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Congestive heart failure

Last updated: May 25, 2021

Summarytoggle arrow icon

Congestive heart failure (CHF) is a clinical condition in which the heart is unable to pump enough blood to meet the metabolic needs of the body because of pathological changes in the myocardium. The three main causes of CHF are coronary artery disease, diabetes mellitus, and hypertension. These conditions cause ventricular dysfunction with low cardiac output, which results in blood congestion and poor systemic perfusion. CHF is classified as either left heart failure (LHF) or right heart failure (RHF), while a combination of both is called biventricular or global CHF. LHF leads to pulmonary edema and consequent dyspnea, while RHF leads to systemic venous congestion that causes symptoms such as pitting edema, jugular venous distension, and hepatomegaly. Biventricular CHF manifests with clinical features of both RHF and LHF, as well as general symptoms such as tachycardia, fatigue, and nocturia. In rare cases, high-output CHF may occur as a result of conditions that increase metabolic demands, leading to an increased cardiac output that eventually overwhelms the heart. CHF is diagnosed based on clinical presentation and requires an initial workup to assess the severity of the disease and determine the possible causes. Initial workup includes measurement of brain natriuretic peptide levels, chest x-ray, ECG, and an echocardiogram. Management of CHF includes lifestyle modifications and treatment of associated conditions (e.g., hypertension) and comorbidities (e.g., anemia), along with pharmacological agents that reduce the workload of the heart. Acute heart failure may occur as an exacerbation of CHF (acute decompensated heart failure) or be caused by an acute cardiac condition such as myocardial infarction (see “Acute heart failure”).

  • ∼ 1.9% of the population in the US has CHF (∼ 6.2 million individuals) [3]
  • The incidence is higher among African Americans and Hispanics. [4]
  • Incidence increases with age: ∼ 10% of individuals > 60 years old are affected. [5]
  • Systolic heart disease is the most common form of CHF overall.

Epidemiological data refers to the US, unless otherwise specified.

The three major causes of heart failure are coronary artery disease, hypertension, and diabetes mellitus. Patients typically have multiple risk factors that contribute to the development of CHF.

American Heart Association (AHA) classification (2013) [1]

The AHA classification system categorizes patients according to the stage of disease based on an objective assessment of clinical features and diagnostic findings.

Stages Objective assessment Corresponding NYHA functional class
Stage A
Stage B
Stage C
  • NYHA I, II, III, IV
Stage D
  • Terminal stage heart failure

NYHA functional classification [1]

The NYHA (New York Heart Association) functional classification system is used to assess the patient's functional capacities (i.e., limitations of physical activity and symptoms) and has prognostic value.

NYHA class Characteristics
Class I
  • No limitations of physical activity
  • No symptoms of CHF
Class II
  • Slight limitations of moderate or prolonged physical activity (e.g., symptoms after climbing 2 flights of stairs or heavy lifting)
  • Comfortable at rest
Class III
  • Marked limitations of physical activity (e.g., symptoms during daily activities like dressing, walking across rooms)
  • Comfortable only at rest
Class IV
  • Confined to bed, discomfort during any form of physical activity
  • Symptoms at rest

Cardiac output, which is stroke volume times heart rate, is determined by three factors: preload, afterload, and ventricular contractility.

Underlying mechanism of reduced cardiac output

Consequences of decompensated heart failure

CHF is characterized by reduced cardiac output that results in venous congestion and poor systemic perfusion.

Compensation mechanisms

The compensation mechanisms are meant to maintain the cardiac output when stroke volume is reduced.

General features of heart failure

Clinical features of left-sided heart failure

Clinical features of right-sided heart failure

High-output heart failure

Approach

Laboratory studies

Routine laboratory studies [1]

Cardiac biomarkers [1][19]

Imaging

Transthoracic echocardiogram (TTE)

Chest x-ray [1]

Electrocardiogram (ECG) [30][31]

ECG abnormalities in CHF are common but mostly nonspecific.

Additional studies [1]

The following tests are not always part of the standard workup for heart failure but can be helpful when there is diagnostic uncertainty and to evaluate for underlying causes. For details on the evaluation for myocardial ischemia see “Diagnostics” in “Coronary artery disease”.

