II. Causes

III. Types: High or Low Output

  1. Low output Heart Failure
    1. Classic Systolic Dysfunction with decreased Cardiac Output
    2. Example causes
      1. Coronary Artery Disease
      2. Severe Hypertension
      3. Cardiomyopathy
      4. Heart Valve disorders
  2. High output Heart Failure
    1. Normal Cardiac Output, but demands of hypermetabolic state outpaces supply
    2. Example causes
      1. Thyrotoxicosis
      2. Severe Anemia
      3. Thiamine deficiency
      4. Valvular regurgitation

IV. Types: Left or Right Sided

  1. Left-Sided Heart Failure
    1. Presents with pulmonary edema
    2. Causes (either Systolic Dysfunction or Diastolic Dysfunction)
      1. See Heart Failure Causes
  2. Right-Sided Heart Failure
    1. Presents with systemic edema (JVD, Leg Edema, Hepatomegaly)
    2. Causes
      1. Left sided Heart Failure (most common cause)
      2. Chronic lung disease (e.g. COPD)
      3. Coronary Artery Disease
      4. Right-sided Valvular disease (pulmonic stenosis, Tricuspid stenosis, tricuspid insufficiency)
      5. Pericardial Effusion
      6. Left-to-right shunt

V. Mechanism (with associated symptoms)

  1. Left ventricular Systolic Dysfunction
    1. Results in decreased contractility and Cardiac Output
    2. Compensatory increase in Catecholamines to drive up cardiac ouput
    3. Catecholamines increase Afterload (and increased Blood Pressure)
    4. Increased Afterload decreases renal perfusion
    5. Decreased renal perfusion stimulates ADH, Aldosterone and the the renin-Angiotensin system
    6. Results in sodium retention and Fluid Overload
      1. Acute: Increased myocardial wall tension causes Diastolic Dysfunction and increased oxygen demand
      2. Chronic: Ventricular dilation and decreased ejection fraction
  2. Decreased filling pressure (congestion)
    1. Increased left sided pressure: Dyspnea, Orthopnea, PND
    2. Increased right sided pressure: Edema, Ascites, JVD
  3. Decreased Cardiac Output
    1. Fatigue
    2. Depression

VI. History: Past Medical

  1. See Heart Failure Causes
  2. Primary heart or vascular conditions
    1. Prior Myocardial Infarction
    2. Hypertension
    3. Valvular heart disease
    4. Atrial Fibrillation
  3. Primary pulmonary conditions
    1. Cor Pulmonale
    2. Pulmonary Embolism
    3. Sleep Apnea
  4. Primary renal conditions
    1. Renal Failure
    2. Nephrotic Syndrome
    3. Glomerulonephritis
  5. Cardiotoxins
    1. Alcohol Abuse
    2. Doxorubicin
    3. Catecholamines
    4. Cobalt
    5. Cocaine abuse
  6. Medications that cause fluid retention
    1. Chemotherapy
    2. COX2 Inhibitors
    3. Sex hormones (Androgens, Estrogens)
    4. Glitazones (e.g. actos)
  7. Other provocative factors
    1. Anemia
    2. Fluid Overload (excessive salt intake)
    3. Septic Shock
    4. Medications
      1. Beta Blocker
      2. Calcium Channel Blocker
    5. Thyroid disease (Hypothyroidism or Hyperthyroidism)
    6. Hepatic disease

VII. Symptoms

  1. Early symptoms
    1. Decreased Exercise tolerance
    2. Dyspnea on Exertion
      1. Test Sensitivity: 100%
      2. Test Specificity: 17%
        1. See Dyspnea Causes
  2. Non-specific symptoms
    1. Unexplained confusion or lethargy (often in elderly)
    2. Weight gain
    3. Fatigue
      1. Most common presenting symptom of CHF in the elderly
  3. Left-sided Heart Failure symptoms (left = lung)
    1. Orthopnea
    2. Paroxysmal Nocturnal Dyspnea
      1. Not sensitive or specific for CHF
  4. Right-sided Heart Failure symptoms
    1. RUQ Abdominal Pain or fullness, early satiety
      1. Hepatic engorgement
      2. Ascites
    2. Lower extremity edema (often Dependent Edema)
      1. Venous Insufficiency
      2. Lymphedema

