Congestive Heart Failure

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Congestive Heart Failure

Congestive heart failure (CHF), or heart failure, is a condition in which the heart can't
pump enough blood to the body's other organs.
This can result from:
narrowed arteries that supply blood to the heart muscle coronary artery
disease
past heart attack, or myocardial infarction, with scar tissue that interferes with the
heart muscle's normal work
high blood pressure
heart valve disease due to past rheumatic fever or other causes
primary disease of the heart muscle itself, called cardiomyopathy.

heart defects present at birth congenital heart defects.

infection of the heart valves and/or heart muscle itself endocarditis and/or
myocarditis

The "failing" heart keeps working but not as efficiently as it should. People with heart
failure can't exert themselves because they become short of breath and tired.
As blood flow out of the heart slows, blood returning to the heart through the veins
backs up, causing congestion in the tissues. Often swelling (edema) results. Most often
there's swelling in the legs and ankles, but it can happen in other parts of the body, too.
Sometimes fluid collects in the lungs and interferes with breathing, causing shortness of
breath, especially when a person is lying down.
Heart failure also affects the kidneys' ability to dispose of sodium and water. The
retained water increases the edema.
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Predisposing Factors
Infection.
Anaemia.
Thyrotoxicosis.

Pregnancy: Women with rheumatic valvular disease can first experience symptoms
during pregnancy and following delivery of the baby these symptoms may be resolved.
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Abnormal heart rhythms.

Rheumatic fever.
Infective endocarditis and Myocarditis.
Hypertension (High Blood Pressure).
Heart attack.
Myocardial infarction.
Pulmonary embolism.
Overexercise.
Sudden increase in salt in the diet.
Excessive environmental heat or humidity.
Emotional crises.

Pathophysiology
Causes:
Myocarditis
Ventricular aneurysm
Cardiac temponade
Pericarditis
Hypertension

Tachycardia
Ventricular dilatation
Myocardial hypertrophy

Fluid overload
Water reabsorption

Decrease cardiac output

Decrease renal perfusion

Increase ADH
Increase Osmotic pressure

Increase sodium retention

Anatomy and Physiology

To understand what occurs in heart failure, it is useful to be familiar with the anatomy of
the heart and how it works. The heart is composed of two independent pumping
systems, one on the right side, and the other on the left. Each has two chambers, an
atrium and a ventricle. The ventricles are the major pumps in the heart.

The
external
structures
of
the
heart
include
the
ventricles,
atria, arteries,
and
veins.
Arteries carry
blood
away
from the heart
while
veins
carry blood into
the heart. The
vessels colored
blue
indicate
the transport of
blood
with
relatively low content of oxygen and high content of carbon dioxide. The vessels colored
red indicate the transport of blood with relatively high content of oxygen and low content
of carbon dioxide.
The Right Side of the Heart
The right system receives blood from the veins of the whole body. This is "used" blood,
which is poor in oxygen and rich in carbon dioxide.

The right atrium is the first chamber that receives blood.

The chamber expands as its muscles relax to fill with blood that has returned
from the body.
The blood enters a second muscular chamber called the right ventricle.
The right ventricle is one of the heart's two major pumps. Its function is to pump
the blood into the lungs.
The lungs restore oxygen to the blood and exchange it with carbon dioxide,
which is exhaled.

The Left Side of the Heart

The left system receives blood from the lungs. This blood is now oxygen rich.

The oxygen-rich blood returns through veins coming from the lungs (pulmonary
veins) to the heart.
It is received from the lungs in the left atrium, the first chamber on the left side.

Here, it moves to the left ventricle, a powerful muscular chamber that pumps the
blood back out to the body.
The left ventricle is the strongest of the heart's pumps. Its thicker muscles need
to perform contractions powerful enough to force the blood to all parts of the
body.
This strong contraction produces systolic blood pressure (the first and higher
number in blood pressure measurement). The lower number (diastolic blood
pressure) is measured when the left ventricle relaxes to refill with blood between
beats.
Blood leaves the heart through the ascending aorta, the major artery that feeds
blood to the entire body.

The Valves
Valves are muscular flaps that open and close so blood will flow in the right direction.
There are four valves in the heart:

The tricuspid regulates blood flow between the right atrium and the right
ventricle.
The pulmonary valve opens to allow blood to flow from the right ventricle to the
lungs.
The mitral valve regulates blood flow between the left atrium and the left
ventricle.
The aortic valve allows blood to flow from the left ventricle to the ascending
aorta.

The Heart's Electrical System.

The heartbeats are triggered and regulated by the conducting system, a network of
specialized muscle cells that form an independent electrical system in the heart
muscles. These cells are connected by channels that pass chemically caused electrical
impulses.

Left Sided Congestive Heart Failure

Pathophysiology
Causes
o Myocardial Infarction
o Hypertension
o Aortic stenos is insufficiency

Reduced myocardial contractility

Increases cardiac workload
Decreased diastolic filling
Obstructions of left atrial emptying

Bloods dams back into

the pulmonary
capillary bed

Left sided CHF

Left atrial pressure

Stroke volume decreases

Pressure at the
pulmonary capillary bed

Pulmonary edema

Tissue perfusion
decreases
Cellular hypoxia

Bloods flow to the kidneys

RAAS stimulation

Vasoconstriction and
reabsorption of Na and water
ECF volume

S/S
Total blood volume
Systemic BP

Sign and Symptoms

Symptoms are dependent on two factors. The first is based on the side of the heart,
right or left, that is involved. The second factor is based on the type of failure, either
diastolic or systolic. Symptoms and presentation may be indistinguishable making
diagnosis impossible based on symptoms.

Left side of the heart pumps blood from the lungs to the organs, failure to do so leads to
congestion of the lung veins and symptoms that reflect this, as well as reduced supply
of blood to the tissues.
The predominant respiratory symptom is shortness of breath on exertion (dyspnea)
or in severe cases at rest - and easy fatigueability. Orthopnea is increasing
breathlessness on reclining, often measured in the number of pillows required to lie
comfortably. Paroxysmal nocturnal dyspnea is a nighttime attack of severe
breathlessness, usually several hours after going to sleep. Poor circulation to the
body leads to dizziness, confusion and diaphoresis and cool extremities at rest.
Predominant left-sided clinical signs are tachypnea and increased work of breathing
(signs of respiratory distress not specific to heart failure), rales or crackles, which
suggests the development of pulmonary edema, dullness of the lung fields to
percussion and diminished breath sounds at the bases of the lung, which suggests the
development of a pleural effusion (fluid collection in the pleural cavity) that is transudative
in nature, and cyanosis which suggests hypoxemia, caused by the decreased rate of
diffusion of oxygen from fluid-filled alveoli to the pulmonary capillaries.

Right Sided Congestive Heart Failure

Pathophysiology
Causes:
LSCHF
Pulmonary Embolism
Right ventricular infarction
Congenital septal defects

Obstruction of right atrial

emptying
Increase right atrial pressure

Reduced myocardial
s/s: contractility
Neck vein engorgement
hepatomegaly
Portal hypertension
ascites
Contraction
Peripheral
edemaof right sided
atrial
filling
sleenomegaly
Right sided CHF
Jaundice

Increases cardiac
workload

Decreased diastolic filling

Increased
Blood drains
pressure
backinfrom
the veins
RV
to RA