to aging populations and improved survival rates of patients with acute cardiovascular events, leading to a greater burden of chronic heart failure 1234567891011121314151617181920212223242526272829303132333435363738394041424344454647484950.

Clinical Presentation

The clinical presentation of congestive heart failure is diverse, encompassing classic symptoms such as dyspnea (particularly on exertion), fatigue, and peripheral edema, alongside atypical manifestations like cognitive impairment, arrhythmias, and gastrointestinal symptoms such as nausea and abdominal distension. Red-flag features include acute onset of symptoms, unexplained weight loss, severe dyspnea at rest, and signs of systemic congestion like jugular venous distension and pulmonary rales. These presentations guide the diagnostic workup and necessitate prompt evaluation to differentiate CHF from other conditions 1234567891011121314151617181920212223242526272829303132333435363738394041424344454647484950.

Diagnosis

The diagnosis of congestive heart failure involves a comprehensive clinical assessment complemented by specific diagnostic criteria and tests. Key steps include:

  • Clinical Evaluation: Detailed history and physical examination focusing on symptoms and signs of heart failure.
  • Echocardiography: Essential for assessing left ventricular ejection fraction (LVEF), ventricular function, and structural abnormalities.
  • Cardiac Biomarkers: B-type natriuretic peptide (BNP) or N-terminal pro-BNP (NT-proBNP) levels, with elevated levels supporting the diagnosis.
  • Chest X-ray: Reveals pulmonary congestion and cardiac silhouette changes.
  • Electrocardiogram (ECG): Identifies arrhythmias and signs of ischemia or hypertrophy.

    • Specific Criteria and Tests:

  • Echocardiography: LVEF <50% (or <40% in some guidelines) 1234567891011121314151617181920212223242526272829303132333435363738394041424344454647484950.
  • BNP/NT-proBNP: Elevated levels (typically >100 pg/mL for BNP, >300 pg/mL for NT-proBNP) 1234567891011121314151617181920212223242526272829303132333435363738394041424344454647484950.
  • Differential Diagnosis:
    • - Asthma/COPD: Characterized by reversible airflow obstruction, not typically associated with elevated BNP levels. - Pulmonary Embolism: Presence of sudden onset dyspnea, pleuritic chest pain, and D-dimer elevation. - Anemia: Considered if hemoglobin levels are low without signs of fluid overload.

    Management

    First-Line Treatment

  • Diuretics: Furosemide (20-80 mg IV/PO daily), adjust based on response and renal function 1234567891011121314151617181920212223242526272829303132333435363738394041424344454647484950.
  • ACE Inhibitors/ARBs: Enalapril (2.5-20 mg daily) or Losartan (12.5-100 mg daily), titrate to target blood pressure and renal function 1234567891011121314151617181920212223242526272829303132333435363738394041424344454647484950.
  • Beta-Blockers: Metoprolol (12.5-200 mg daily), initiated cautiously and titrated slowly 1234567891011121314151617181920212223242526272829303132333435363738394041424344454647484950.

    • Second-Line Treatment

  • ARNI (ARNI = ARB + ACE Inhibitor): Considered in patients not achieving target BP or LVEF improvement with monotherapy 1234567891011121314151617181920212223242526272829303132333435363738394041424344454647484950.
  • MRA (Mineralocorticoid Receptor Antagonists): Spironolactone (12.5-50 mg daily), added if LVEF <35% and tolerated 1234567891011121314151617181920212223242526272829303132333435363738394041424344454647484950.

    • Refractory / Specialist Escalation

  • Ivabradine: For rate control in patients with sinus tachycardia and contraindications to beta-blockers 1234567891011121314151617181920212223242526272829303132333435363738394041424344454647484950.
  • Digoxin: For heart failure with atrial fibrillation or severe LV dysfunction 1234567891011121314151617181920212223242526272829303132333435363738394041424344454647484950.
  • Specialist Referral: For complex cases, consider referral to a cardiologist for advanced therapies like cardiac resynchronization therapy (CRT) or implantable cardioverter-defibrillator (ICD) 1234567891011121314151617181920212223242526272829303132333435363738394041424344454647484950.

    • Contraindications

  • Diuretics: Severe renal impairment, anuria.
  • ACE Inhibitors/ARBs: Hyperkalemia, bilateral renal artery stenosis.
  • Beta-Blockers: Bradycardia, severe heart block, asthma.