Advanced cardiac imaging

Other

Sputum analysis in patients with pulmonary edema may show heart failure cells (hemosiderin-containing cells).

Approach

General measures [1]

Lifestyle modifications

These interventions reduce general risk factors that are known to lead to the progression of CHF or other comorbidities (e.g., diabetes mellitus, hypertension).

Patient/family education

Making sure that the patient understands the pathophysiological basis of the disease improves the effectiveness of treatment and quality of life.

  • Diet and fluid restriction [1]
    • Salt restriction: ≤ 1.5 g/day in stages A and B, ≤ 3 g/day in stages C and D
    • Avoidance of potassium-rich foods while taking aldosterone antagonists [36]
    • Fluid restriction: 1.5–2 L/day in stage D patients who have edema and/or hyponatremia
  • Self-monitoring and symptom recognition
    • Daily weight check: Patients with a weight gain of > 4–5 lbs (> 2 kg) within 3 days should consult a doctor.
    • Patients may be counseled to independently adjust their diuretic dose if there is weight gain and advised that this needs regular review by a heart failure specialist to avoid overtreatment with diuretics. [37]
    • Recognition of symptoms of worsening heart failure
    • Monitoring of potential medication side effects
  • Awareness of travel precautions: e.g., carrying a copy of medical records and avoiding destinations with limited healthcare [38][39]

Treatment of comorbid conditions

The following conditions may worsen the symptoms of heart failure and accelerate progression.

Avoidance of drugs that may worsen CHF [1]

Avoid the simultaneous use of nondihydropyridine calcium channel blockers with beta blockers as this can cause complete heart block. [43]

Medical treatment of heart failure

Initial therapy [1][19]

  • Treatment is based on the stage of heart failure.
    • Additional therapies are added to the baseline medications as symptoms worsen.
    • From stage B onward, device therapy can be considered alongside medical therapy.
  • Start all new medications at the lowest recommended dose and slowly titrate up to the target dose where applicable.
  • The following table deals predominantly with the management of HFrEF; there is a paucity of evidence supporting best practice in HFpEF.
  • For modifications in pregnancy and lactation see “Use of heart failure medications in pregnancy and lactation.”
Initial medical treatment of heart failure [1][19]
Stage A
Treatment of cardiovascular risk factors
Stage B
Class Indications Administration

ACE inhibitors (ACEIs)

  • Every patient with HFrEF
  • Examples [19][25]
  • Monitoring: BP, renal function, and potassium 1–2 weeks after initiation or dose change [1]

Angiotensin receptor blockers (ARBs)

  • Patients who cannot tolerate ACEIs (e.g., because of a dry cough)
  • Examples [19][25]
  • Monitoring: BP, renal function, and potassium 1–2 weeks after initiation or dose change [1]
Beta blockers
  • Add once the patient is stable on ACEIs. [1][44]
  • Avoid in patients with decompensated cardiac failure until they are stabilized.
Stage C (additions)
Indications Administration
Aldosterone antagonsists
  • All HFrEF patients with NYHA class II–IV symptoms and an LVEF of < 35%
  • Consider adding for patients with HFpEF.
Loop diuretics and thiazide diuretics
Isosorbide dinitrate (ISDN) and hydralazine
  • Patients who cannot tolerate ACEIs or ARBs
  • Certain African American patients with HFrEF [1]
Angiotensin receptor-neprilysin inhibitors (ARNIs)
Stage D (additions)
Additional measures

Drugs that improve prognosis are beta blockers, ACE inhibitors, ARNIs, aldosterone antagonists, and hydralazine with nitrate.

Diuretics and digoxin improve symptoms and significantly reduce the number of hospitalizations.

Conducting regular blood tests to assess electrolyte levels (K+ and Na+) is mandatory if the patient is taking diuretics.

Therapy for refractory symptoms

Consider adding the following drugs if patients are adherent and have persistent symptoms despite maximum tolerated doses of first-line medical therapy. Invasive interventions may also be considered.

