A 60-year-old baker presents to your clinic, complaining of increasing shortness of breath and nonproductive cough over the last month. She feels like she can't do as much activity as she used to do without becoming tired. She even has to sleep upright in her recliner at night to be able to breathe comfortably. She denies any chest pain, nausea, or sweating. Her past medical history is significant for high blood pressure and coronary artery disease. She had a hysterectomy in her 40s for heavy vaginal bleeding. She is married and is retiring from the local bakery soon. She denies any tobacco, alcohol, or drug use. Her mother died of a stroke and her father died from prostate cancer. She denies any recent upper respiratory illness, and she has had no other symptoms. On examination she is in no acute distress. Her blood pressure is 160/100 and her pulse is 100. She is afebrile and her respiratory rate is 16. With auscultation she has distant air sounds and she has late inspiratory crackles in both lower lobes. On cardiac examination the S 1 and S 2 are distant and an S 3 is heard over the apex. What disorder of the chest best describes her symptoms?

Heart failure is a long-term chronic disease, although it can sometimes develop suddenly. It can affect only one side of the heart and is called, depending on the case, right heart failure or left heart failure. Even if it develops on only one side of the heart, both sides are affected as time goes on.

Because the heart's pumping function is impaired, blood may return to other areas of the body, accumulating, for example, in the lungs, liver, gastrointestinal tract, arms and legs. Hence the other name given to the disease: congestive heart failure. Thus, oxygen and nutrients are lacking in the organs where blood has accumulated, impairing and reducing their ability to work properly.

Left heart failure causes fluid to accumulate in the lungs and consequently shortness of breath. Initially, shortness of breath occurs only during exertion, but as heart failure progresses, shortness of breath begins to occur with less effort and finally even at rest. People with severe left heart failure may find themselves short of breath when lying down (a condition called orthopnea) as gravity causes more fluid to enter the lungs. These people often wake up panting or wheezing (a clinical condition called paroxysmal nocturnal dyspnea). When sitting, some of the fluid is drained to the lower lungs, which makes breathing easier. People with left heart failure feel tired and weak during physical activity because their muscles are not getting enough blood.