VIII. Signs: Left sided Heart Failure

  1. Laterally displaced apical impulse (highly specific)
  2. S3 Gallop Rhythm
    1. Most specific CHF indicator over age 40
      1. Test Sensitivity: 24%
      2. Test Specificity: 99%
    2. CHF patients (n=19) with Ejection Fraction <30%
      1. S3 Gallop present in 68% of these patients
    3. Reference
      1. Mattleman (1983) J Am Coll Cardiol 1(2):417-20
  3. Rales (nonspecific)
    1. Do not clear with cough
    2. Not sensitive or specific for CHF
  4. Pulsus alternans
    1. Tachycardia accompanied by low volume pulse

IX. Signs: Right-sided Heart Failure

  1. Elevated Jugular Venous Distention (highly specific)
    1. Consider hepatojugular reflex
  2. Pulsatile Liver
  3. Lower extremity edema
    1. Not attributable to Dependent Edema
    2. Not sensitive or specific for CHF
  4. Poor perfusion
    1. Poor Capillary Refill
    2. Cool distal extremities
    3. Altered Mental Status

X. Labs: Initial

  1. Complete Blood Count (CBC)
    1. Evaluate for Anemia
  2. Comprehensive Metabolic Panel or Chemistry panel
    1. Electrolytes
    2. Serum Calcium
    3. Renal Function tests
    4. Liver Function Tests
    5. Serum Magnesium
  3. Urinalysis
  4. B-Type Natriuretic Peptide (BNP) or NT-BNP
    1. Sensitive and specific marker for CHF
    2. Useful for its Negative Predictive Value (CHF is unlikely with a normal BNP)
  5. Serum Albumin
    1. Nephrotic Syndrome
  6. Thyroid Stimulating Hormone (TSH)
    1. Over age 65
    2. Atrial Fibrillation
  7. Troponin I
    1. Acute CHF presentation

XI. Labs: Additional tests to consider (Cardiomyopathy causes)

  1. Urine Toxicologic screen
    1. If Cocaine abuse suspected
  2. Lyme serology
  3. Parvovirus B19 serology
  4. Blood Cultures
    1. If endocarditis or Sepsis suspected
  5. Human Immunodeficiency Virus

XII. Imaging: Chest XRay

XIII. Diagnostics: Electrocardiogram (EKG)

  1. Findings suggestive of CHF
    1. Anterior Q waves
    2. Left Bundle Branch Block
    3. Efficacy
      1. Test Sensitivity: 94%
      2. Test Specificity: 61%
  2. Other findings
    1. Ventricular hypertrophy
    2. Atrial enlargement
    3. Conduction abnormality
    4. Arrhythmia
    5. Prior Myocardial Infarction
    6. Active ischemia Myocardial Ischemia

XIV. Diagnostics: Advanced

  1. See Bedside Lung Ultrasound in Emergency (Blue Protocol)
  2. See Rapid Ultrasound in Shock (RUSH Exam)
  3. See Inferior Vena Cava Ultrasound for Volume Status
  4. Echocardiogram
    1. See Echocardiogram in CHF
    2. Indicated in every Congestive Heart Failure patient
    3. Ejection Fraction 40% or less
    4. Other factors evaluated
      1. Chamber size and shape
      2. Wall thickness
      3. Valvular function
  5. Evaluation for Ischemic Heart Disease
    1. Modalities
      1. Exercise Stress Testing
      2. Nuclear (Thallium or Cardiolyte-Technetium)
    2. Observe for reversible ischemic changes
      1. Consider cardiac catheterization and possible Angioplasty (PTCA)
      2. Consider Coronary Artery Bypass Graft (CABG)
  6. Ambulatory rhythm monitor (Holter Monitor)
    1. Observe for ventricular arrhythmia
    2. Consider patient for Implantable Defibrillator

XV. Diagnosis

  1. Sensitive CHF markers (if absent, CHF is unlikely)
    1. Framingham Heart Failure Diagnostic Criteria
    2. Dyspnea on exertion
    3. EKG with anterior Q Waves or Left Bundle Branch Block
    4. B-Type Natriuretic Peptide elevation
      1. Best for its Negative Predictive Value
      2. BNP is more reliable than nt-BNP
      3. BNP <95 pg/ml
      4. nT-BNP <642 pg/ml
  2. Specific CHF markers (if present, suggest CHF)
    1. Displaced Cardiac Apex on palpation
    2. S3 Gallup Rhythm
    3. Jugular Venous Distention
      1. With or without hepatojugular reflex
    4. Chest XRay with cardiomegaly or vascular congestion
  3. References
    1. Dosh (2004) Am Fam Physician 70:2145-52
      1. Also cited for efficacy under signs and symptoms

