2. A state in which the heart cannot provide sufficient
cardiac output to satisfy the metabolic needs of
the body,
Because of problem with the structure or function of
the heart impairs.
It is common end point for many diseases of
cardiovascular system, is caused by any condition
which reduces the efficiency of the myocardium
or heart muscle, through damage or overloading.
There are many different ways to categorize heart
failure, including:
the side of the heart involved (left heart failure
against right heart failure or both).
Left heart failure compromises aortic flow to the
body and brain.
Right heart failure compromises pulmonic flow to
the lungs.
3. Left ventricular failure is a life-threatening
condition.
The left side of the heart receives blood rich in
oxygen from the lungs and pumps it to the
remainder of the body. As the ability to pump
blood forward from the left side of the heart is
decreased, the remainder of the body does not
receive enough oxygen especially when
exercising, this results in fatigue.
causes congestion of the pulmonary vasculature,
and so the symptoms are predominantly
respiratory in nature
Alternative name: Congestive left heart failure
4. Drinking too much alcohol
Heart attack
Heart muscle infections
High blood pressure
-volume overload: high output status
-pressure overload: systemic hypertension, outflow
obstruction
Hypothyroidism
Leaking or narrow heart valves
Any other disease that damages the heart muscle
Poor left-side heart function due to prior heart
attacks
5. Over time left sided failure increases in workload will produce
changes to the heart itself:
-Neuhormonal: sympathetic activity,vasopressin.
-Cellular changes-program cell death(apoptosis),increase amount of
fibrous tissue.
-Hemodynamic
-Reduced contractility, or force of contraction, due to overloading
of the ventricle, as the ventricle is loaded with blood to the point
where heart muscle contraction becomes less efficient, this is
due to reduced ability to cross-link actin and myosin filaments in
over-stretched heart muscle.
-A reduced stroke volume, as a result of a failure of systole, diastole
or both.
Increased end systolic volume is usually caused by reduced
contractility.
Decreased end diastolic volume results from impaired ventricular
filling – as occurs when the compliance of the ventricle falls
6. -Hypertrophy (an increase in physical size) of the myocardium,
caused by the terminally differentiated heart muscle fibres
increasing in size in an attempt to improve contractility
This may contribute to the increased stiffness and decreased ability
to relax during diastole.
-The general effect is one of reduced cardiac output and increased
strain on the heart. This increases the risk of cardiac arrest
Symptoms
Cough (produces frothy or blood-tinged mucus)
Decreased urine production
Difficulty lying down; need to sleep with the head elevated to avoid
shortness of breath
Fatigue, weakness, faintness
Irregular or rapid pulse
Sensation of feeling the heartbeat (palpitations)
Shortness of breath
Waking up due to shortness of breath (paroxysmal nocturnal
dyspnea)
Weight gain from fluid retention
7.
8. Signs
Left-sided failure
Common respiratory signs are tachypnea (increased
''rate'' of breathing) and increased ''work'' of breathing
(non-specific signs of respiratory distress).
Rales or crackles, heard initially in the lung bases, and
when severe, throughout the lung fields suggest the
development of pulmonary edema (fluid in the
alveoli). Cyanosis which suggests severe hypoxemia,
is a late sign of extremely severe pulmonary edema.
Additional signs indicating left ventricular failure
include a laterally displaced apex beat, may be heard
as a marker of increased blood flow, or increased
intra-cardiac pressure. Heart murmurs may indicate
the presence of valvular heart disease, either as a
cause or as a result of the heart failure
9. Echocardiography- is commonly used to support a
clinical diagnosis of heart failure, uses ultrasound to
determine the stroke volume, end diastolic volume.
Chest X-rays- are frequently used to aid in the this may
show visible enlargement of the heart,in left
ventricular failure, there may be evidence of vascular
redistribution, cuffing of the areas around the
bronchi, and interstitial edema.
electrocardiogram (ECG)- is used to identify ischemic
heart disease, right and left ventricular hypertrophy,
and presence of conduction delay or abnormalities.
Blood test-An elevated B-type natriuretic peptide (BNP)
is a specific test indicative of heart failure, BNP can
be used to differentiate between causes of dyspnea
due to heart failure
10. Treatment of congestive heart failure consists of a
combination of non-drug and drug strategies.
Lifestyle changes include the following:
Stay active as possible under limitations set by a doctor
Schedule relaxation and rest periods throughout the day
Avoid excessive fluid intake
Do not drink alcohol
Keep a diary of daily weight
Medication:
Digoxin – helps the heart beat more efficiently to reduce the
symptoms of CHF. It may also help to control certain
abnormal heart rhythms.
Beta blockers – slow the heart down and reduce the risk of
abnormal heart rhythms.
Verapamil – is a calcium channel blocker that is especially
useful in the treatment of diastolic CHF.
