Congestive Heart Failure(CHF)

BY
Miss. S. D. Ajetrao
Assistant Professor
ADCDP, Ashta.
 Congestive Heart Failure (CHF)

Definition:

"Heart Failure means inefficacy of the heart to supply sufficient oxygenated blood for
the body needs.“
"Congestive heart failure is a condition in which cardiac muscle (myocardium) become
weak and fail to pump the blood efficiently to meet the metabolic requirements of the
body.“
OR
“Congestive heart failure is a disease in which the heart is unable to pump sufficient
amount of blood to satisfy the metabolic requirements of different parts of the body."
OR
Congestive Heart Failure (CHF) is a group of condition where the imbalance between
metabolic demand and oxygen supply leads to abnormal anatomical and physiological
changes in heart which gradually leads to functional failure with inability of heart to
either fill up or empty its chambers
TYPES OF CHF:

There are many different ways to classify heart failure, including:

1. The side of the heart involved (Left and Right Heart Failure)
2. Based on severity (Acute and Chronic Heart Failure)

1. Left-Sided Heart Failure:

The most common type of heart failure is left-sided heart failure. The left heart ventricle is located in the
bottom left side of the heart. This area pumps oxygen-rich blood to the rest of the body. Left-sided heart
failure arises when the left ventricle doesn't pump efficiently. This prevents the body from getting enough
oxygen-rich blood. The blood backs up into the lungs instead, which causes shortness of breath and a
buildup of fluid.

Causes of Left Side Heart Failure:

➢ Ischemic Heart Disease
➢ Myocardial Diseases
➢ Systemic Hypertension
2. Right-Sided Heart Failure:

Right-sided or right ventricular (RV) heart failure usually occurs as a result of left-
sided failure. The right heart ventricle is responsible for pumping blood to the
lungs to collect oxygen. Right-sided heart failure occurs when the right side of the
heart can't perform its job effectively. It's usually triggered by left-sided heart
failure. Left-sided heart failure leads to the accumulation of blood in the lungs
which makes the right ventricle work harder. This cause stress to the right side of
the heart and makes it to fail.

Right-sided heart failure can also occur by some other conditions, such as:
• Lung's disease
• Pulmonary Hypertension
• Myocardial diseases
• Tricuspid valve ruptur
3. Acute Heart Failure:
• Acute means for shorter duration and easily curable.
• In acute heart failure, the symptoms become visible suddenly but go away
fairly quickly.
• This condition generally occurs after a heart attack.
• It may also be a consequence of a problem with the heart valves that
control the flow of blood in the heart.

4. Chronic Heart Failure:

• Chronic means for longer duration and can't be cure easily.
• In chronic heart failure, however, symptoms are continuous and don't
recover over time. The vast majority of heart failure cases are chronic
heart failure.
Epidemiology:
CHF is sparsely seen in below 45 years of age.
The prevalence and incidence grade in years is -55-
65< 65 above < 75 above
Male and female both genders are equally susceptible.
Post incidence life span is more in female as compared
to male
In case of race, blacks are more prone to CHF as
compared to other non-whites and whites
 Prevalence is more in people with poor
socioeconomic status
Etiopathogenesis:
1. Causes:
Congestive heart failure occurs due to decreased efficiency of myocardium to pump the blood. The efficiency
mainly decreases due to age but apart from that there are many other causes as following which can impair cardiac
efficiency.
A) Coronary artery disease
Due to obstruction in coronary arteries blood flow to cardiac myocytes decreases thus oxygen supply also decreases.
As oxygen supply decreases, energy production also decreases and metabolic demand of heart can’t be met.

B) Cardiac stroke
When coronary artery gets blocked suddenly- mostly by blood clot. The blood supply stops in the particular part of
heart wall. This causes immediate damage to heart wall and decreases function of heart.

C) Cardiomyopathy
It is damage to cardiac muscles where reason can be oxygen deprivation, free radicles, infections, toxins or drug
abuse.

D) Hypertension
When your blood pressure is higher than normal, it may lead to CHF. Hypertension has many different causes.
Among them is the hardening of your arteries, which increases pressure in the arteries.

