Insuficiência cardíaca: manifestações clínicas e diagnóstico em adultos

Abstract

Introduction: HF is a complex clinical syndrome identified by the presence of current or past characteristic symptoms, such as dyspnea and fatigue, and evidence of cardiac dysfunction as the cause of these symptoms (e.g., abnormal left ventricular [LV] and/or right ventricular [RV] filling and elevated filling pressures). From a hemodynamic perspective, HF is a disorder in which the heart cannot pump blood to the body at a rate compatible with its needs, or can do so only at the cost of high filling pressures. Patients with HF may or may not have associated physical signs, such as those related to fluid retention. Objective: To discuss heart failure and its clinical manifestations and diagnosis in adults. Methodology:Literature review from Scielo, PubMed and BVS databases, from April to June 2024, with descriptors “Heart failure”, “Clinical manifestations” and “Diagnosis”. Articles from 2019-2024 (total 39) were included, excluding other criteria and selection of 05 full-text articles. Results and Discussion: HF should be suspected in individuals with one or more symptoms of HF not caused by a noncardiac condition. The diagnosis of HF is established based on the findings of the following assessments (algorithm 1 ): Identifying the symptoms of HF is a fundamental step in the diagnosis of HF. Although a history alone is insufficient to make the diagnosis of HF, a detailed history remains the best discriminator for determining the acuity, etiology, and rate of progression of HF, and the history often provides important clues to the cause of HF. Physical examination can provide evidence of the presence and extent of elevated cardiac filling pressure, right-sided failure, ventricular enlargement, pulmonary hypertension, and reduced cardiac output. An echocardiogram alone does not establish or exclude the diagnosis of HF, but it is useful in identifying findings consistent with HF and in identifying potential causes of HF (e.g., left ventricular [LV] systolic dysfunction, LV diastolic dysfunction, valvular dysfunction). Natriuretic peptide levels – Natriuretic peptide levels should be interpreted in the context of other clinical information; they may lend weight to the diagnosis of HF or trigger consideration of HF, but should NOT be used alone to diagnose or exclude HF. Role of exercise testing – Evaluation to distinguish cardiac from other causes may include a cardiopulmonary exercise test. Conclusion: Heart failure (HF) is a condition in which the heart cannot pump enough blood to meet the body’s needs. As a result, fluid can accumulate in the legs, lungs, and other tissues throughout the body.