From the Guidelines
Pulmonary symptoms of congestive heart disease (CHD) include breathlessness, orthopnoea, paroxysmal nocturnal dyspnoea, nocturnal cough, wheezing, pulmonary crepitations, and tachypnoea (>16 breaths/min) as outlined in the 2012 European Society of Cardiology guidelines for the diagnosis and treatment of acute and chronic heart failure 1. These symptoms are a result of the heart's inability to pump enough blood to meet the body's needs, leading to fluid buildup in the lungs and subsequent pulmonary congestion.
- Key pulmonary symptoms of CHD include:
- Breathlessness
- Orthopnoea
- Paroxysmal nocturnal dyspnoea
- Nocturnal cough
- Wheezing
- Pulmonary crepitations
- Tachypnoea (>16 breaths/min) According to the European Society of Cardiology guidelines, these symptoms are crucial in diagnosing and monitoring heart failure, and their persistence or worsening despite treatment indicates the need for additional therapy or prompt medical attention 1. The guidelines emphasize the importance of establishing the cause of heart failure, particularly specific correctable causes, and monitoring a patient's response to treatment and stability over time 1. In clinical practice, it is essential to recognize these pulmonary symptoms as potential indicators of CHD and to provide timely and appropriate treatment to prevent further complications and improve patient outcomes.
From the Research
Pulmonary Symptoms of Congestive Heart Disease (CHD)
The pulmonary symptoms of congestive heart disease (CHD) can be understood by examining the relationship between heart failure and respiratory function.
- Dyspnea is a common symptom of pulmonary hypertension, which can be a result of left ventricular failure 2.
- Exertional dyspnea is the most common symptom attributable to pulmonary hypertension 2.
- Other symptoms that may be related to pulmonary hypertension include syncope, signs of right ventricular dysfunction, and unexplained dyspnea on exertion 2.
- Patients with right ventricular failure often experience volume overload, and careful volume management is crucial in these cases 2.
- The association between heart failure and chronic obstructive pulmonary disease (COPD) can lead to significant systemic effects and a chronic, progressive evolution, affecting exercise tolerance and quality of life 3.
- Symptoms such as dyspnea, orthopnea, nocturnal cough, exercise intolerance, and muscle weakness may coexist in both heart failure and COPD 3.
Common Symptoms
Some common symptoms of heart failure that may be relevant to CHD include:
- Dyspnea, which occurs in all functional classes of heart failure 4
- Profound fatigue, which is more reliable than dyspnea as an indicator of functional class 4
- Paroxysmal nocturnal dyspnea, which is associated with functional class IV and hospital setting 4
- Sudden weight gain, which increases with worsening functional class 4
- Coughing, which can be a symptom of heart failure, especially in patients with pulmonary congestion 5, 6
Complexity of Pulmonary Heart Disease
Pulmonary heart disease (PHD) refers to altered structure or function of the right ventricle occurring in association with abnormal respiratory function 5.
- The degree, nature, severity, and causality of pulmonary hypertension in relation to PHD are not necessarily linear and direct 5.
- Abnormal gas exchange is a fundamental underpinning of PHD, affecting pulmonary vascular, cardiac, renal, and neurohormonal systems 5.
- The physiologic interactions between abnormal respiratory and cardiovascular function are complex, with PHD representing a heterogeneous end-organ effect of an integrated multisystem process 5.