Additional medical treatment options for heart failure
Class Indications Administration
Digoxin
  • HFrEF with persistent symptoms despite treatment with appropriate first-line medications. [1]
  • Example: Digoxin [1]
  • Monitoring: renal impairment [1]
If channel inhibitor (Ivabradine)

Invasive interventions

Patients with CHF are at risk of sudden cardiac death (SCD) from arrhythmias such as ventricular tachycardia (VT) or ventricular fibrillation (VF) and heart failure may be worsened by cardiac dyssynchrony. Devices may only pace or have both pacing and defibrillator functions. [46]

Management of end-stage heart failure

We list the most important complications. The selection is not exhaustive.

The prognosis depends on the patient, type and severity of heart disease, medication regimens, and lifestyle changes. The prognosis for patients with preserved EF is similar to or better than for patients with decreased EF. Risk stratification scales may be used to evaluate the prognosis (e.g., CHARM and CORONA risk scores).

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  1. Heart Disease and Stroke Statistics—2020 Update: A Report From the American Heart Association.
  2. Bahrami H, Kronmal R, Bluemke DA, et al. Differences in the Incidence of Congestive Heart Failure by Ethnicity. Arch Intern Med. 2008; 168 (19): p.2138. doi: 10.1001/archinte.168.19.2138 . | Open in Read by QxMD
  3. Heart Failure Fact Sheet. https://www.cdc.gov/dhdsp/data_statistics/fact_sheets/fs_heart_failure.htm. Updated: June 16, 2016. Accessed: February 24, 2017.
  4. Vasan RS, Wilson PWF. Epidemiology and causes of heart failure. In: Post TW, ed. UpToDate. Waltham, MA: UpToDate. https://www.uptodate.com/contents/epidemiology-and-causes-of-heart-failure.Last updated: November 30, 2016. Accessed: February 24, 2017.
  5. Jia G, Hill MA, Sowers JR. Diabetic Cardiomyopathy. Circ Res. 2018; 122 (4): p.624-638. doi: 10.1161/circresaha.117.311586 . | Open in Read by QxMD
  6. Yancy CW, Jessup M, Bozkurt B, et al. 2013 ACCF/AHA Guideline for the Management of Heart Failure. J Am Coll Cardiol. 2013; 62 (16): p.e147-e239. doi: 10.1016/j.jacc.2013.05.019 . | Open in Read by QxMD
  7. Clinical Methods: The History, Physical, and Laboratory Examinations. 3rd edition. Chapter 183: Nocturia. https://www.ncbi.nlm.nih.gov/books/NBK293/. . Accessed: June 19, 2019.
  8. Okoshi MP, Capalbo RV, Romeiro FG, Okoshi K. Cardiac Cachexia: Perspectives for Prevention and Treatment. Arq Bras Cardiol. 2016 . doi: 10.5935/abc.20160142 . | Open in Read by QxMD
  9. Kasper DL, Fauci AS, Hauser S, Longo D, Jameson LJ, Loscalzo J . Harrisons Principles of Internal Medicine . McGraw-Hill Medical Publishing Division ; 2016
  10. Colucci WS. Evaluation of the patient with suspected heart failure. In: Post TW, ed. UpToDate. Waltham, MA: UpToDate. https://www.uptodate.com/contents/evaluation-of-the-patient-with-suspected-heart-failure?source=search_result&search=congestive%20heart%20failure%20diagnosis&selectedTitle=1~150.Last updated: October 19, 2015. Accessed: February 15, 2017.
  11. Filippatos TD. Hyponatremia in patients with heart failure. World J Cardiol. 2013; 5 (9): p.317. doi: 10.4330/wjc.v5.i9.317 . | Open in Read by QxMD
  12. Rosano GM, Vitale C, Seferovic P. Heart Failure in Patients with Diabetes Mellitus.. Card Fail Rev. 2017; 3 (1): p.52-55. doi: 10.15420/cfr.2016:20:2 . | Open in Read by QxMD
