CONGESTIVE HEART

FAILURE
By.P. Dhilip Kumar
DEFINITION
It is the abnormal clinical condition involving
impaired cardiac pumping that results in
pathophysiologic changes in the body
CAUSES
 Coronary artery disease
 MI
 Hypertension
 Dysrhythmias
 Rheumatic heart disease
 Cardiomyopathy
 Congenital heart disease
 Corpulmonale (pulmonary heart disease)
 Valvular heart disorders
 Anemia
 Infective endocarditis
pulmonary emboli
 Myocarditis
 Thyrotoxicosis causing altered metabolism of myocardial tissue
CLASSIFICATION OF HEART
FAILURE
 Systolic failure: It is the defect in which there
is inability of the ventricles to pump causing
increased ventricular filling and dilatation
 Diastolic failure: It is the impaired ability of
the ventricles to relax due to stiff and
noncompliant ventricles
 Mixed systolic & diastolic failure: It is seen in
cases of cardiomyopathy that is characterized
by poor systolic function that is compromised
by ventricular hypertrophy and ventricles
inability to relax
CONTD…
 Left sided heart failure: this occurs due to
left ventricular dysfunction which prevets
normal flow of blood and causes blood to
backflow in to the left atrium & pulmonary
vasculature
 Right sided heart failure: due to increased
backflow of blood in to the pulmonary
arteries and right ventricle it leads right
ventricular congestion & failure.
PATHOPHYSIOLOGY OF HEART
FAILURE
Due to any of the above causes

Increased systemic vascular resistance

Increased force of left ventricular contraction

Increased left ventricle oxygen demand

Left ventricular hypoxia

Decreased left ventricular contraction

Increased left ventricular preload (amount of blood in the chamber during diastole)
Left ventricular failure

Increased left atrial preload

Pulmonary edema

Increased pulmonary vascular resistance

Right ventricular failure

CLINICAL MANIFESTATION
Right sided failure:
-right ventricle heaves- visible pulsation on the chest wall
-cardiac murmurs
 Jugular venous distension
 Edema
 Weight gain
 Increased heart rate
 Ascites
 Anasarca (whole body edema)
 Hepatomegaly
 Anxiety & depression
 Abdominal pain
 Anorexia & GI distension
 Nausea & vomiting
CONTD…
Left sided failure:
 Left ventricle heaves
pulsus Alternans (alternate strong and weak pulse felt on
palpation)
 Respiratory crackles due to pulmonary edema
 Abnormal heart murmurs
 Altered mental status like restlessness, confusion & anxiety
 Depression
 Dyspnea
 Shallow respirations
 Paroxysmal nocturnal dyspnea
 Orthopnea
 Dry cough and frothy pink sputum
DIAGNOSTIC STUDIES
 History & physical exmn to assess the type of failure
 Cardiac enzymes like CPK (>200mg/dl) and

CK-MB (>20mg/dl) are elevated

ABG analysis to assess the oxygen saturation
Sr. Electrolytes to assess electrolyte imbalance
Chest X-ray to detect cardiomegaly and Rt. or Lt. axis
deviation
Echocardiogram to assess the valvular function
ECG to assess for dysrrhythmias
Sr. B-type natriuretic peptide (>100pg/ml) is elevated
Nuclear imaging studies to monitor for hypertrophy
Cardiac catheterisation to assess the chamber pressures.
MANAGEMENT
 Treat the underlying cause like correction of MI using
CABG surgery, Hypertension with antihypertensives,
Cardiomyopathy with heart transplantation
 Loop diuretics like inj. Lasix to decrease fluid overload
 Fowler’s position to aid in breathing
 IV nitroprusside to treat hypertension and for
vasodilation
 Morphine sulphate to treat chest pain
 Digoxin to increase ventricular contractility
 Cordarone to treat cardiac dysrrhyrhmias
 Nessiritde is an IV vasocative therapy to cause arterial
and venous vasodilation
CONTD…
 Oxygen therapy to assist in breathing
 Sympathomimetic agents like dopamine and
dobutamine to increase myocardial
contractility
 Defibrillation to revert severe dysrrhythmias
INVASIVE THERAPIES
 Intra aortic Balloon Pump: it is a sausage
shaped balloon that is inserted through femoral
access and advanced into the aorta which is
connected to a pneumatic helium device which
inflates and deflates alternatively with heart’s
pumping action which temporarily supports the
heart by increasing ventricular contractility
 Ventricular assist devices: It is a temporary
device which is connected with the right & left
side of the heart used to temporarily support
the heart by providing pumping action
SURGICAL MANAGEMENT
 Heart transplantation: this is the treatment
of choice for patients with severe heart
failure
It is of 2 types
- Orthotopic transplantation: In which the
recipient heart is removed and the donor’s
heart is transplanted
- Heterotopic transplantation: In which the
recipient heart is left in place and the
donor’s heart is placed near anastomsing it
with the right atrium