XVI. Management: General Measures

  1. See Congestive Heart Failure Exacerbation Management
  2. Limit salt intake: 2-3 gram Sodium Diet (no added salt)
  3. Graded Exercise program
    1. Reduces Heart Failure related mortality
    2. Piepoli (2004) BMJ 328:189-92
  4. Control comorbid conditions
    1. Hypertension
    2. Coronary Artery Disease
    3. Diabetes Mellitus
    4. Obstructive Sleep Apnea
    5. Major Depression
  5. Avoid Provocative Medications
    1. Avoid Nonsteroidal Anti-inflammatory drugs (NSAIDS)
      1. NSAIDs block ACE Inhibitor activity
      2. NSAIDs block Diuretic activity
    2. Avoid Calcium Channel Blockers (except Amlodipine)
      1. Avoid Diltiazem, Verapamil and Nifedipine
    3. Avoid Pioglitazone (Actos)
    4. Avoid beta agonists unless absolutely indicated
      1. Higher hospitalization and mortality rates in CHF
        1. Au (2003) Chest 123:1964-9
      2. May be started slowly once CHF is stable and compensated
    5. Avoid ARB with ACE Inhibitor and Beta Blocker
      1. Valsartan plus ACE Inhibitor showed no benefit
      2. Valsartan + ACE + Beta Blocker increased mortality
      3. Cohn (2001) N Engl J Med 345:1667-75
  6. Stop habits associated with hospital readmission
    1. Tobacco Cessation
    2. Alcohol cessation
  7. Establish target Ideal Weight (not dry weight)
    1. Assess for too dry (Orthostatic Hypotension)
      1. Monitor standing Blood Pressure in clinic
      2. Evaluate Renal Function tests for Azotemia
    2. Assess for too wet
      1. No Orthopnea
      2. No paroxysmal nocturnal Dyspnea
    3. Assess for maintenance of Ideal Weight
      1. Follow daily weight at home with weight diary
      2. Report weekly weight gain 3-5 lb (1.5 - 2.0 kg)
      3. Patient may adjust their lasix at home (see below)
  8. Sliding scale Diuretics (uses daily weights)
    1. Based on weight variation from maintenance weight
    2. Protocol 1
      1. Criteria: Weight gain of 2 pounds in one day or 5 pounds overall
      2. Increase Diuretics (and potassium supplement) for 3 days
    3. Protocol 2
      1. Weight gain 1-3 pounds: No change to Diuretic dose
      2. Weight gain 3-5 pounds: Take extra Diuretic dose
      3. Weight gain >5 pounds: Call clinic nurse immediately

