From the Guidelines
Yes, crackles can be present in congestive heart failure (CHF). These abnormal breath sounds, also called rales, typically occur in the lower lung fields and result from fluid accumulation in the alveoli and small airways due to increased pressure in the pulmonary circulation 1. In CHF, the heart's reduced pumping efficiency causes blood to back up in the pulmonary vessels, leading to fluid leakage into the lung tissue.
Key Points
- Crackles in CHF are often described as fine, wet sounds heard during inspiration that sound similar to hair being rubbed between fingers near the ear or like Velcro being pulled apart.
- They typically worsen when lying flat and may improve when sitting upright, as gravity helps reduce pulmonary congestion.
- The presence of crackles, especially when accompanied by other symptoms like dyspnea, orthopnea, peripheral edema, and fatigue, can be an important clinical sign for diagnosing CHF or monitoring its progression 1.
- Treatment of the underlying heart failure with diuretics, ACE inhibitors, beta-blockers, and other heart failure medications typically leads to resolution of these crackles as pulmonary congestion decreases 1.
- According to the most recent guidelines, pharmacotherapy for HF with reduced ejection fraction, including agents such as angiotensin-converting enzyme inhibitors, angiotensin receptor blockers, and sodium-glucose cotransporter 2 inhibitors, can improve symptoms and quality of life 1.
From the Research
Crackles in CHF
- Crackles can be present in patients with congestive heart failure (CHF) 2
- A study found that the crackle transmission coefficient (CTC) and crackle frequency in CHF were statistically different from those in interstitial pulmonary fibrosis (IPF) and pneumonia 2
- The CTC averaged 25 +/- 8% for CHF, and the crackle frequency averaged 311 +/- 62 Hz for CHF 2
- Age-related pulmonary crackles (rales) can also be present in asymptomatic cardiovascular patients, including those with CHF, and their prevalence increases with age 3
- The presence of crackles in CHF patients can be an important consideration in diagnosis and management, as they can be a sign of pulmonary congestion or other complications 4
Diagnosis and Management
- The diagnosis of CHF is often determined by a careful history and physical examination, characteristic chest-radiograph findings, and measurement of serum brain natriuretic peptide and echocardiography 4
- Therapy for CHF is directed at restoring normal cardiopulmonary physiology and reducing the hyperadrenergic state, with loop diuretics being a mainstay of treatment 5, 6
- The choice of loop diuretic, such as torsemide or furosemide, may not significantly impact mortality or rehospitalization rates in CHF patients 5, 6