Post MI Heart Failure

Signs and Symptoms

The symptoms and signs of heart failure (HF) are shown in Table 1.

The origins of the symptoms of HF are not fully understood, although breathlessness and lung oedema are caused by increased capillary pressure in the pulmonary vascular bed.²

When they persist after treatment, symptoms can be used to predict prognosis.² One of the most common symptom-based systems used to describe the severity of HF is the New York Heart Association classification (Table 2). NYHA class III or IV HF carries a poor prognosis.²

In patients with post-MI HF, the Killip classification (Table 3) is used to assess patients.¹

Table 1. Symptoms and signs of heart failure.1
Symptoms	Signs
Exertional dyspnoea	Cardiomegaly
Orthopnoea	Third and fourth heart sounds
Paroxysmal nocturnal dyspnoea	Elevated jugular venous pressure
Fatigue	Tachycardia - Hypotension - Bi-basal crackles - Pleural effusion - Ankle oedema - Ascites - Tender hepatomegaly

Table 2. New York Heart Association (NYHA) classification of heart failure.1
Class	Description
I	No limitation. Normal physical exercise does not cause fatigue, dyspnoea or palpitations.
II	Mild limitation. Comfortable at rest but normal physical activity produces fatigue, dyspnoea or palpitations.
III	Marked limitation. Comfortable at rest but less gentle physical activity produces marked symptoms of heart failure.
IV	Symptoms of heart failure occur at rest and are exacerbated by any physical activity.

Table 3. Killip classification of post-MI heart failure.1
Class	Description
I	No crackles and no third heart sound
II	Crackles in <50% of the lung fields or a third heart sound
III	Crackles in >50% of the lung fields
IV	Cardiogenic shock

References:

Kumar P, Clark M. Clinical medicine. 7th ed. Edinburgh: Saunders Elsevier, 2009.
Dickstein K, Cohen-Solal A, Filippatos G, et al. ESC guidelines for the diagnosis and treatment of acute and chronic heart failure 2008. Eur Heart J 2008;29:2388-442.

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