Congestive HEART FAILURE (CHF) 

Is the inability of the heart to pump sufficient blood to meet the needs of the tissues for oxygen and nutrients

Types of HEART FAILURE  :

• Systolic vs. diastolic 
• Left-sided vs. right-sided 
• Acute vs. chronic 

 Pathophysiology : 

• HF results from a variety of cardiovascular diseases but leads to some common heart abnormalities that result in decreased contraction (systole), decreased filling (diastole), or both.  
• HF results in depression of ventricular function and compensation take place by stretching of myocardial fiber. 
• This stretching leads to cardiac dilation which occur when left ventricle fail to eject its normal end diastolic volume. 
• Myocardial dysfunction most often occurs before the patient experiences signs and symptoms of HF. 

  Different causes of heart failure : 

• CAD/Ischemic heart disease                        •  Cardiomyopathies 

• Hypertension                                                •  Valvular heart disease 

• Hypertension                                                •  Ischemic heart disease 

   Assessment and Diagnostic Findings  :

 * HF may go undetected until the patient presents with signs and symptoms of                   pulmonaryand peripheral edema (congestion)  .

•  Assessment of ventricular function is an essential part of the initial diagnostic workup.  
• An echocardiogram                 
• A chest x-ray 
• electrocardiogram (ECG)     
• Exercise testing or cardiac catheterization  
• Laboratory studies include:  
• Serum electrolytes  
• blood urea nitrogen (BUN)  
• creatinine,  
• a complete blood cell count (CBC)  
• Routine urinalysis.  

    

 Managing the patient with HF includes

•  Providing general counseling and education about:  

• sodium restriction  
• monitoring daily weights  
• other signs of fluid retention  
• encouraging regular exercise  
• Avoidance of excessive fluid intake, alcohol, and smoking.  
• Oxygen therapy  

                                   

  PHARMACOLOGIC THERAPY 

1/Angiotensin-Converting Enzyme (ACE) Inhibitors. 

     • Inhibiting neurohormonal activation  

     • Improving ventricular emptying.  

     • Decreasing afterload and preload by promoting vasodilation and diuresis.  

N.B. Promoting diuresis, by decrease the secretion of aldosterone  

     • stimulate the kidneys to excrete sodium and fluid (while retaining potassium)  

     • Decreasing pulmonary congestion.  

     • Relieve fatigue or dyspnea on exertion  

N.B. Patients receiving ACE-I therapy are monitored for hypotension, hypovolemia, hyponatremia, and            alterations in renal function 

2 / Beta-Blockers.  

     • The side effects are most common in the initial few weeks of treatment.  

     • The most frequent side effects are dizziness, hypotension, and bradycardia.  

3 / Diuretics .

       • Increase the rate of urine production and the removal of excess extracellular fluid from the body.  

4 / Digoxin (Lanoxin):  

     • It improves contractility  

     • Increasing left ventricular output  

     • Enhances diuresis, which removes fluid and relieves edema

5 / Calcium Channel Blockers Calcium channel blockers, cause vasodilation, reducing systemic                     vascular resistance