Heart failure at an internal medicine department: a retrospective study.

R M Santos, F Gonçalves, J Nóbrega, L Nascimento, L Ravara


The files of 222 patients (112 men) admitted to a Medical Department (Medicina 1) of the Hospital de Santa Maria (Lisbon) between 1/1/87 and 21/6/88 with the diagnosis of congestive heart failure (CHF) were studied retrospectively. The next parameters were considered: sex, age, cause of cardiac disease, duration of CHF, presence of diabetes, predispondent factors of CHF episodes, cardiac rhythm and blood pressure on admission, presence of rales, ascitis and edema, echocardiographic findings and evolution. Ischemic heart disease (IHD) (50%) and hypertensive heart disease (HHD) (31%) were the most frequent causes of CHF in this study. The mean age was 70 years, being higher in women (74 versus 66 years). Men were predominant in the younger groups. The rheumatic heart disease (RHD) group had the lowest mean age (54) while the cardiac diseases of unknown origin had the highest mean age (79). Patients with RHD were those with longer CHF (16 years) while patients with IHD, idiopathic cardiomyopathy and cor pulmonale had a shorter duration of CHF (less than 5 years). The respiratory infection was the most frequent predisponent factor (40%). In a high number of cases (31%) it was not possible to find the presumable cause of the CHF episode. Atrial fibrillation was the predominant disarrhythmia (44%) on admission, specially in patients with RHD. Patients with HHD isolated or associated to other causes were those with higher initial blood pressure. Echocardiographic studies were suggestive that HHD can be associated with CHF without a significant increase in left atrium and ventricle dimensions nor impairment of left ventricle systolic function. Echocardiographic analysis of larger numbers of patients and the study of left ventricular diastolic function and Doppler flow patterns will eventually contribute to a better understanding of CHF physiopathology.

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