1. Mr Wright’s admission states that he has CCF (congestive cardiac failure). Clearly define CCF. What organs and which body systems are affected by this disorder?
Congestive cardiac failure defined
Congestive cardiac failure (CCF) is a progressive disease of the heart, which involves loss of pumping ability by the heart. Congestive cardiac failure occurs when the myocardium loses its ability to pump enough blood to meet the body’s metabolic needs and is generally accompanied by fluid accumulation in the body tissues, especially the lungs. The build–up of fluid affects the normal function of the heart, pulmonary circulation, blood pressure, the distribution of oxygen and nutrients, and electrolyte balance. Where oedema occurs in the body depends on the part of the heart that is affected by heart failure. Heart failure is almost always a chronic, long term condition, although sometimes it can develop suddenly. Pump failure usually occurs in a damaged left ventricle, but may also happen in the right ventricle. Usually, left ventricle heart failure develops first [Springhouse 2009 p38].
Usually the loss in pumping action is a symptom of an underlying problem, such as coronary artery disease [Springhouse 2009 p38]. Other conditions that may contribute to CCF are:
High blood pressure
Myocardial infarction - where scar tissue hinders the normal working of the heart muscle
Impairment of a heart valve Congenital defects of the heart Myocarditis – an inflammation of the muscular tissue of the heart (myocardium) Cardiomyopathy - a disorder of the heart muscle or myocardium, generally of unknown causes
Endocarditis - an inflammation of the heart valves and the endocardium
[Medicinenet (2009) p1]
Heart failure can be classified as:
Left-sided failure - is a result of ineffective left ventricular contractile function, which affects the hearts ability to pump blood forward from the left side of the heart. This may lead to decreased cardiac output, pulmonary congestion or pulmonary oedema. Common causes of left ventricular failure are myocardial infarction (MI), hypertension, and aortic and mitral valve stenosis. As the decreased pumping ability of the left ventricle persists, fluid accumulates, backing up into the left atrium and then into the lungs. If this worsens, pulmonary oedema and right sided heart failure may also result [Springhouse 2009 p39].
Right-sided failure - is caused by ineffective right ventricular contractile function, which means the right ventricle loses its pumping function. It may be caused by acute right ventricular infarction or pulmonary embolus. However the most common cause is the backward flow due to left sided heart failure. The right ventricle becomes stressed because of having to pump against a greater pulmonary vascular resistance and left ventricular pressure. The blood pools up in the right ventricle and right atrium. The backed up blood causes pressure and congestion in the vena cava and systemic circulation [Springhouse 2009 p40-41].
Systolic failure - in systolic heart failure the ability of the left ventricle to pump sufficient blood supply out into the system circulation during the systolic period is decreased. Haemodynamic disturbances such as excessive cardiac workload caused by volume overload or pressure overload, limit the heart’s pumping ability. Consequently, the blood backs up into the pulmonary circulation, the pressure rises in the pulmonary venous system and cardiac output falls. This problem can result from hypertension or cardiac stenosis [Springhouse 2009 p41].
Diastolic failure - in diastolic failure the left ventricle can’t relax and fill properly during diastole and the amount of blood pumped by the left ventricle in one contraction (stroke volume) falls. As a result larger amounts of ventricular volume are needed to maintain cardiac output [Harris Nagy, & Vardaxis...