XVII. Management: Medications

  1. See Acute Pulmonary Edema Management
  2. Overall protocol (starting dosing listed)
    1. Step 1: Loop Diuretic: Lasix 20-40 mg PO 1-2x/day
    2. Step 2: ACE Inhibitor: Lisinopril 2.5 mg PO daily
    3. Step 3: Beta Blockers: Metoprolol XL 12.5 mg PO daily
    4. Step 4: Add adjunct (choose one line)
      1. Angiotensin Receptor Blocker: Losartan 25 mg qd or
      2. Aldosterone Antagonist: Spironolactone 12.5 mg qd or
      3. Hydralazine with Isosorbide
    5. Step 5: Add Digoxin
  3. Primary Medical Management (Class I, II, III)
    1. ACE Inhibitor (most important agent in CHF)
      1. See ACE Inhibitor in CHF for management protocol
      2. See ACE Inhibitor in CHF for alternative agents
        1. Angiotensin-receptor blocker is alternative
      3. Consider adding Spironolactone early (see below)
        1. Blocks aldosterone escape from ACE Inhibitor
    2. Beta Blocker
      1. Protocol
        1. Avoid in decompensated CHF (start when stable)
        2. Start with low doses
        3. Titrate doses slowly (double dose q2-4 weeks)
        4. Evaluate worse Dyspnea, failure or Hypotension
          1. Decrease or discontinue Beta-Blocker dose
          2. Consider increasing Diuretic dose
        5. Expect initial drop in ejection fraction
          1. Patients will feel more Fatigued in first month
          2. Beta Blocker benefits realized by 3 months
      2. Agents
        1. Metoprolol (Lopressor)
          1. Toprol XL
            1. Start at 12.5 to 25 mg qd (max: 200 mg/day)
        2. Bisoprolol (Zebeta)
          1. Start: 1.25 mg daily (maximum: 10 mg/day)
        3. Carvedilol (Coreg)
          1. Start at 3.125 mg bid
          2. Slowly titrate to 12.5 - 25 mg bid over 2 weeks
          3. Superior to Metoprolol in increasing Ejection Fraction
            1. Raiput (2003) Am J Cardiol 92:218-21
      3. Outcomes
        1. Safe and well tolerated even in Class IV CHF
        2. Reduces mortality and hospitalization rates
        3. Improved CHF related symptoms
        4. Goldstein (2001) J Am Coll Cardiol 38:932-8
  4. Relief of Congestive Heart Failure symptoms
    1. Diuretics (reduce volume overload)
      1. First Line: Loop Diuretics
        1. Use as adjunct to other drugs above
        2. Diuretics are not the primary CHF treatment
        3. Start Furosemide 20-40 mg PO daily to bid
        4. Consider changing Furosemide to Torsemide in CHF refractory cases
      2. Second: Spironolactone or Eplerenone (Aldosterone Antagonists)
        1. Indicated for NYHA Class III or IV Heart Failure
        2. Serum Creatinine must be <2.5 mg/dl (GFR > 30 ml/minute/1.73m2)
        3. Serum Potassium must be normal (below 5.0 to 5.5 meq/L)
        4. Bozkurt (2003) Am J Cardiol 41:211-4
    2. Digoxin (Increased contractility)
      1. Typical dose: 0.125 mg daily (up to 0.25 mg daily)
        1. Decrease to 0.0625 if drug interactions or Chronic Renal Insufficiency
      2. Does not decrease mortality, but significantly improves quality of life
      3. Increased mortality if serum Digoxin >1.0 ng/ml
        1. Keep serum Digoxin level 0.5 to 0.8 ng/ml (measure 6-8 hours after dose)
        2. Rathore (2003) JAMA 289:871-8
      4. May be associated with increased mortality in women
        1. Rathore (2002) N Engl J Med 347:1403-11
  5. Consider Additional Management
    1. Coronary revascularization (e.g. PTCA) if ischemia
    2. Atrial Fibrillation treatment if present
    3. Cardiac resynchronization
      1. Indications
        1. Ejection fraction >35% and
        2. QRS Duration >120 ms and
        3. Symptomatic despite maximal medical therapy
      2. Efficacy
        1. Reduces mortality and hospitalization rate
        2. Pacemaker with Defibrillator was most effective
      3. References
        1. Bristow (2004) N Engl J Med 350:2140-50
        2. McAlister (2004) Ann Intern Med 141:381-90
    4. Implantable Defibrillator
      1. Indications
        1. LVEF <35% due to Ischemic Heart Disease
        2. LVEF <35% with NYHA Class II and III
      2. Reduces mortality (Amiodarone does not)
        1. Bardy (2005) N Engl J Med 352:225-37
    5. Coumadin
      1. Aspirin is a reasonable alternative
      2. Indicated for arrhythmia
      3. Indicated for Thromboembolism risk (especially while hospitalized)
      4. Not indicated in standard Cardiomyopathy
      5. No data to support use in low ejection fraction
    6. Eplerenone (Inspra)
      1. Mechanism: Aldosterone blockade
      2. Effective in CHF from acute Myocardial Infarction
      3. See Spironolactone above for containdications (GFR<30, Serum Potassium >5)
      4. Alternative to Spirinolactone, but much more expensive
        1. Does not warrant additional cost in most cases
        2. Consider if severe Gynecomastia on Spironolactone
      5. References
        1. Pitt (2003) N Engl J Med 348:1309-21
    7. Tolvaptan
      1. Mechanism: Vasopressin Receptor Antagonist
      2. Reduces volume overload and congestion immediately
      3. Appears to have longterm benefit in CHF
      4. Gheorghiade (2004) JAMA 291:1963-71
    8. Hydralazine and Isosorbide Dinitrate
      1. Especially effective in younger black patients
      2. Indicated for NYHA Class III or Class IV Heart Failure
      3. Start
        1. Hydralazine 12.5 mg PO and
        2. Isosorbide Dinitrate or Isosorbide Mononitrate
          1. Dinitrate 5-10 mg tid with 12 hour-free or
          2. Mononitrate 30 mg qd
      4. Maintenance
        1. BiDil 37.5/20 1 po tid (max 2 tid) or
        2. Hydralazine 37.5-75 mg/day and Dinitrate 20-40 mg
  6. Disproven therapies (avoid these)
    1. Nesiritide (Natrecor)
      1. Recombinant Human Brain Natriuretic Peptide
      2. Results in venous and arterial vasodilation
      3. Dosing
        1. Bolus: 2 mcg/kg IV bolus
        2. Maintenance: 0.01 mcg/kg/min for 24-48 hours
      4. Improves CHF symptoms but may increase mortality
      5. Sackner-Bernstein (2005) JAMA 293:1900-5

