[Skip to Content]
[Skip to Content Landing]
January 1940


Author Affiliations


From the Medical Clinic of the Massachusetts General Hospital.

Arch Intern Med (Chic). 1940;65(1):163-170. doi:10.1001/archinte.1940.00190070173012

It is well known that fever often occurs in patients with congestive heart failure. During the early use of the clinical thermometer Wunderlich1 noted this finding, but he also said that subnormal temperatures were by no means uncommon.

In reviewing the medical literature it is surprising to find so little has been said either about fever in relation to congestive heart failure or concerning the frequency with which complications occur in patients suffering from that disease.

Harrison's2 opinion, as expressed in his book entitled "Failure of the Circulation," is as follows:

Fever in some degree occurs in a large proportion of patients with congestive heart failure. A slight increase in temperature may possibly be dependent on the increase in the metabolic rate which many patients exhibit, but fever of more considerable magnitude usually signifies infection, infarction, or thrombus formation. More commonly fever is to be ascribed to pulmonary

Wunderlich, C. R. A.:  On the Temperature in Diseases: A Manual of Medical Thermometry , London, New Sydenham Society, 1871, pp. 430 and 431.
Harrison, T. R.:  Failure of the Circulation , Baltimore, Williams & Wilkins Company, 1936, p. 264.
Cohn, A. E., and Steele, J. M.:  Unexplained Fever in Heart Failure ,  J. Clin. Investigation 13:853, 1934.Crossref
Oral temperatures are notoriously unreliable as an indication of internal body temperature in the presence of dyspnea, which so often necessitates mouth breathing with resultant cooling and drying of the mucous membranes of the mouth.
Left ventricular failure alone, usually based on the symptom of dyspnea in cases with cardiac enlargement secondary to systemic hypertension, aortic valvular disease or large myocardial infarcts, is graded as 1 with reference to extent of stasis, moderate or marked pulmonary vascular engorgement occurring only transiently in attacks of paroxysmal dyspnea in a few of the cases; right ventricular failure, as a rule secondary either to failure of the left ventricle or to disease of the mitral valve, is graded as 2 and 3, respectively, because of the obvious and chronic generalized stasis in the systemic circulation.
Emerson, C. P., in Cecil, R. L.:  A Textbook of Medicine , ed. 4, Philadelphia, W. B. Saunders Company, 1937, p. 866.