E) Defect in heart valves

Congenital or acquired defects in heart valve disturb the cardiac output.
2. Risk factors:

• Age > 65 years

• Family history
• Sedentary lifestyle
• Unhealthy diet with high fat, sodium and
carbohydrate
• Anaemia
• Tobacco consumption in form of chewing or
• smoking
• Alcoholism and drug abuse
• Concomitant endocrine disorder like diabetes, thyroid
• Obesity
Pathogenesis of CHF:
• Increase in metabolic demand or decrease in oxygenated blood supply decreases cardiac contractility. As
a result of which cardiac output reduces and efficiency of heart decrease causing heart failure. To
compensate the decrease in force of contraction and cardiac output, heart adapts compensatory
mechanisms.
• As first compensatory mechanism, sympathetic discharge increases. This leads to vasoconstriction to
increase preload-afterload and activation of B1 receptor in heart to increase Heart Rate (HR) and Force
of Contraction (FOC). This initially leads to increase in Cardiac Output (CO) to compensate heart failure
but if persists; it decreases cardiac output worsening heart failure.
• Increase in sympathetic discharge forces heart to work with more intensity and frequency. While
attaining this, cardiac myocytes need to adapt hypertrophic cellular changes which lead to change in
shape and structure of ventricular heart wall known as cardiac remodelling.
• Remodelled heart and increases thickness of ventricular wall periodically decrease force of contraction
and cardiac output by ventricular chamber dilation. On the other hand, the back pressure created by
remodelled heart causes oedematous condition.
• The second compensatory mechanism begins as renal blood perfusion decrease with decrease in cardiac
output. As renal perfusion decreases, GFR also decreases and renin release increases.
• Decreased GFR causes sodium and water retention producing oedema. Increased renin release increases
level of angiotensin I and II plus subsequently aldosterone also. Aldosterone as per its physiology causes
retention of sodium and water and increases oedema.
• Thus, as the heart failure precipitates, the innate compensatory mechanisms try to revert the loss. If the
treatment is not started well in time, heart failure progresses towards cardiac arrest and death
Clinical Manifestation:

1) Signs
Swelling in extremities
Abnormal heartbeat pattern- cardiac murmur

2) Symptoms
Difficulty in breathing even at rest
Fatigue
Sweating
Chest tightness
Disturbances in sleep
Disturbances in vision
Sudden weight gain due to fluid accumulation
DIAGNOSIS:
1. Electrocardiogram (ECG):
➢ It is a test used to measure electrical activity in the heart.
➢ Electrical sensors called leads are attached to predetermined positions on
the chest, arms and legs to record electrical activity and help to check the
heart function.
2. Angiography:
➢ The word itself came from the Greek words angeion "vessel", and
graphein, "to write" or "record".
➢ The image or film of the blood vessels is called an angiograph.
➢ Arteriography is a medical imaging technique which is used to visualize
the inside, or lumen of blood vessels and other organs of the body, with
particular interest in the arteries, veins, and the heart chambers.
➢ This is generally done by injecting a radio-opaque contrast agent into the
blood vessel and having an image by using X-ray based techniques such as
fluoroscopy
Non-Pharmacological Management:

1) Lifestyle modifications
2) Patient education on what is heart failure
3) Dietary modifications i.e. low salt intake, more
vegetables
4) Weight reduction in patients with obesity
5) Cardio-supportive aerobic exercise
6) Cessation of smoking
7) Reduction/ cessation of alcohol consumption
Pharmacological Management:
There are several medications that can be used to treat CHF, including ACE
inhibitors, beta blockers, etc.
1) ACE inhibitors:
E.g. Captopril, Enalapril, Fosinopril, Benazepril, Lisinopril.
ACE inhibitors prevents angiotensin converting enzyme to convert
angeiotensin 1 to angiotensin 2. Angiotensin 2 narrows the blood vessel
which causes high blood pressure.
2) Angiotensin receptor blockers:
E.g. Telmisartan, Losartan, Valsartan, Candesartan.
Angiotensin receptor blockers (ARB) prevents angiotensin 2 from binding to
its receptor (AT receptors)
3) Beta blockers:
E.g. Carvedilol, Metaprolol, Bisoprolol, Atenolol.
These drugs slow your heart rate and reduce blood pressure. Beta blockers
may reduce signs and symptoms of heart failure.
4) Diuretics:
E.g. Furosemide(Lasix), Spironolactone(Aldactone),
Hydrochlorothiazide(Microzide.)
Often called water pills, increase urine output. Diuretics,
such as furosemide (Lasix), also decrease fluid in your
lungs so you can breathe more easily.

5) Vasodilators:
E.g. Hydralazine, Sod. Nitroprusside, Nitrates.
These medications are used for opening blood vessels if
you cannot tolerate ACE inhibitors