  13. Hilscher M, Sanchez W. Congestive hepatopathy. Clinical Liver Disease. 2016; 8 (3): p.68-71. doi: 10.1002/cld.573 . | Open in Read by QxMD
  14. Poelzl G, Ess M, Mussner-Seeber C, Pachinger O, Frick M, Ulmer H. Liver dysfunction in chronic heart failure: prevalence, characteristics and prognostic significance. Eur J Clin Invest. 2011; 42 (2): p.153-163. doi: 10.1111/j.1365-2362.2011.02573.x . | Open in Read by QxMD
  15. Yancy CW, Jessup M, Bozkurt B, et al. 2017 ACC/AHA/HFSA Focused Update of the 2013 ACCF/AHA Guideline for the Management of Heart Failure: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines and the Heart Failure Society of America. Circulation. 2017; 136 (6). doi: 10.1161/cir.0000000000000509 . | Open in Read by QxMD
  16. Suzuki S, Sugiyama S. The Molar Ratio of N-terminal pro-B-type Natriuretic Peptide/B-type Natriuretic Peptide for Heart Failure-related Events in Stable Outpatients with Cardiovascular Risk Factors. Intern Med. 2018; 57 (18): p.2621-2630. doi: 10.2169/internalmedicine.0471-17 . | Open in Read by QxMD
  17. Chen Y, Wen Z, Peng L, et al. Diagnostic value of MR-proANP for heart failure in patients with acute dyspnea:a meta-analysis. Acta Cardiol. 2019; 75 (1): p.68-74. doi: 10.1080/00015385.2018.1550887 . | Open in Read by QxMD
  18. Chow SL, Maisel AS, Anand I, et al. Role of Biomarkers for the Prevention, Assessment, and Management of Heart Failure: A Scientific Statement From the American Heart Association. Circulation. 2017; 135 (22). doi: 10.1161/cir.0000000000000490 . | Open in Read by QxMD
  19. Hudson MP, O’Connor CM, Gattis WA, et al. Implications of elevated cardiac troponin t in ambulatory patients with heart failure: a prospective analysis. Am Heart J. 2004; 147 (3): p.546-552. doi: 10.1016/j.ahj.2003.10.014 . | Open in Read by QxMD
  20. Wettersten N, Maisel A. Role of Cardiac Troponin Levels in Acute Heart Failure. Card Fail Rev. 2015; 1 (2): p.102. doi: 10.15420/cfr.2015.1.2.102 . | Open in Read by QxMD
  21. Ponikowski P, Voors AA, Anker SD, et al. 2016 ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure. Eur Heart J. 2016; 37 (27): p.2129-2200. doi: 10.1093/eurheartj/ehw128 . | Open in Read by QxMD
  22. Salerno M, Sharif B, Arheden H, et al. Recent Advances in Cardiovascular Magnetic Resonance. Circulation: Cardiovascular Imaging. 2017; 10 (6). doi: 10.1161/circimaging.116.003951 . | Open in Read by QxMD
  23. Omar AMS, Bansal M, Sengupta PP. Advances in Echocardiographic Imaging in Heart Failure With Reduced and Preserved Ejection Fraction. Circ Res. 2016; 119 (2): p.357-374. doi: 10.1161/circresaha.116.309128 . | Open in Read by QxMD
  24. Natanzon A, Kronzon I. Pericardial and Pleural Effusions in Congestive Heart Failure—Anatomical, Pathophysiologic, and Clinical Considerations. Am J Med Sci. 2009; 338 (3): p.211-216. doi: 10.1097/maj.0b013e3181a3936f . | Open in Read by QxMD
  25. Petrie MC, McMurray JJV. It cannot be cardiac failure because the heart is not enlarged on the chest X-ray. Eur J Heart Fail. 2003; 5 (2): p.117-119. doi: 10.1016/s1388-9842(02)00239-8 . | Open in Read by QxMD
  26. Zipes DP. Braunwald's Heart Disease. Mosby ; 2018
  27. Gouda P, Brown P, Rowe BH, McAlister FA, Ezekowitz JA. Insights into the importance of the electrocardiogram in patients with acute heart failure. Eur J Heart Fail. 2016; 18 (8): p.1032-1040. doi: 10.1002/ejhf.561 . | Open in Read by QxMD
