Epidemiology
Etiology
Pathophysiology
Clinical features
Diagnostics
Pathology
- Sputum analysis in patients with pulmonary edema may show heart failure cells (hemosiderin-containing cells).
- Pulmonary venous congestion may result in intra-alveolar bleeding. Macrophages that subsequently phagocytose the erythrocytes are called “heart failure cells.” These cells may also be detected in the sputum of patients with pulmonary infarction, vasculitis, or aspiration of blood.
- Their color is most likely due to hemosiderin from ingested erythrocytes.
ECG
- ECG-CHF triad
- Low QRS voltages in the limb leads (caused by peripheral edema in CHF patients)
- Left ventricular hypertrophy (prominent precordial QRS voltages)
- Very slow R wave progression in chest leads (rS in V4)
Treatment
| Agent | Mortality Benefit |
|---|---|
| Angiotensin receptor-neprilysin inhibitor (e.g., sacubitril-valsartan) OR ACE inhibitor (e.g., lisinopril) OR Angiotensin II receptor blocker (e.g., losartan) | Yes |
| Beta blocker (e.g., metoprolol, carvedilol) | Yes |
| Mineralocorticoid receptor antagonist (e.g., spironolactone, eplerenone) | Yes |
| Sodium-glucose cotransporter-2 inhibitor (e.g., dapagliflozin, empagliflozin) | Yes |
| Diuretic (e.g., furosemide, metolazone) | No, only improves symptoms & reduces hospitalization. |
| Digoxin | No, only reduces hospitalization. |
Explanation
- Spironolactone also block the deleterious effect of aldosterone on the heart, causing regression of myocardial fibrosis and improvement in ventricular remodeling.