chf

1. Congestive Heart failure
 Definition:
Heart failure is a complex
clinical syndrome in which the heart
cannot pump enough blood to meet
the body's requirements.

3. Introduction
 Heart failure — sometimes known as
congestive heart failure — occurs
when the heart muscle doesn't pump
blood as well as it should. When this
happens, blood often backs up and
fluid can build up in the lungs, causing
shortness of breath.

4. Clinical menifestations
 Heart failure can be ongoing (chronic), or it may start
suddenly (acute).
 Heart failure signs and symptoms may include:
 Shortness of breath with activity or when lying down
 Fatigue and weakness
 Swelling in the legs, ankles and feet
 Rapid or irregular heartbeat
 Reduced ability to exercise
 Persistent cough or wheezing with white or pink blood-tinged
mucus
 Swelling of the belly area (abdomen)
 Very rapid weight gain from fluid buildup
 Nausea and lack of appetite
 Difficulty concentrating or decreased alertness
 Chest pain if heart failure is caused by a heart attack

5. Type of heart failure Description
Left-sided heart failure
Fluid may back up in the lungs,
causing shortness of breath.
Right-sided heart failure
Fluid may back up into the
abdomen, legs and feet,
causing swelling.
Systolic heart failure (also
called heart failure with
reduced ejection fraction)
The left ventricle can't contract
vigorously, indicating a
pumping problem.
Heart failure with preserved
ejection fraction
The left ventricle can't relax or
fill fully, indicating a filling
problem.
Types of Heart failure

6. Following conditions leads to cardiac
Heart failure
 Any of the following conditions can damage or weaken your heart
and can cause heart failure. Some of these can be present without
your knowing it:
 Coronary artery disease and heart attack. Coronary artery
disease is the most common form of heart disease and the most
common cause of heart failure. The disease results from the buildup
of fatty deposits in the arteries, which reduces blood flow and can
lead to heart attack.
 A heart attack occurs suddenly when a coronary artery becomes
completely blocked. Damage to your heart muscle from a heart
attack may mean that your heart can no longer pump as well as it
should.
 High blood pressure. If your blood pressure is high, your heart has
to work harder than it should to circulate blood throughout your body.
Over time, this extra exertion can make your heart muscle too stiff or
too weak to properly pump blood.
 Faulty heart valves. The valves of the heart keep blood flowing in
the proper direction. A damaged valve — due to a heart defect,
coronary artery disease or heart infection — forces the heart to work
harder, which can weaken it over time.

7. Conditions…
 Damage to the heart muscle. Heart muscle damage can
have many causes, including certain diseases, infection,
heavy alcohol use, and the toxic effect of drugs, such as
cocaine or some drugs used for chemotherapy. Genetic
factors also can play a role.
 Inflammation of the heart muscle (myocarditis).
Myocarditis is most commonly caused by a virus, including
the COVID-19 virus, and can lead to left-sided heart failure.
 A heart problem that you're born with (congenital heart
defect). If your heart and its chambers or valves haven't
formed correctly, the healthy parts of your heart have to work
harder to pump blood, which may lead to heart failure.
 Abnormal heart rhythms (arrhythmias). Abnormal heart
rhythms may cause your heart to beat too fast, creating extra
work for your heart. A slow heartbeat also may lead to heart
failure.
 Other diseases. Long-term diseases — such as diabetes,
HIV, an overactive or underactive thyroid, or a buildup of iron
or protein — also may contribute to chronic heart failure.

8. Complications of heart Failure
 Complications of heart failure depend on the severity of heart
disease, your overall health and other factors such as your
age. Possible complications can include:
 Kidney damage or failure. Heart failure can reduce the
blood flow to your kidneys, which can eventually cause
kidney failure if left untreated. Kidney damage from heart
failure can require dialysis for treatment.
 Heart valve problems. The valves of the heart, which keep
blood flowing in the right direction, may not work properly if
your heart is enlarged or if the pressure in your heart is very
high due to heart failure.
 Heart rhythm problems. Heart rhythm problems may lead to
or increase your risk of heart failure.
 Liver damage. Heart failure can cause fluid buildup that puts
too much pressure on the liver. This fluid backup can lead to
scarring, which makes it more difficult for your liver to work
properly.

9. Diagnosis of CHF
 Blood tests. Blood tests are done to look for signs of diseases that
can affect the heart.
 Chest X-ray. X-ray images can show the condition of the lungs and
heart.
 Electrocardiogram (ECG). This quick and painless test records the
electrical signals in the heart. It can show the timing and length of
the heartbeats.
 Echocardiogram. Sound waves are used to produce images of the
heart in motion. This test shows the size and structure of the heart
and heart valves and blood flow through the heart. An
echocardiogram can be used to measure ejection fraction, which
shows how well the heart is pumping and helps classify heart failure
and guides treatment.
 Stress test. Stress tests measure the health of the heart during
activity. You may be asked to walk on a treadmill while attached to
an ECG machine, or you may receive an IV drug that simulates the
effect of exercise on the heart.
 Sometimes a stress test is done while wearing a mask that
measures how well the heart and lungs get oxygen and breathe out
carbon dioxide.