    • Complications

  • Acute Decompensation: Triggered by infections, non-adherence to medication, or dietary sodium overload. Requires close monitoring and potential hospitalization.
  • Chronic Complications: Progressive renal dysfunction, arrhythmias (e.g., atrial fibrillation), and reduced quality of life. Regular follow-up and management of comorbidities are crucial 1234567891011121314151617181920212223242526272829303132333435363738394041424344454647484950.

    • Prognosis & Follow-up

    The prognosis of congestive heart failure varies widely based on the severity of the condition, patient comorbidities, and adherence to treatment. Prognostic indicators include LVEF, BNP levels, and functional status (e.g., NYHA class). Regular follow-up intervals typically involve:
  • Monthly: Initial phase post-diagnosis or significant changes in management.
  • Quarterly: To monitor medication efficacy and adjust as needed.
  • Annually: Comprehensive assessment including echocardiography and biomarker levels 1234567891011121314151617181920212223242526272829303132333435363738394041424344454647484950.

    • Special Populations

  • Pregnancy: Management requires careful consideration of teratogenic risks and hemodynamic changes; close monitoring and multidisciplinary care are essential 12345678910111213141516171819202122232425262728293031323334353637383940414243444546474849[5

    • References

    Showing 100 most recent of 1678 indexed papers.

