History is Key to Discovering Heart Failure Etiology

Although often short changed because of time, a thorough history from a patient suspected of having heart failure is critical to determining the etiology. History should be systematic and focused on determining potential causes which can then be further explored physical examination and  testing. 

Common CHF Symptoms

Risk Factors

  • Age
  • Hypertension
  • Obesity
  • Tabacco use
  • Multiple pregnancies
  • Recurrent infection-URI, UTI, pneumonia 
  • Diabetes
  • Sedentary
  • Chronic kidney disease

Key clues in history

  • Progressive activity intolerance-can be subtle-ask about habit changes, more naps, confusion, memory issues
  • Heart failure is more common in men than women
  • African Americans have a much higher prevalence of heart failure than other groups
  • Heart failure runs in families and a good family history is very important
  • Chest pain and dyspnea suggest diseases like coronary disease, hypertension, and valve abnormalities
  • Palpitations suggest arrhythmias such as atrial fibrillation 
  • Changes in skin tone, diabetes symptoms suggest potential hemochromatosis 
  • Uncontrollable hypertension may be from hyperthyroidism, renal artery stenosis, or another endocrine condition
  • Excessive fatigue can be related to anemia, uncontrolled diabetes, hypothyroidism, sleep disorder, or depression  
  • Substance abuse and alcoholism should be asked of all patients regardless of socioeconomic status
  • Chronic pulmonary disease, recurrent pulmonary embolism , and pulmonary hypertension can lead to right ventricular failure (for pulmonale)

Associated Conditions

  • Coronary disease
  • Anemia
  • Pagets disease
  • Beriberi, malnutrition
  • Valve disease
  • Congenital heart disease
  • Substance abuse
  • Hyperthyroidism
  • Hemochromatosis
  • Current or prior cancer
  • AIDS