10. Diagnosis…
 Cardiac computerized tomography (CT) scan. In a cardiac CT scan, you lie on
a table inside a doughnut-shaped machine. An X-ray tube inside the machine
rotates around your body and collects images of the heart and chest. Sometimes,
contrast is given. Because the contrast agent could affect kidney function, talk to
your doctor if you have kidney problems.
 Magnetic resonance imaging (MRI). In a cardiac MRI, you lie on a table inside a
long, tubelike machine. Radio waves create images of the heart.
 A cardiac MRI may be done with a dye (contrast). It's important to tell your doctor
about any problems with your kidneys before you receive a cardiac MRI or other
MRI because contrast can cause a rare and serious complication in people who
have kidney disease.
 Coronary angiogram. In this test, a thin, flexible tube (catheter) is inserted into a
blood vessel, usually in the groin, and guided to the heart arteries. A dye (contrast)
is injected through the catheter to make the arteries show up more clearly on an
X-ray, helping the doctor spot blockages.
 Myocardial biopsy. In this test, a doctor inserts a small, flexible cord into a vein in
the neck or groin, and removes very small pieces of the heart muscle for
examination. This test may be done to diagnose certain types of heart muscle
diseases that cause heart failure.

11. Non Pharmacological
management
 Reducing Salt
 Eating salt causes the body to retain more
fluid. This is not a problem for healthy people,
as the body can rebalance and eliminate any
excess fluid and salt fairly efficiently.
 However, if you have heart failure or kidney
disease, this doesn't happen as efficiently as
it should—increasing your chances of fluid
accumulation.5 Many people with heart
failure notice that symptoms of swelling and
shortness of breath worsen with increased
salt intake.

12. Continued..
 Healthy Diet
 A heart-healthy diet is also important
for preventing heart failure from
developing or getting worse, because
coronary artery disease (CAD) is a
major contributor to heart failure. You
should avoid excess cholesterol and
fat (especially trans fat), and instead
base your diet mostly on whole,
unprocessed foods.7

13.  Watching Weight
 Maintaining a healthy weight helps protect
your heart from the burden of having to pump
blood to support a heavier body—a concern,
as a strain on the heart is already a problem
in heart failure. To lose weight successfully,
you may need advice from a dietitian, who
can evaluate your diet to see if you should
cut back on carbohydrates, fat, or calories in
general.
 For some people, weight loss surgery is an
option when diet and exercise aren't enough
to lose weight. Bariatric surgery has been
shown to help prevent and manage heart
failure

14.  Physical Activity
 Staying active is important for everybody, but
for people with heart failure especially, it can
keep your heart muscle strong. Over time, it
can help make the heart work more
efficiently, reducing heart rate and blood
pressure. It can also boost your stamina and
improve your breathing.
 Exercise may not be easy for everyone with
heart failure, so you should be careful to
avoid overexertion. Walking is an ideal
activity for most people. Remember to slow
down or take a break if you ever feel too
short of breath, or if you feel dizzy or faint.

15.  Over-the-Counter Therapies
 Over-the-counter (OTC) medications
are not normally beneficial in heart
failure. In fact, a number of them can
cause heart failure to worsen.9 Some
can also interfere with prescription
heart failure medications, preventing
them from working as they should.

16. Pharmacological
management
 Beta-Blockers
 Beta-blockers are used for heart
failure because they slow down the
heart rate. This allows the heart to fill
more completely before pumping,
providing the body with more blood
each heartbeat. This helps alleviate
some of the fatigue you can
experience due to heart failure.

17.  Diuretics
 Diuretics are medications that act on
the kidneys and promote the
elimination of water and excess
sodium from the body. This relieves
the edema and shortness of breath of
heart failure, as both of these
symptoms result from fluid buildup in
the body.

18.  Angiotensin-Converting Enzyme
(ACE) Inhibitors
 These medications work to relax the
blood vessels to lower the pressure
your heart has to pump against. The
most common ACE inhibitors used in
heart failure include:1

19.  Dopamine
 By making the heart beat more
forcefully, dopamine helps it circulate
oxygen-rich blood more efficiently.
Dopamine also increases the amount
of urine the body produces, which
helps get rid of the extra fluid building
up in the lungs, arms, and legs.

20.  Lanoxin (digoxin): Digoxin, also
called digitalis, is used to help a weak
heart pump more efficiently. Digoxin
strengthens the force of the heart
muscle's contractions and, in low
doses, helps restore a normal, steady
heart rhythm. Some cardiologists
(doctors who specialize in heart
disorders) have been reluctant to
prescribe digoxin because long-term
use can cause arrhythmias.

21.  Aldosterone Antagonists
 Aldosterone antagonists, such
as Aldactone (spironolactone) and
Inspra (eplerenone), block the action
of a hormone called aldosterone
and remove fluid from the body. They
are known as "potassium-sparing"
because they prevent the potassium
level in the body from becoming too
low.2

22.  Nitrates: Nitrates are a type of
vasodilator used in the treatment of
acute heart failure. Nitrates work by
decreasing left ventricular filling
pressure (pressure on the left side of
the heart) and systemic vascular
resistance (the pressure that counters
blood flow), while also modestly
improving the amount of blood
pumped by the heart (cardiac output)