XVIII. Management: Based on Heart Failure Classification

XIX. Management: Refractory CHF

  1. Indicated for lack of response to above measures
  2. Assumes ACE Inhibitors and Beta Blockers above
  3. Step 1: Loop Diuretic
    1. Double dose (not twice daily) if no response
    2. Double dose if Serum Creatinine remains >2.0
  4. Step 2: Add second Diuretic with caution
    1. Thiazide Diuretic
    2. Spironolactone (offers aldosterone blockade)
      1. Dose: 25 mg qd
      2. Indicated in Class III or Class IV CHF
      3. Contraindicated if Serum Creatinine >2.5 mg/dl
      4. Alternative: Eplerenone
    3. Metolazone (Zaroxolyn)
      1. Dose 5-10 mg twice weekly 1 hour before lasix
  5. Step 3: Add Hydralazine and Nitrates
  6. Step 4: Loop Diuretic IV
  7. Step 5
    1. Dobutamine with low dose Dopamine
      1. Intermittent Dobutamine reduces mortality
      2. Nanas (2004) Chest 125:1198-204
    2. Consider Milrinone
  8. Step 6
    1. Consider for Revascularization if indicated
    2. Bi-Ventricular Pacing (especially in Left Bundle Branch Block)
    3. Left Ventricular Assist Device (LVAD)
    4. Consider for Cardiac Transplantation
    5. Consider Palliative Care

XX. Prognosis

  1. Congestive Heart Failure Exacerbation Decision Rule
  2. Six-Minute Walk Test
    1. Predicts mortality and hospitalization
  3. Survival for Hypertensive Heart Failure
    1. Men: 24% five-year survival
    2. Women: 31% five-year survival

Images: Related links to external sites (from Google)

Ontology: Cardiomyopathy, Dilated (C0007193)

