Heart Failure

Definition: Heart failure is a condition in which the heart is unable to pump sufficient
blood for metabolizing tissues or can do so only from an abnormally elevated filling
pressure. It is important to identify the underlying nature of the cardiac disease and the
factors that precipitate acute congestive heart failure.
Underlying cardiac disease: Includes states that depress ventricular function (coronary
artery disease, hypertension, dilated cardiomyopathy, valvular disease, congenital heart
disease) and stated that restrict ventricular filling (mitral stenosis, restrictive
cardiomyopathy, pericardial disease).
Acute precipitating factors: Include: 1- increase Na intake
2- Acute MI
3- Exacerbation of hypertension.
4- Acute arrhythmias.
5- Infections and/or fever.
6- Pulmonary embolism.
7- Anemia.
8- Thyrotoxicosis.
9- Pregnancy.
10- Acute Myocarditis or infective endocarditis.
Symptoms: Due to inadequate perfusion of peripheral tissues (fatigue, Dyspnea) and
elevated intracardiac filling pressures (orthopnea, paroxysmal nocturnal Dyspnea,
peripheral edema).
Physical signs: Tachycardia, pulmonary congestion (rales, dullness over pleural
effusion), cardiac enlargement, fourth heart sound (S4: atrial gallop), third heart sound
(S3: ventricular gallop), neck vein distention (jugular vein), hepatic enlargement, edema
in lower extremity and ascites.
Laboratory: CXR can reveal cardiomegaly, pulmonary vascular redistribution, Kerley B
lines, and pleural effusions. Left ventricular contraction can be assessed by
echocardiography or radionuclide ventriculography. In addition, echo can identify
underlying valvular, pericardial, or congenital heart disease, as well as regional wall
motion abnormalities typical of coronary artery disease.
Conditions that mimic CHF (pulmonary disease): chronic bronchitis, emphysema, and
asthma; look for sputum production and abnormalities on CXR and pulmonary function
tests.

Treatment: Aimed at symptomatic relief, removal of precipitating factors, and control of

underlying disease. ACE inhibitors should be begun early, and control excess of fluid
retention must be done.
1General measures: restrict salt intake, avoid antiarrhythmics for
asymptomatic arrythmia. Avoid NSAIDs, immunize against influenza
and pneumococcal pneumonia.
2Diuretics.
3ACE inhibitors.
4Beta blockers.
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