Congestive Heart Failure

Definition of the congestive heart failure

1. Heart failure is also called congestive heart failure.
   1. This congestive heart failure (biventricular) is used in various conditions, but the best is to restrict this terminology to right heart failure resulting from pre-existing left heart failure.
   2. Biventricular cardiac failure is the most common manifestation of heart failure and can be divided into:
      1. Left cardiac failure.
      2. Right cardiac failure.
   3. Heart failure may be:
      1. Compensated type. The symptoms are stable, and obvious features of fluid retention are absent.
      2. Decompensated type. It is acute or continuing deterioration of heart failure.
2. Congestive heart failure is due to damage to the cardiac muscles.
3. In this condition, the heart cannot pump the blood at a rate needed by the body for the metabolism of the tissues.

Pathophysiology of Congestive Heart Failure

1. The heart failure may be due to:
   1. Coronary artery disease (CAD). If the coronary arteries become blocked or severely narrowed, the heart becomes starved of oxygen and nutrients.
      1. The heart attack damages the heart muscle, resulting in a scarred area that does not function properly.
   2. Cardiomyopathy. Damage to the heart muscle causes other than artery or blood flow problems, such as infections or alcohol or drug abuse.
   3. High blood pressure leads to overwork of the heart.
   4. Other diseases like valvular diseases, thyroid disease, kidney disease, diabetes, or heart defects present at birth can all cause heart failure.
   5. Heart failure can occur when several diseases or conditions are present at once.
2. In many pathologic conditions, the onset of heart failure is preceded by cardiac hypertrophy, which is the compensatory response of the heart.

Clinical presentation of heart failure

1. Left heart failure:
   1. The ischemic disease is the most common cause.
   2. There is systemic hypertension, chronic or malignant.
   3. There may be aortic or mitral valve diseases.
   4. There may be cardiomyopathy.
2. Right heart failure:
   1. This syndrome is seen in various conditions.
   2. It is seen in left heart failure.
   3. This may be due to chronic lung disease (cor pulmonale).
   4. The patient may have tricuspid valve disease.
   5. There may be pulmonary valve disease.
   6. There may be isolated right ventricular cardiomyopathy.
   7. There may be atrial or ventricular septal defects.
   8. There may be mitral valve disease with pulmonary hypertension.

3. Congestive heart failure is the most common cause of transudative pleural effusion.
4. In treated cases, transudate may change into exudate.
5. Effusion due to congestive heart failure is more on the right side.

Classification of congestive heart failure:

Heart failure, according to the American College of Cardiology and American heart association, has divided into four stages:

Stage A:

1. These patients in stage A are those groups with the following illness and risk of developing heart failure but have no sign or symptom of failure.
   1. Patients with diabetes.
   2. With H/O blood pressure.
   3. Patient with H/O coronary disease.
   4. Patient with metabolic syndrome.
   5. Excessive use of alcohol.
   6. With H/o cardiac toxic drug therapy.
   7. H/O rheumatic fever.
   8. Patients with family H/O of cardiomyopathy.

Stage B:

1. These patients have heart disease but no symptoms.
   1. Patients with H/O heart attack.
   2. Patient with low ejection fraction.
   3. Valvular diseases without symptoms.

Stage C:

1. This group has heart disease and symptoms.
   1. These patients have shortness of breath.
   2. Decreased stamina or decreased ability for exercise.
   3. Easy fatigability.

Stage D: 

1. This group has advanced heart disease and needs aggressive medical treatment.
2. These patients have systolic heart failure and all signs and symptoms of heart failure.

 Workup of the patient with heart failure:

1. Electrocardiogram (ECG).
2. X-Ray chest.
3. Blood test for:
   1. Electrolytes, Na. K, Mg.
   2. Cardiac enzymes.
   3. Thyroid function test.
4. Kidney function test.
5. Stress test.
6. MRI
7. Cardiac catheterization or angiography.

Lab findings in heart failure:

Serum
Sodium	Normal or decreased
Potassium	Normal
Bicarbonate	Normal
Chloride	Decreased
Volume	Increased
Urine
Sodium	Decreased
Potassium	Normal
pH	Normal
Volume	Decreased

Treatment:

1. To prevent heart failure, advise the patient:
   1. Stop smoking.
   2. Stop alcohol intake.
   3. Stop the use of harmful drugs (drug abuse).
2. Treat hypertension.
3. Treat hypercholesterolemia.
4. Give adequate treatment after AMI.
5. Treatment of chronic heart failure target:
   1. Relieve the symptoms.
6. Bed rest is helpful in the early days of congestive heart failure.
7. Diuretics reduce the load on the heart.
8. Bed rest may lead to deep vein thrombosis, so put the patient on heparin and give elastic stockings.
9. Slowly starts exercises for 20 to 30 minutes, walking 2 to 3 times per week.
10. Can start cycling for 20 minutes at 70% to 80% of peak heart rate five times per week.
11. modify the diet.

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