Congestive Heart Failure

Congestive Heart Failure

Congestive Heart Failure

Definition:
A condition in which the heart is inefficient . its pumping function is hampered. the heart is unable to meet the demands of the body. as a result, the blood circulation becomes. { the heart is unable to pump a sufficient amount of blood to meet the needs of the tissues for oxygenation and nutrient}.
The leads to congestion of many organs with blood and tissues fluids.
Heart failure can be mild or severe and might be Rt. Or Lt. or both.
When the patient receives treatment and shows no symptoms, the case is called compensated, while when he shows symptoms it is called decompensated.

Aetiology:

1. Rheumatoid fever ( destroys the heart valves).

2. Myocardial infarction ( occlusion of coronary veins and arteries ).

3. pericarditis ( lead to constriction of the heart ).

4. hyperthyroidism : ( it places excessive demand on the heart, it led to tachycardia or bradycardia ).


N.B:-

 CHF might appear in older ages due to :

- Arteriosclerosis ( loss of the elasticity of the arterial wall).

- Atherosclerosis ( deposition of fat in the arterial walls).

- Increased blood pressure.

- Physiological changes in the heart muscles it becomes weak.



Pthophysiology:
Narrowing of the mitral valve impedes the blood flow from left atrium to left ventricle.

Left atrium cannot empty normally so it becomes enlarged, the pressure increased in it – this increased pressure causes lung congested with fluids, because of the distended Lt. atrium cannot effectively receive oxygenated blood coming from the lungs.

Lung congestion results in inefficient oxygenation of blood, the pt. develops (signs of Lt. sided HF) as dyspnea. orthopnea. a cough and sometimes hemoptysis.

Because of the congestion, Rt. Ventricle unable to pump blood effectively to the lungs, the Rt. The side of the heart becomes congested with blood.

Venous blood return to the Rt. Aside from the heart cannot pump blood to the lungs quickly and effectively so large veins leading to the heart and other organs and tissues develop congestion.

Dependent oedema appears in the feet, ankles on standing, ascites in the abdomen and the enlarged liver.

Signs and symptoms :

Related to retention of fluids in the lungs and peripheral tissues.

A- lt. side heart failure:

1- Dyspnea on exertion.

2- Weakness, and easily tiredness.

3- An Occasional cough without blood-streaked sputum.

B- Rt. Side heart failure:

1- As oedema increases, weight might increase.

2- Edema of the abdomen, thighs and legs follows.

3- Others symptoms might develop depending on the area of oedema ( e.g. abdominal signs and symptoms such as anorexia and flatulence etc. ).

4- Respiratory signs and symptoms as mentioned above.

N.B. Oedema in lower limbs is called pitting oedema.

Treatment:

Aimed at decrease the amount of circulating blood volume which leads to decrease the oxygen needed by the cardiac muscle.

1- Rest decrease the work of the heart.

2- Sedative to help patient rest.

3- Decrease intake of sodium.

4- Digitalis (decreases heart rate and increases the force of the heartbeat).

5- Diuretics.

6- Oxygen to improve ventilation.



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