Congestive Heart Failure

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INTRODUCTION
Definition;

It is a complex clinical syndrome that can result from any cardiac disorder that impairs the ability of the ventricle to deliver adequate quantities of blood to the metabolizing tissues during normal activity or at rest.

Causes

1. Although the disease occurs most commonly among the elderly (80% of patients hospitalized with CHF are > 65 years of age), it may appear at any age as a consequence of underlying cardiovascular disease. 2. There currently is no single diagnostic test for CCHF, and the clinical diagnosis is normally based on patient history and physical examination. 3. CHF should not be considered an independent diagnosis because it is super imposed on an underlying cause. a)Coronary artery disease (CAD) is the cause of CHF in about two thirds of patients with left ventricular systolic dysfunction. b)The remaining third of patients have a non-ischemic cause of systolic dysfunction owing to other causes of myocardial stress, which included trauma, disease, or other abnormal states (e.g. , pulmonary embolism, infection, anemia, pregnancy, drug use or abuse, fluid over load, arrhythmia, valvular heart disease, cardiomyopathies, congenital heart disease) . 4. The New York Heart Association (NYHA) developed a classification system, still used today to quantify the functional limitations of CHF patients. The NYHA classes are as follows: a)Class I : Degree of effort necessary to elicit CHF symptoms equals those that would limit normal individuals. b)Class II: Degree of effort necessary to elicit CHF symptoms occurs with ordinary exertion. c)Class III : Degree of effort necessary to elicit CHF symptoms occurs with less- than ordinary d)exertion.

e)Class IV. Degree of effort necessary to elicit CHF symptoms occurs while at rest.

Substances That May Exacerbate Heart Failure;

Promote Sodium
RetentionProduce
Osmotic EffectDecrease Contractility
Androgens
Albumin
Antiarrhythmic agents (e.g.,
disopyramide, flecainide,
quinidine)
CorticosteroidsGlucose
DiazoxideMannitolβ-adrenergic blockers
Estrogens
Saline
Select calcium channel blockers
(e.g., diltiazem, nifedipine,
verapamil)
LicoriceUrea
Lithium carbonate

amphetamines) Direct cardiotoxins (e.g.,
doxorubicin, ethanol, cocaine)

NSAIDsTricyclic antidepressants

Treatment goals.

CCHF requires a two-pronged therapeutic approach, the overal l goals of which are; 1. To remove or mitigate the underlying causes or risk factors; For example, by eliminating ingest ion of certain drugs or other substances that can produce or exacerbate CHF or by correcting an anemic syndrome, which can increase cardiac demands (Table 42-3) . In addition, modify risk factors that can cause cardiac injury by treating hypertension and diabetes; managing atherosclerotic disease; and controlling smoking, alcohol, and illicit drug use. 2. To relieve the symptoms and improve pump function by:

a)Reducing metabolic demands through rest, relaxation, and pharmaceutical controls b)Reducing fluid volume excess through dietary and pharmaceutical controls c)Administering a combination of diuretics, angiotensin-converting enzyme inhibitors (ACEIs) β-adrenergic blockers, and angiotensin- receptor blockers (ARBs) d)Promoting patient compliance and self - regulation through education e)Selecting appropriate patients for cardiac transplantation

Stages of CHF Based on Evolution and Progression of
Clinical Findings And Approach to CCHF
At Risk for Heart FailureHeart Failure
Stage A Stage B Stage C Stage D
PatientsPatients at high risk of
developing
CHF because of presence of
conditions
that are strongly
associated with development of
condition;
such patients
have no identified
structural or
functional
abnormalities of the
pericardium,
myocardium, or cardiac valves and have never
shown signs
or symptoms
of CHFPatients who have developed
Structural heart
disease that is
strongly associated
with...
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