Definition (NCI) Cardiomyopathy which is characterized by dilation and contractile dysfunction of the left and right ventricles. It may be idiopathic, or it may result from a myocardial infarction, myocardial infection, or alcohol abuse. It is a cause of congestive heart failure.
Definition (MSH) A form of CARDIAC MUSCLE disease that is characterized by ventricular dilation, VENTRICULAR DYSFUNCTION, and HEART FAILURE. Risk factors include SMOKING; ALCOHOL DRINKING; HYPERTENSION; INFECTION; PREGNANCY; and mutations in the LMNA gene encoding LAMIN TYPE A, a NUCLEAR LAMINA protein.
Concepts Disease or Syndrome (T047)
MSH D002311
ICD10 I42.0
SnomedCT 389995008, 399020009, 195021004, 195018001, 74368002
English Cardiomyopathies, Congestive, Cardiomyopathies, Dilated, Congestive Cardiomyopathies, Congestive Cardiomyopathy, Dilated Cardiomyopathies, Dilated Cardiomyopathy, COCM - Congestive cardiomyop, Cardiomyopathy, Dilated, CCM - Congestive cardiomyopath, Cardiomyopathy, dilated, dilated cardiomyopathy (diagnosis), congestive cardiomyopathy, congestive cardiomyopathy (diagnosis), dilated cardiomyopathy, COCM Congestive (dilated) cardiomyopathy, Congestive (dilated) cardiomyopathy, CARDIOMYOPATHY DILATED, Cardiomyopathy, Dilated [Disease/Finding], Cardiomyopathy;congestive, cardiomyopathy dilated, primary dilated cardiomyopathy, cardiomyopathy congestive, Congestive cardiomyopathy, Primary dilated cardiomyopathy, COCM - Congestive cardiomyopathy, DCM - Dilated cardiomyopathy, Dilated cardiomyopathy, Congestive dilated cardiomyopathy, CCM - Congestive cardiomyopathy, Congestive cardiomyopathy (disorder), Primary dilated cardiomyopathy (disorder), cardiomyopathy; cardiomyopathy, dilated, heart; dilatation, cardiomyopathy, Cardiomyopathy, Congestive, Cardiomyopathy, congestive
Italian Cardiomiopatia congestizia, Cardiomiopatia congestizia (dilatativa), Cardiomiopatia congestizia (dilatativa) cronica, Cardiomiopatia dilatativa, Miocardiopatia congestizia
Dutch congestieve (verwijde) cardiomyopathie, congestieve COCM (verwijde) cardiomyopathie, gedilateerde cardiomyopathie, cardiomyopathie; hartdilatatie, hart; dilatatie, cardiomyopathie, Cardiomyopathie met hartdilatatie (niet-obstructief), congestieve cardiomyopathie, Cardiomyopathie met hartdilatatie, Cardiomyopathie, congestieve, Congestieve cardiomyopathie, Dilatatiecardiomyopathie
French Cardiomyopathie (dilatée) congestive, CMD (CardioMyopathie Dilatée), Cardiomyopathie congestive, Cardiomyopathie non obstructive, Myocardiopathie non obstructive, Cardiomyopathie dilatée
German kongestive (dilatative) Kardiomyopathie, COGM kongestive (dilatative) Kardiomyopathie, dilatative Kardiomyopathie, Kardiomyopathie, kongestive, Kardiomyopathie, dilatative, kongestive Kardiomyopathie, Dilatative Kardiomyopathie, Kongestive Kardiomyopathie
Portuguese Miocardiopatia congestiva (dilatada), Miocardiopatia dilatada, Miocardiopatia Dilatada, Cardiomiopatia Dilatada, Cardiomiopatia congestiva, Miocardiopatia Congestiva, Cardiomiopatia Congestiva
Spanish Cardiomiopatía congestiva (dilatada), Cardiomiopatía dilatada, Cardiomiopatía Dilatada, Miocardiopatía Dilatada, Cardiomiopatia Dilatada, Miocardiopatia Dilatada, Congestive cardiomyopathy, miocardiopatía congestiva (trastorno), miocardiopatía congestiva dilatada, miocardiopatía congestiva, miocardiopatía congénita (trastorno), miocardiopatía congénita, miocardiopatía dilatada primaria (trastorno), miocardiopatía dilatada primaria, Cardiomiopatía congestiva, Miocardiopatía Congestiva, Miocardiopatia Congestiva, Cardiomiopatia Congestiva, Cardiomiopatía Congestiva
Japanese うっ血性(拡張型)心筋症, ウッケツセイカクチョウガタシンキンショウ, カクチョウガタシンキンショウ, ウッケツセイシンキンショウ, うっ血型心筋症, 心筋症-拡張型, うっ血性心筋症, うっ血性心筋障害, 心筋症-鬱血性, 拡張型心筋症, 鬱血性心筋症, 心筋症-うっ血性, 拡張性心筋症, 欝血型心筋症, 欝血性心筋症, 鬱血型心筋症
Swedish Kardiomyopati, dilaterande
Czech kardiomyopatie dilatační, kardiomyopatie kongestivní, Kongestivní kardiomyopatie, Kongestivní (dilatační) kardiomyopatie, Dilatační kardiomyopatie, Kongestivní (dilatační) kardiomyopatie DKMP, DKMP
Finnish Dilatoiva kardiomyopatia
Russian DILATATSIONNAIA MIOKARDIOPATIIA, KARDIOMIOPATIIA DILATATSIONNAIA, KARDIOMIOPATIIA ZASTOINAIA, ZASTOINAIA KARDIOMIOPATIIA, ДИЛАТАЦИОННАЯ МИОКАРДИОПАТИЯ, ЗАСТОЙНАЯ КАРДИОМИОПАТИЯ, КАРДИОМИОПАТИЯ ДИЛАТАЦИОННАЯ, КАРДИОМИОПАТИЯ ЗАСТОЙНАЯ
Korean 확장성 심장근육병증
Polish Kardiomiopatia rozstrzeniowa
Hungarian COCM pangásos (dilatált) cardiomyopathia, Dilatált cardiomyopathia, Pangásos (dilatált) cardiomyopathia, Congestiv cardiomyopathia