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Association of the Endothelial Activation and Stress Index (EASIX) with short-term mortality in critically ill patients with congestive heart failure: A retrospective cohort study from the MIMIC database. Medicine 2026. link 7 DeProspero DJ, Harris AN, Cooper A, Adin DB. Moderate to severe hypochloremia is associated with shortened survival in dogs with stable congestive heart failure. Journal of the American Veterinary Medical Association 2026. link 8 Manis G, Platakis D, Sassi R. Exploration on Bubble Entropy. IEEE journal of biomedical and health informatics 2026. link 9 Loyst RA, Liu SH, Mahboubiardakani R, Cerri-Droz P, Walker P, Komatsu DE et al.. Postoperative outcomes linked to congestive heart failure in arthroscopic rotator cuff repair. European journal of orthopaedic surgery & traumatology : orthopedie traumatologie 2025. link 10 Guan F, Lai T, Luo G, Chen Y, Zhao Y, Hu K et al.. Association between periodontitis and cardiovascular mortality, all-cause mortality in patients with congestive heart failure: NHANES 2009-2014. Medicine 2025. link 11 Abdallah N, Mohamoud A, Daher H, Abdallah M, Mehfooz A. Relationships between adrenal insufficiency and cardiovascular outcomes in patients with congestive heart failure. Nutrition, metabolism, and cardiovascular diseases : NMCD 2025. link 12 Manz WJ, Nash AE, Novak J, Fink J, Kadakia R, Coleman MM et al.. Non-emergent Conditions of the Ankle, Hindfoot, and Midfoot in Elderly Patients Are as Mobility Limiting as Congestive Heart Failure. Foot & ankle specialist 2025. link 13 Rogg S, Mochel JP, Kundu D, Tropf MA, Masters AK, Adin DB et al.. Frequency and progression of azotemia during acute and chronic treatment of congestive heart failure in cats. Journal of veterinary internal medicine 2025. link 14 Yaghoubi A, Heijl C, Khoshnood AM, Wändell PE, Carlsson AC, Wessman T. Association between endostatin and mortality in patients with acute dyspnoea, with or without congestive heart failure: a single-centre, prospective, observational study. BMJ open 2025. link 15 Wang K, Zhang H, Chen Y. Beta blockers linked to reduced 1-Year mortality in critically ill congestive heart failure patients with differential benefits across subgroups. Scientific reports 2025. link 16 Gaydos SS, McHugh KE, Woodard FK, Judd RN, Brenzel TJ, Henderson HT et al.. Sodium-glucose cotransporter-2 inhibitor use in patients with a Fontan circulation. Cardiology in the young 2025. link 17 Park J, Choi W, Hwang J, Jang HY, Kim Y, Ah YM et al.. Impact of sirolimus on long-term adverse cardiovascular outcomes in kidney transplant recipients: A nationwide cohort study. European journal of clinical investigation 2025. link 18 Buchanan KM, Fries RC, Kadotani S. Time to refractory congestive heart failure in cats presenting with pleural effusion vs. pulmonary edema. Journal of veterinary cardiology : the official journal of the European Society of Veterinary Cardiology 2025. link 19 Fan Z, Yang L, Song J, Hu H, Zhu K, Fu X et al.. Correlation between Visceral Adiposity Index (VAI) and Congestive Heart Failure (CHF) in patients with hypertension: a study based on NHANES 2001-2018. BMC cardiovascular disorders 2025. link 20 Zhao J, Wang Y, Lv C, Peng J, Lu S, Shen L. Dietary inflammation and its impact on congestive heart failure in older adults with depression. Scientific reports 2025. link 21 Duan R, Chen S, Li S, Ding J, Wang L, Li Y et al.. Association between GLIM diagnosed malnutrition and 18-month mortality in hospitalized adults with congestive heart failure: A prospective cohort study. JPEN. Journal of parenteral and enteral nutrition 2025. link 22 Yoshida M, Fujioka T, Inage A. A case of isolated right subclavian artery and right patent ductus arteriosus successfully treated with catheter intervention in early infancy. Cardiology in the young 2025. link 23 Gao M, Li Q, Bian J, Wang X, Wang C, Yuan R et al.. Contribution of albumin-corrected anion gap and associated biomarkers to the mortality of patients with congestive heart failure: a retrospective cohort study. BMC cardiovascular disorders 2025. link 24 Wang L, Xu Y, Chen L, Zhang H. Estimated glucose disposal rate mediates the association between Life's Crucial 9 and congestive heart failure: a population-based study. Frontiers in endocrinology 2025. link 25 Mogallapalli H, Osman F, Parajuli S, Garg N, Aziz F, Djamali A et al.. Belatacept Conversion in Kidney Transplant Recipients with Congestive Heart Failure: Survival and 30-Day Readmission Outcomes. Transplantation proceedings 2025. link 26 Bianco M, Scarciglia A, Bonanno C, Valenza G. Quantifying Chaotic Behavior in Noisy Dynamical Systems: A Study on Heartbeat Dynamics. IEEE transactions on bio-medical engineering 2025. link 27 Esin Ç, Güzel M. Changes in hepatic and renal Doppler ultrasonography: Current standard therapy in dogs with congestive heart failure. Open veterinary journal 2025. link 28 Hoffman GJ, Alexander NB, Ha J, Nguyen T, Min LC. Medicare's Hospital Readmission Reduction Program reduced fall-related health care use: An unexpected benefit?. Health services research 2024. link 29 Convey V, Huh T, Achilles EJ, Massey LK, McKaba VF, Loughran KA et al.. Urine sodium concentration after intravenous furosemide in dogs with acute congestive heart failure and correlation with treatment efficacy. Journal of veterinary internal medicine 2024. link 30 Zhang K, Han Y, Gu F, Gu Z, Liang J, Zhao J et al.. Association Between Body Temperature and In-Hospital Mortality Among Congestive Heart Failure Patients with Diabetes in Intensive Care Unit: A Retrospective Cohort Study. Therapeutic hypothermia and temperature management 2024. link 31 Kolp E, Junge HK, Schläpfer JA, Gerspach C, Gamsjäger L. Bovine medicine: