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