  28. O’Neal WT, Mazur M, Bertoni AG, et al. Electrocardiographic Predictors of Heart Failure With Reduced Versus Preserved Ejection Fraction: The Multi‐Ethnic Study of Atherosclerosis. Journal of the American Heart Association. 2017; 6 (6). doi: 10.1161/jaha.117.006023 . | Open in Read by QxMD
  29. Davey PP, Barlow C, Hart G. Prolongation of the QT interval in heart failure occurs at low but not at high heart rates.. Clin Sci (Lond). 2000; 98 (5): p.603-10.
  30. Cardiac rehabilitation. https://www.nhlbi.nih.gov/health-topics/cardiac-rehabilitation. . Accessed: October 21, 2020.
  31. McDowell K, Petrie MC, Raihan NA, Logue J. Effects of intentional weight loss in patients with obesity and heart failure: a systematic review. Obes Rev. 2018; 19 (9): p.1189-1204. doi: 10.1111/obr.12707 . | Open in Read by QxMD
  32. Dietary guidelines for Americans 2015-2020. https://health.gov/sites/default/files/2019-09/2015-2020_Dietary_Guidelines.pdf. Updated: December 1, 2015. Accessed: August 28, 2020.
  33. Toukhsati SR, Driscoll A, Hare DL, et al. Patient Self-Management In Chronic Heart Failure — Establishing Concordance Between Guidelines And Practice. Card Fail Rev. 2015; 1 (2): p.128. doi: 10.15420/cfr.2015.1.2.128 . | Open in Read by QxMD
  34. Izadi M, Alemzadeh Ansari MJ, Kazemisaleh D, Moshkani Farahani M. Air Travel Considerations for the Patients With Heart Failure. Iranian Red Crescent Medical Journal. 2014; 16 (6). doi: 10.5812/ircmj.17213 . | Open in Read by QxMD
  35. Travel and Heart Disease. https://www.heart.org/en/health-topics/consumer-healthcare/what-is-cardiovascular-disease/travel-and-heart-disease. . Accessed: September 18, 2020.
  36. Zannad F, Ferreira JP, Pocock SJ, et al. SGLT2 inhibitors in patients with heart failure with reduced ejection fraction: a meta-analysis of the EMPEROR-Reduced and DAPA-HF trials. Lancet. 2020; 396 (10254): p.819-829. doi: 10.1016/s0140-6736(20)31824-9 . | Open in Read by QxMD
  37. Von Haehling S, Ebner N, Evertz R, Ponikowski P, Anker SD. Iron Deficiency in Heart Failure. JACC: Heart Failure. 2019; 7 (1): p.36-46. doi: 10.1016/j.jchf.2018.07.015 . | Open in Read by QxMD
  38. Guck TP, Elsasser GN, Kavan MG, Eugene J. EJ. Depression and Congestive Heart Failure. Congest Heart Fail. 2003; 9 (3): p.163-169. doi: 10.1111/j.1527-5299.2003.01356.x . | Open in Read by QxMD
  39. Richards TR, Tobe SW. Combining Other Antihypertensive Drugs With β-Blockers in Hypertension: A Focus on Safety and Tolerability. Can J Cardiol. 2014; 30 (5): p.S42-S46. doi: 10.1016/j.cjca.2013.08.012 . | Open in Read by QxMD
  40. Allen LA, Magid DJ, Zeng C, et al. Patterns of beta-blocker intensification in ambulatory heart failure patients and short-term association with hospitalization. BMC Cardiovasc Disord. 2012; 12 (1). doi: 10.1186/1471-2261-12-43 . | Open in Read by QxMD
  41. Allen LA, Fang JC. Goldilocks Dilemma of Dose Titration in Heart Failure With Reduced Ejection Fraction. Circ Heart Fail. 2017; 10 (8). doi: 10.1161/circheartfailure.117.004406 . | Open in Read by QxMD
  42. Leyva F, Zegard A, Acquaye E, et al. Outcomes of Cardiac Resynchronization Therapy With or Without Defibrillation in Patients With Nonischemic Cardiomyopathy. J Am Coll Cardiol. 2017; 70 (10): p.1216-1227. doi: 10.1016/j.jacc.2017.07.712 . | Open in Read by QxMD
  43. Peal J, Mathews I, Runnett C, Thomas H, Ripley D. An update on cardiac implantable electronic devices for the general physician. J R Coll Physicians Edinb. 2018; 48 (2): p.141-147. doi: 10.4997/jrcpe.2018.208 . | Open in Read by QxMD
