Congestive Heart Failure (CHF) is when the Heart has difficulty keeping up with the needs of the body.

Typically seen in patients over the age of 65

However, some patients, depending on other medical issues, accidents, drug use (overdose), and other causes are getting CHF and younger ages.

Congenital problems of the heart and other issues can predispose a new infant to CHF. In some cases, this is reversible through surgery, medications, or other treatments.

When the heart decreases in function it is typically associated with one of the four factors. The functionality of the pump can be associated with several contributing factors.

The heart itself in some cases can become enlarged. Heart failure may be Right sided or Left sided or eventually BOTH.

There are 4 areas that affect the function of the heart

1.  Contractile state of myocardium
2.  Pre-load of ventricle
3.  The Afterload of the ventricle
4.  The heart rate

Left sided heart failure

–  Low cardiac output
–  Elevated pulmonary venous pressure
–  Dyspnea is a common symptom.

 Right sided heart failure

–  Fluid retention is common
–  Ascites
–  Hepatic congestion
–  Can be caused by left ventricle failure

Causes

–  Myocardial Infarction
–  Ishcemic cardiomyopathy
–  Coronary Artery Disease
–  Systemic Hypertension
–  Rheumatic Heart Disease
–  Alcohol
–  Viral Myocarditis
–  Bacteria
–  Dilated Cardiomyopathies
–  Drug toxicity
–  Valvular heart diseases

Symptoms

–  Cough
–  Shortness of breath
–  Edema
–  Enlarged heart
–  Fatigue
–  Loss of Energy
–  Lack of motivation
–  Difficulty moving, walking

Diagnosis

–  ECG may show and underlying arrhythmia
–  Chest X-ray will show the shape and size of heart
–  Echocardiogram helps with diagnosis
–  Ultrasound may be helpful
–  Radionuclide angiography helps analyze pressure

Classification

Functional Classification is done by New York Heart Association Functional Classification

Class I:  No limitation in any activities – no symptoms of normal activities
Class II:  Mild limitation in some activities – comfortable at rest or mild exertion
Class III:  Marked limitation with activity – only comfortable at rest
Class IV:  Discomfort with activity and symptomatic at rest

According to American College of Cardiology/American Heart Association: 4 stages of heart failure

Stage A: High risk for heart failure in future – but no current structural change
Stage B:  Some structural change but no symptoms
Stage C:  Symptoms are present with an underlying structural change of heart using medical treatment
Stage D:  Advance disease that requires hospital support, heart transplant, or palliative care

Treatment can be Complicated

Stage A

–  Treat hypertension
–  Stop smoking
–  Stop Alcohol
–  Treat lipid disorders
ACE Inhibitors

Stage B

–  Inclusive of Stage A
–  ACE inhibitors
–  ARBs
–  Beta blockers
–  Implantable defibrillators

Stage C

–  Inclusive of Stage A and B
–  Diuretics
–  ACE inhibitors
–  Beta blockers
–  Aldosterone antagonist
–  ARBs
–  Digitalis
–  Hydralazine/nitrates
–  Biventricular pacing
–  Implantable defibrillators

Stage D

–  Inclusive of Stage A,B and C if appropriate
–  Hospice

*** – Hunt SA et al:ACC/AHA 2005 Guidelines

Diuretics

ACE Inhibitors

Angiotension II Receptor Blockers

Beta-Blockers

–  Initially were thought to be bad with patients with heart failure
–  Are now considered very beneficial
.  Carvedilol – a non selective Beta-1 and Beta-2
.  Bisoprolol
.  Metoprolol

Digitalis Glycosides

.  Digoxin

****Calcium Channel Blockers should be avoided in almost all cases of CHF

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