Ontology: Left-Sided Heart Failure (C0023212)

Definition (NCI) Failure of adequate output by the left ventricle despite an increase in distending pressure and in end-diastolic volume, with dyspnea, orthopnea, and other signs and symptoms of pulmonary congestion and edema.
Definition (NCI) Failure of adequate output by the left ventricle despite an increase in distending pressure and in end-diastolic volume, with dyspnea, orthopnea, and other signs and symptoms of pulmonary congestion and edema.
Definition (MSH) Heart failure involving the LEFT VENTRICLE.
Concepts Disease or Syndrome (T047)
MSH D006333
ICD9 428.1
ICD10 I50.1
SnomedCT 155376009, 85232009, 195113008
English LEFT HEART FAILURE, CARDIAC FAILURE LEFT, FAILURE HEART LEFT, FAILURE LEFT HEART, PULMONARY EDEMA CARDIAC CAUSE, PULMONARY OEDEMA CARDIAC CAUSE, Left Ventricular Failure, Heart failure, left-sided, Left-sided heart failure syndrome, Heart Failure, Left-Sided, Left Sided Heart Failure, Heart Failure, Left Sided, left heart failure, Left ventricular failure (disorder), Left-Sided Heart Failure, Pulmonary edema cardiac cause, Pulmonary oedema cardiac cause, Cardiac failure left, Left cardiac failure, Failure heart left, Failure left heart, LEFT VENTRICULAR FAILURE, VENTRICULAR FAILURE, LEFT, FAILURE, LEFT VENTRICULAR, failure left ventricular, heart failure left, left-sided heart failure, Failure;ventricular;left, left side heart failure, failure heart left sided, lvf, failure heart left side, LVF, Left ventricular failures, Left ventricular insufficiency, Left heart failure, Left ventricular failure, LVF - Left ventricular failure, Left heart failure (disorder), Left-sided heart failure, edema; lung, acute, meaning failure, left ventricle, lung; edema, acute, meaning failure, left ventricle, left ventricular failure
French Défaillance ventriculaire gauche, Défaillances ventriculaires gauches, Défaillance du coeur gauche, Oedème pulmonaire d'origine cardiaque, Insuffisance ventriculaire gauche, Insuffisance cardiaque gauche, Défaillance cardiaque gauche, DEFAILLANCE CARDIAQUE GAUCHE, OEDEME PULM ORIGINE CARDIAQUE, FVG
Italian Insufficienza ventricolare sinistra, Insufficienze ventricolari sinistre, Edema polmonare cardiogeno, Insufficienza cardiaca sinistra, Insufficienza parte sinistra del cuore
Dutch longoedeem cardiale oorzaak, hartfalen links, links decompensatie, linker ventriculaire insufficiëntie, linkerhartfalen, pulmonaal oedeem cardiale oorzaak, falen linker harthelft, LVF, long; oedeem, acuut, in de betekenis van decompensatie, linker ventrikel, oedeem; long, acuut, in de betekenis van decompensatie, linker ventrikel, Linker-ventrikeldecompensatie, falen linkerventrikel, linkerventrikelfalen
German pulmonales Oedem verusacht durch Herzproblem, linksventrikulaere Insuffizienz, Versagen Herz rechts, linkes Herzversagen, Herzversagen links, Versagen links Herz, Linksherzinsuffizienz, Linksinsuffizienz, LINKSHERZVERSAGEN, LUNGENOEDEM KARDIAL, LVF, Formen der Linksherzinsuffizienz
Portuguese Insuficiência cardíaca esquerda, Edema pulmonar de causa cardíaca, Insificiência ventricular esquerda, EDEMA PULMONAR DE CAUSA CARDIACA, INSUFICIENCIA CARDIACA ESQUERDA, Insuficiência do ventrículo esquerdo, Insuficiências do ventrículo esquerdo
Spanish Insuficiencia del corazón izquierdo, Fallo cardiaco izquierdo, Edema pulmonar de origen cardiaco, Insuficiencia cardiaca izquierda, Fallo del corazón izquierdo, Fallo ventricular izquierdo, Left ventricular failure, EDEMA PULMONAR, CAUSA CARDIACA, INSUFICIENCIA CARDIACA IZQUIERDA, IVI, insuficiencia ventricular izquierda (trastorno), insuficiencia ventricular izquierda, Insuficiencia ventricular izquierda, Insuficiencias del ventrículo izquierdo
Japanese 左心室不全, 左室不全, 左心不全, 心性肺水腫, サシンフゼン, シンセイハイスイシュ, サシツフゼン, サシンシツフゼン
Czech Levostranné srdeční selhání, Kardiogenní plicní edém, Selhání levé komory srdeční, Selhání levé komory, Plicní edém kardiogenní, Insuficience levé komory, levostranné selhání srdce, srdce - selhání levostranné, levostranné srdeční selhání, Přetížení levé komory
Korean 좌심실 기능상실
Hungarian Bal ventricularis elégtelenségek, Bal kamrai elégtelenség, Cardialis eredetű pulmonalis oedema, Bal ventricularis elégtelenség, Bal szívfél elégtelensége, Szív bal felének elégtelensége, LVF, Cardialis okú pulmonalis oedema, Balszívfél-insufficientia, Balszívfél-elégtelenség