Whats´s your diagnosis?. Schweizer Archiv fur Tierheilkunde 2024. link 32 Sun L, Du J. Magnesium status, serum vitamin D concentration and mortality among congestive heart failure patients: a cohort study from NHANES 2007-2018. Magnesium research 2024. link 33 Somé NH, Devlin RA, Mehta N, Sarma S. Primary care payment models and avoidable hospitalizations in Ontario, Canada: A multivalued treatment effects analysis. Health economics 2024. link 34 Sa Z, Badgery-Parker T, Long JC, Braithwaite J, Brown M, Levesque JF et al.. Impact of mental disorders on unplanned readmissions for congestive heart failure patients: a population-level study. ESC heart failure 2024. link 35 Li R, Sidawy A, Nguyen BN. Preoperative Congestive Heart Failure Is Associated with Higher 30-Day Myocardial Infarction and Pneumonia after Endovascular Repair of Abdominal Aortic Aneurysm. Journal of vascular research 2024. link 36 Chamberlin KW, Yuan Y, Li C, Luo Z, Reeves M, Kucharska-Newton A et al.. Olfactory Impairment and the Risk of Major Adverse Cardiovascular Outcomes in Older Adults. Journal of the American Heart Association 2024. link 37 Lourdesamy Anthony AI, Abdul Rani R. The epidemiological characteristics of sleep disordered breathing in congestive heart failure: A prospective, single centre study in Southeast Asia. The journal of the Royal College of Physicians of Edinburgh 2024. link 38 Foust R, Clarkson S, Nordberg M, Joly J, Griffin R, May J. Iron Deficiency Among Hospitalized Patients With Congestive Heart Failure. Journal for healthcare quality : official publication of the National Association for Healthcare Quality 2024. link 39 Zhan X, Liu Y, Chen T, Wan H, Xiong S, Li S et al.. The association between serum testosterone level and congestive heart failure in US male adults: data from National Health and Nutrition Examination Survey (NHANES) 2011-2016. Reproductive biology and endocrinology : RB&E 2024. link 40 Kriström K, Häggström J, Fascetti AJ, Ström L, Dirven M, Yu J et al.. The association between taurine concentrations and dog characteristics, clinical variables, and diet in English cocker spaniels: The Canine taURinE (CURE) project. Journal of veterinary internal medicine 2024. link 41 Tippett A, Ess G, Hussaini L, Reese O, Salazar L, Kelly M et al.. Influenza Vaccine Effectiveness Pre-pandemic Among Adults Hospitalized With Congestive Heart Failure or Chronic Obstructive Pulmonary Disease and Older Adults. Clinical infectious diseases : an official publication of the Infectious Diseases Society of America 2024. link 42 Nakatsukasa T, Ishizu T, Hayakawa R, Ouchi M, Kawamatsu N, Sato K et al.. 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Retrospective evaluation of the utility of shock index to determine the presence of congestive heart failure in dogs with myxomatous mitral valve disease (2019-2021): 98 cases. Journal of veterinary emergency and critical care (San Antonio, Tex. : 2001) 2024. link 47 Mallon T, Schulze J, Dams J, Weber J, Asendorf T, Böttcher S et al.. Evaluating palliative care case conferences in primary care for patients with advanced non-malignant chronic conditions: a cluster-randomised controlled trial (KOPAL). Age and ageing 2024. link 48 Peng S, Chen Q, Ke W, Wu Y. The relationship between serum anion gap levels and short-, medium-, and long-term all-cause mortality in ICU patients with congestive heart failure: a retrospective cohort study. Acta cardiologica 2024. link 49 Chahrour M, Chamseddine H, Kabbani L, Aboul Hosn M. Regional Anesthesia is Associated with Improved Mortality and Morbidity in Patients with Congestive Heart Failure Undergoing Lower Extremity Amputation. Annals of vascular surgery 2024. link 50 Bian Y, Kou H, Jia Z, Cui Q, Wu P, Ma J et al.. Association between aspartate aminotransferase to alanine aminotransferase ratio and mortality in critically ill patients with congestive heart failure. Scientific reports 2024. link 51 Sherazi AW, Zamir A, Rehman AU, Ashraf W, Imran I, Saeed H et al.. A Systematic Critical Review of Clinical Pharmacokinetics of Torasemide. Therapeutic drug monitoring 2024. link 52 García CA, Bardají S, Pérez-Tirador P, Otero A. RHRVEasy: Heart rate variability made easy. PloS one 2024. link 53 Tashkovska M, Krsteski S, Kizhevska E, Valič J, Gjoreski H, Luštrek M. Predictive models for health-related quality of life built on two telemonitoring datasets. PloS one 2024. link 54 Shi W, Lin H, Zhang X, Xu W, Lan T, Jiang W et al.. The association between frailty and the risk of mortality in critically ill congestive heart failure patients: findings from the MIMIC-IV database. 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LncRNA-TUG1 Downregulation is Correlated with the Development of Progressive Chronic Kidney Disease Among Patients with Congestive Heart Failure. Molecular biotechnology 2022. link 83 Jett L, Mooshian S, Anderson E. Acquired Systolic Dysfunction and Subsequent Congestive Heart Failure Following Treatment of Hypoadrenocorticism in Two Dogs. Journal of the American Animal Hospital Association 2022. link 84 Lu T, Sun X, Necela BM, Lee HC, Norton N. TRPC6 N338S is a gain-of-function mutant identified in patient with doxorubicin-induced cardiotoxicity. Biochimica et biophysica acta. Molecular basis of disease 2022. link 85 Oppenheimer N, Kelmer E, Shwartzshtei N, Segev G, Ohad D, Klainbart S. Retrospective evaluation of the outcome and prognosis of undergoing positive pressure ventilation due to cardiac and noncardiac causes in dogs and cats (2019-2020): 101 cases. Journal of veterinary emergency and critical care (San Antonio, Tex. : 2001) 2022. link 86 Schur RM, Eck BL, Yuan A. 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    Original source

    1. [1]
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