Congestive Heary Failure
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:
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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. Predisposing Factors o Infection. o Anaemia. o 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.
Causes: Myocarditis Ventricular aneurysm Cardiac temponade Pericarditis Hypertension
Tachycardia Ventricular dilatation Myocardial hypertrophy
Fluid overload Water reabsorption Increase ADH Increase Osmotic pressure
Decrease cardiac output Decrease renal perfusion 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.
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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.
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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:
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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 o o o Myocardial Infarction Hypertension Aortic stenos is insufficiency Mitral stenos is insufficiency Left sided CHF Stroke volume decreases Pressure at the pulmonary capillary bed Tissue perfusion decreases Cellular hypoxia Bloods flow to the kidneys Reduced myocardial contractility Increases cardiac workload Decreased diastolic filling Obstructions of left atrial emptying
Bloods dams back into the pulmonary capillary bed
Left atrial pressure
Vasoconstriction and reabsorption of Na and water ECF volume
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
Reduced myocardial contractility
Increases cardiac workload
Decreased diastolic filling Obstruction of right atrial emptying Contraction of right sided atrial filling
Increase right atrial pressure
Right sided CHF
Blood drains back from RV to RA Increased pressure in the veins
s/s: Neck vein engorgement hepatomegaly Portal hypertension ascites Peripheral edema sleenomegaly Jaundice