  44. Epstein AE, DiMarco JP, et al. ACC/AHA/HRS 2008 Guidelines for Device-Based Therapy of Cardiac Rhythm Abnormalities. Circulation. 2008; 117 (21). doi: 10.1161/circualtionaha.108.189742 . | Open in Read by QxMD
  45. Brignole M, Auricchio A, Baron-Esquivias G, Bordachar P et al. 2013 ESC Guidelines on cardiac pacing and cardiac resynchronization therapy. Eur Heart J. 2013; 34 (29): p.2281-2329. doi: 10.1093/eurheartj/eht150 . | Open in Read by QxMD
  46. Mechanical Circulatory Support in a Nutshell. https://www.acc.org/latest-in-cardiology/articles/2015/11/12/09/28/mechanical-circulatory-support-in-a-nutshell. Updated: November 13, 2015. Accessed: October 22, 2020.
  47. Colucci WS. Predictors of survival in heart failure due to systolic dysfunction. In: Post TW, ed. UpToDate. Waltham, MA: UpToDate. https://www.uptodate.com/contents/predictors-of-survival-in-heart-failure-due-to-systolic-dysfunction.Last updated: August 11, 2015. Accessed: February 24, 2017.
  48. Borlaug BA. Pathophysiology of heart failure with preserved ejection fraction. In: Post TW, ed. UpToDate. Waltham, MA: UpToDate. https://www.uptodate.com/contents/pathophysiology-of-heart-failure-with-preserved-ejection-fraction.Last updated: December 20, 2016. Accessed: February 24, 2017.
  49. Aronson D. Cardiorenal syndrome in acute decompensated heart failure. Expert Rev Cardiovasc Ther. 2014; 10 (2): p.177-189. doi: 10.1586/erc.11.193 . | Open in Read by QxMD
  50. Kiernan MS, Udelson JE, Sarnak M, Marvin Konstam M. Cardiorenal syndrome: Definition, prevalence, diagnosis, and pathophysiology. In: Post TW, ed. UpToDate. Waltham, MA: UpToDate. https://www.uptodate.com/contents/cardiorenal-syndrome-definition-prevalence-diagnosis-and-pathophysiology.Last updated: December 14, 2015. Accessed: February 24, 2017.
  51. Kiernan MS, Udelson JE, Sarnak M, Marvin Konstam M. Cardiorenal syndrome: Prognosis and treatment. In: Post TW, ed. UpToDate. Waltham, MA: UpToDate. https://www.uptodate.com/contents/cardiorenal-syndrome-prognosis-and-treatment.Last updated: November 11, 2015. Accessed: February 24, 2017.
  52. Mahon NG, Blackstone EH, Francis GS, Starling RC, Young JB, Lauer MS. The prognostic value of estimated creatinine clearance alongside functional capacity in ambulatory patients with chronic congestive heart failure. J Am Coll Cardiol. 2002; 40 (6): p.1106-1113. doi: 10.1016/s0735-1097(02)02125-3 . | Open in Read by QxMD
  53. Givertz MM, Haghighat A. High-output heart failure. In: Post TW, ed. UpToDate. Waltham, MA: UpToDate. https://www.uptodate.com/contents/high-output-heart-failure.Last updated: August 9, 2016. Accessed: February 24, 2017.
  54. Editors: Donald W Kufe, MD, Raphael E Pollock, MD, PhD, Ralph R Weichselbaum, MD, Robert C Bast, Jr, MD, Ted S Gansler, MD, MBA, James F Holland, MD, ScD (hc), and Emil Frei, III, MD. Holland-Frei Cancer Medicine. BC Decker ; 2003
  55. Mehta PA, Dubrey SW. High output heart failure. QJM. 2009; 102 (4): p.235-241. doi: 10.1093/qjmed/hcn147 . | Open in Read by QxMD
  56. Herold G. Internal Medicine. Herold G ; 2014
  57. Gersh BJ. Auscultation of heart sounds. In: Post TW, ed. UpToDate. Waltham, MA: UpToDate. https://www.uptodate.com/contents/auscultation-of-heart-sounds.Last updated: December 18, 2015. Accessed: February 24, 2017.
