Determining the etiology and severity of heart failure or cardiomyopathy
- Wilson S Colucci, MD
Wilson S Colucci, MD
- Section Editor — Heart Failure
- Professor of Medicine
- Boston University School of Medicine
Heart failure (HF) is a common clinical syndrome caused by a variety of cardiac diseases . Evaluation of the etiology and severity of HF is discussed here. Initial evaluation of suspected HF and the management and prognosis of HF are discussed separately. (See "Evaluation of the patient with suspected heart failure" and "Overview of the therapy of heart failure with reduced ejection fraction" and "Prognosis of heart failure".)
Evaluation of patients with HF should also include evaluation for concurrent conditions as appropriate, such as sleep-disordered breathing. (See "Sleep-disordered breathing in heart failure".)
Heart failure (HF) is a complex clinical syndrome that can result from any structural or functional cardiovascular disorder causing systemic perfusion inadequate to meet the body’s metabolic demands without excessively increasing left ventricular filling pressures . It is characterized by specific symptoms, such as dyspnea and fatigue, and signs, such as fluid retention. There are many ways to assess cardiac function. However, there is no diagnostic test for HF, since it is largely a clinical diagnosis that is based upon a careful history and physical examination. (See "Evaluation of the patient with suspected heart failure".)
Classification of HF severity — The history, including assessment of New York Heart Association (NYHA) functional class, and physical examination in conjunction with the diagnostic tests reviewed below should both establish the primary cause of the HF and provide a reasonable estimate of its severity.
The classification system that is most commonly used to quantify the degree of functional limitation imposed by HF is one first developed by the NYHA. This system assigns patients to one of four functional classes, depending on the degree of effort needed to elicit symptoms (table 1):
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- Classification of HF severity
- Stages in the development of HF
- - Categories of disease
- - Systolic dysfunction
- - Diastolic dysfunction
- Classification of cardiomyopathy
- DETERMINING THE CAUSE AND SEVERITY OF HEART FAILURE OR CARDIOMYOPATHY
- Diagnostic approach
- Clinical presentation
- Physical examination
- INITIAL TESTS
- Initial blood tests
- Exercise testing
- Detection of coronary artery disease
- - Stress testing
- - Coronary arteriography
- Potential complications
- - Noninvasive coronary angiography
- ADDITIONAL TESTS
- Blood tests
- Cardiovascular magnetic resonance
- Endomyocardial biopsy
- Genetic evaluation of cardiomyopathy
- - Family history
- - Family screening
- - Genetic counseling and testing
- INFORMATION FOR PATIENTS
- SUMMARY AND RECOMMENDATIONS