Congestive Heart Failure

Acute exacerbation of CHF is typically caused by cardiac ischemia, although a hypertensive emergency and, less commonly, cardiomyopathy can also cause acute CHF.

Causes

• Main cause of heart failure is coronary artery disease, which is secondary to loss of left ventricular muscle, ongoing ischemia, or decreased diastolic ventricular compliance.
• Most common causes of heart failure are hypertension or high blood pressure.
• Other functional causes of heart failure such as including valvular heart disease, congenital heart disease, dilated cardiomyopathy, lung disease, heart tumo.
• Heart failure may be occur during the last 3 months of pregnancy or several months after pregnancy. It may be occur due to an abnormal immune system response.

Symptoms

• Shortness of breath at rest is the major presenting symptom ++++.
• Paroxysmal nocturnal dyspnea +++
• Orthopnea ++
• Cough
• Fatigue
• Symptoms of myocardial ischemia are common: angina, diaphoresis, and decreased exercise tolerance.

Signs

The presence of physical findings in CHF tends to be more specific than sensitive.

• Vital signs (abnormal): tachycardia, normal or elevated blood pressure, hypotension indicative of cardiac decompensation (shock)
• Wet crackles
• S3 gallop (common in systolic dysfunction), representing rapid ventricular filling associated with impaired ventricular function ++ (>90% specific)
• S4 gallop (common in diastolic dysfunction), representing diminished ventricular compliance
• Peripheral edema ++ (80% specific)
• Jugular venous distention ++ (>90% specific)
• Hepatojugular reflux ++ (>90% specific)

Treatment

• For the treatment of CHF, it requires treatment program of rest, proper diet, modified daily activities, drugs such as including ACE(angiotensin-converting enzyme) inhibitors, digitalis, diuretics, vasodilators.
• Heart failure means, it causes the heart to pump harder to compensate for its weakened pumping ability. To treat the heart failure used beta-blockers, because it help to relax the heart, reduce the vigor of its contractions, and reduce additional strain on the heart.
• Other treatments that are depend on the cause of heart failure, such as including Coronary angioplasty, Coronary artery bypass surgery, Implantable cardiac defibrillator (ICD), Intra-aortic balloon pump (IABP), Left ventricular assist device (LVAD), Valve repair or valve replacement surgery.