The Power Course

In Framingham Heart Study for heart failure which of the following is minor criteria.


1 ) Neck Vein Distension
2 ) Rales
3 ) Increased Venous Pressure > 16 cm of water
4 ) Hepatomegly


Framingham Heart Study was established in the year 1948.  McKee and colleagues in 1971 described the criteria for Heat failure used for an epidemiological and clinical study.

Following are the criteria described under Framingham heart study for heart failure.

Major Criteria Minor Criteria
Paroxysmal Nocturnal Dyspnea Ankle edema
Neck Vein Distention Night cough
Rales Hepatomegaly
Cardiomegaly Plural effusion
Acute Pulmonary Edema Vital capacity reduced by one third from predicted
S3 Gallop Tachycardia more 120/min
Increased Venous Pressure > 16cm of water  
Circulation Time More than 25 secs  
Hepatojugalar reflex positive  
Major Or Minor Criteria Weight loss of more than 4.5kg over 5 days of treatment
For establishing a definite diagnosis of congestive heart failure in this study, 2 major or 1 major & 2 minor criteria had to be present concurrently.

Symptoms and sign of Heart Failure

Paroxysmal Nocturnal Dyspnea 

Paroxysmal nocturnal dyspnea is also called PND is a sign of left heart failure. The patient gets up after lying down for 2 to 3 hours with severe breathlessness and cough. This is due to increase systemic venous return in lying down position, heart can not pump all blood, leading to congestion of lungs. Symptoms usually take half an hour of sitting or standing at the window side to disappear.

Neck Vein Distention

Neck vein gets distended due to increased systemic venous congestion and pressure. This is seen in the right heart failure patients.


Lung congestion from left heart failure produce rales 


Cardiomegaly means an increase in the size of the heart. Normal transverse heart diameter on the chest X-ray PA view is less than 50% of trans thoracic diameter. In the presence, of cardiomegaly diameter of the heart is more than 50%.

Acute pulmonary edema

When the congestion of lungs in left heart failure becomes severe it leads to acute pulmonary edema

S3 Gallop

Normal third heart sound is not audible. In the presence of left ventricular failure, filling pressure of left ventricle increases leading to S3 gallop

Hepato jugular reflex

This was described by Pasteur in year1985 in patients with tricuspid regurgitation, but it is present in all cases of heart failure. Heptojugular reflex is said to present if there is consistent distention of neck veins on applying pressure over the liver.

Ankle edema hepatomegaly is signs of peripheral congestion. 

Plural effusion is also a sign of congestion.

Heart rate increases in heart failure to compensate for decreased cardiac output



Last Modified : 25-Dec-2019

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