Congestive Heart Failure (CHF) Explained – MADE EASY
what is heart failure? Heart failures means that the heart pumping power is weaker than normal. In heart failure bloods moves through the heart at a slower rate, and the pressure in the heart increases therefore, the heart become congested. As the result, the heart cannot pump enough oxygen to meet the body’s demand. We can divide the heart failure into the left side heart failure, which includes the ‘Left Atrium’ and the ‘Left Ventricle’. Or the right side of heart failure, which includes the ‘Right Atrium’ and the ‘Right Ventricle’. Now heart failure can be either due to systolic dysfunction, which is the inability of the heart to contract and push out the blood Or diastolic dysfunction, which is the inability of the heart to relax. So here is some of the risk factors for congestive heart failure; CAD, in which the major blood vessels that supply the heart muscles with blood and oxygen become narrowed or diseased leading to damage to the heart muscles. Myocardial infarction or heart attack which is the death of the heart muscles due to an ischemic event. Cigarette smoking, Hypertension, which leads to left ventricle hypertrophy which makes it harder to oxygenate the heart muscles. and can eventually lead to ischemic damage to the heart muscles. Obesity and diabetes, which can both lead to CAD. Heart valve disease such as aortic stenosis which can eventually lead to left ventricle hypertrophy and ischemic changes similar to hypertension. Cardiomyopathy, which is another name for heart muscle disease for example; dilated cardiomyopathy in which heart’s ability to pump blood is decreased because the heart’s main pumping chamber the left ventricle is enlarged and it’s associated with alcohol and viral infection. Hypertrophic cardiomyopathy, which is associated with thickening of the heart muscle most commonly at the septum between the right and the left ventricle. Restrictive cardiomyopathy, which is the condition in which the walls of the heart are abnormally rigid and lack flexibility to expand as the ventricle fills with blood and it’s associated with, amyloidosis and sarcoidosis and fibrosis. Even though both the left and the right sided heart failure pretty much have the same clinical features The left sided heart failure present with symptom associated with pulmonary edema which is due to the failure of left ventricle to sufficiently remove blood from the pulmonary circulation. This leads to fluid accumulation in the lungs and the clinical features such as dyspnea or shortness of breath, paroxysmal nocturnal dyspnea, which is the sudden worsening of dyspnea at night during sleep and orthopnea, which is shortness of breath that occurs when lying flat and improves when sitting up or standing. And also, Since the heart is not pumping out enough blood there is going to be decreased forward perfusion. This leads to activation of Renin-Angiotensin-Aldosterone System which causes fluid retention and worsens the symptoms of congestive heart failure. The most common cause of right sided heart failure is actually the left sided heart failure. and the common clinical features include; dyspnea, since the right heat is unable to pump blood into the lungs to get oxygenated. Jugular venous distention, since the jugular veins cannot empty their blood into the congested right atrium. pitting edema, which is due to fluid overload and increased hydrostatic pressure ascites, which is due to fluid accumulation in the peritoneal cavity. Nutmeg liver, which is due to chronic passive congestion of the liver and as you can see here it resembles a cut nutmeg. In order to diagnose congestive heart failure we can use echocardiogram which distinguishes systolic from diastolic dysfunction by measuring the ejection fraction. It can also determine if an acute myocardial ischemia is causing heart failure by showing abnormal wall motions as well as identifying any valve diseases. We can also measure B-type Natriuretic Peptide or BNP which are secreted by the ventricles of the heart in response to excessive stretching of the heart muscle cells. and it can be also be used to differentiate between causes of dyspnea due to heart failure from other causes of dyspnea. We can also use chest x-rays which can show us cardiomegaly which is enlargement of the heart. EKG can be also used to identify any arrhythmias ischemic heart diseases, right and left ventricular hypertrophy and conductive delay or abnormalities such as left bundle branch block (LBBB). In order to properly treat congestive heart failure we must first focus on modifying patient’s lifestyle by encouraging the patient to lose weight, stop smoking, exercising, limiting their alcohol intake and having a healthier diet which are all equally effective in preventing diastolic and systolic heart failure. The pharmacological management for systolic dysfunction heart failure includes; ACE inhibitors, and/or Angiotensin Receptor Blockers Beta-blockers, spironolactone, diuretics, and if nothing else works we can give them digoxin. Medical therapies for diastolic dysfunction heart failure are not as well defined as therapies for systolic heart failure. Some of the medications that are used include; Beta-blockers, calcium channel blockers, ACE inhibitors, and diuretics.