Renal impairment and congestive features in heart failure
THE CONTEXT
Advanced heart failure can impair renal function. The accompanying figure identifies congestive findings associated with left and right heart failure.
Renal impairment
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Low cardiac output causes poor renal perfusion, leading to renal impairment.
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Diuretics, angiotensin-converting enzyme (ACE) inhibitors and angiotensin receptor blockers (ARBs) may exacerbate renal impairment.
Features of left and right heart failure
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Left heart failure is associated with pulmonary oedema, pleural effusions and cardiomegaly; raised jugular venous pressure and pitting oedema may also occur.
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Right heart failure is associated with marked elevation of jugular venous pressure, hepatomegaly, ascites and marked peripheral pitting oedema.