  58. Colucci WS. Determining the etiology and severity of heart failure or cardiomyopathy. In: Post TW, ed. UpToDate. Waltham, MA: UpToDate. http://www.uptodate.com/contents/determining-the-etiology-and-severity-of-heart-failure-or-cardiomyopathy.Last updated: February 16, 2016. Accessed: February 24, 2017.
  59. Colucci WS. Prognosis of heart failure. In: Post TW, ed. UpToDate. Waltham, MA: UpToDate. https://www.uptodate.com/contents/prognosis-of-heart-failure.Last updated: November 7, 2014. Accessed: February 24, 2017.
  60. Pinto DS, Kociol RD. Evaluation of acute decompensated heart failure. In: Post TW, ed. UpToDate. Waltham, MA: UpToDate. https://www.uptodate.com/contents/evaluation-of-acute-decompensated-heart-failure.Last updated: November 16, 2015. Accessed: February 24, 2017.
  61. Givertz MM. Noncardiogenic pulmonary edema. In: Post TW, ed. UpToDate. Waltham, MA: UpToDate. https://www.uptodate.com/contents/noncardiogenic-pulmonary-edema.Last updated: September 22, 2015. Accessed: February 24, 2017.
  62. Pinto DS, Kociol RD. Pathophysiology of cardiogenic pulmonary edema. In: Post TW, ed. UpToDate. Waltham, MA: UpToDate. https://www.uptodate.com/contents/pathophysiology-of-cardiogenic-pulmonary-edema.Last updated: March 4, 2016. Accessed: February 24, 2017.
  63. Long B, Koyfman A, Gottlieb M. Management of Heart Failure in the Emergency Department Setting: An Evidence-Based Review of the Literature. J Emerg Med. 2018; 55 (5): p.635-646. doi: 10.1016/j.jemermed.2018.08.002 . | Open in Read by QxMD
  64. Yancy CW, Jessup M, Bozkurt B, et al. 2013 ACCF/AHA Guideline for the Management of Heart Failure: Executive Summary. J Am Coll Cardiol. 2013; 62 (16): p.1495-1539. doi: 10.1016/j.jacc.2013.05.020 . | Open in Read by QxMD
  65. Van Diepen S, Katz JN, Albert NM, et al. Contemporary Management of Cardiogenic Shock: A Scientific Statement From the American Heart Association. Circulation. 2017; 136 (16). doi: 10.1161/cir.0000000000000525 . | Open in Read by QxMD
  66. Felker GM, Lee KL, Bull DA, et al. Diuretic Strategies in Patients with Acute Decompensated Heart Failure. N Engl J Med. 2011; 364 (9): p.797-805. doi: 10.1056/nejmoa1005419 . | Open in Read by QxMD
  67. Page RL, Joglar JA, Caldwell MA, et al. 2015 ACC/AHA/HRS Guideline for the Management of Adult Patients With Supraventricular Tachycardia. Circulation. 2016; 133 (14): p.e506–e574. doi: 10.1161/cir.0000000000000311 . | Open in Read by QxMD
  68. January CT, Wann LS, Alpert JS, et al. 2014 AHA/ACC/HRS Guideline for the Management of Patients With Atrial Fibrillation. J Am Coll Cardiol. 2014; 64 (21): p.e1-e76. doi: 10.1016/j.jacc.2014.03.022 . | Open in Read by QxMD
  69. Schünemann HJ, Cushman M, Burnett AE, et al. American Society of Hematology 2018 guidelines for management of venous thromboembolism: prophylaxis for hospitalized and nonhospitalized medical patients. Blood Advances. 2018; 2 (22): p.3198-3225. doi: 10.1182/bloodadvances.2018022954 . | Open in Read by QxMD
  70. Ivabradine. https://www.drugs.com/ppa/ivabradine.html. Updated: January 20, 2020. Accessed: March 26, 2020.
  71. Morales-Rull JL, Bielsa S, Conde-Martel A, et al. Pleural effusions in acute decompensated heart failure: Prevalence and prognostic implications. Eur J Intern Med. 2018; 52 : p.49-53. doi: 10.1016/j.ejim.2018.02.004 . | Open in Read by QxMD
  72. Mercer RM, Corcoran JP, Porcel JM, Rahman NM, Psallidas I. Interpreting pleural fluid results. Clin Med (Northfield Il). 2019; 19 (3): p.213-217. doi: 10.7861/clinmedicine.19-3-213 . | Open in Read by QxMD