Ontology: Systolic dysfunction (C0749225)

Concepts Pathologic Function (T046)
SnomedCT 371037005
English SYSTOLIC DYSFUNCTION, systolic dysfunction, Systolic dysfunction (finding), Systolic dysfunction
Spanish disfunción sistólica (hallazgo), disfunción sistólica

Ontology: Heart Failure, Systolic (C1135191)

Definition (MSH) Heart failure caused by abnormal myocardial contraction during SYSTOLE leading to defective cardiac emptying.
Concepts Disease or Syndrome (T047)
MSH D054143
ICD9 428.20, 428.2
ICD10 I50.20
SnomedCT 417996009
Spanish insuficiencia cardíaca sistólica (trastorno), insuficiencia cardíaca sistólica, Insuficiencia Cardíaca Sistólica, Insuficiencia Cardiaca Sistolica
English Systolic Heart Failure, Heart Failure, Systolic, Heart Failures, Systolic, Systolic Heart Failures, Systolic hrt failure NOS, Unspecified systolic (congestive) heart failure, Heart Failure, Systolic [Disease/Finding], failure heart systolic, systolic heart failure, heart failure systolic, Systolic heart failure, unspecified, Systolic heart failure, Systolic heart failure (disorder)
Portuguese Insuficiência Cardíaca Sistólica
Finnish Systolinen sydämen vajaatoiminta
French Défaillance cardiaque systolique, Insuffisance cardiaque systolique
German Herzinsuffizienz, Systolische, Systolische Herzinsuffizienz
Italian Scompenso cardiaco sistolico
Russian СЕРДЕЧНАЯ НЕДОСТАТОЧНОСТЬ СИСТОЛИЧЕСКАЯ, SERDECHNAIA NEDOSTATOCHNOST' SISTOLICHESKAIA
Swedish Hjärtsvikt, systolisk
Czech systolické srdeční selhání, srdce - selhání systolické
Polish Niewydolność serca skurczowa, Skurczowa niewydolność serca
Japanese 心不全-収縮期, 収縮期心不全, 収縮性心不全

Ontology: Left ventricular systolic dysfunction (C1277187)

Definition (NCI) A disorder characterized by failure of the left ventricle to produce adequate output despite an increase in distending pressure and in end-diastolic volume. Clinical manifestations may include dyspnea, orthopnea, and other signs and symptoms of pulmonary congestion and edema.
Definition (NCI) An abnormal performance of the left ventricle with an ejection fraction equal to or less than 0.40 (40%).
Concepts Pathologic Function (T046)
SnomedCT 366910008, 366829001, 134401001
English Left Ventricular Systolic Dysfunction, Left ventricular systolic dysfunction, Left ventricular systolic dysfunction (disorder)
Spanish Left ventricular systolic dysfunction, Disfunción sistólica del ventrículo izquierdo, disfunción sistólica del ventrículo izquierdo (trastorno), disfunción sistólica del ventrículo izquierdo
Portuguese Disfunção sistólica do ventrículo esquerdo
French Dysfonctionnerment systolique ventriculaire gauche
Italian Disfunzione sistolica del ventricolo sinistro
German linksventrikulaere systolische Dysfunktion
Dutch systolische disfunctie van linkerventrikel
Czech Systolická dysfunkce levé komory
Japanese 左室収縮機能障害, サシツシュウシュクキノウショウガイ
Hungarian Bal oldali ventricularis systolés dysfunkció