A state in which the heart cannot provide sufficient cardiac output to satisfy the metabolic needs of the body,Because of problem with the structure or function of the heart impairs.It is common end point for many diseases of cardiovascular system, is caused by any condition which reduces the efficiency of the myocardium or heart muscle, through damage or overloading.There are many different ways to categorize heart failure, including:the side of the heart involved (left heart failure against right heart failure or both). Left heart failure compromises aortic flow to the body and brain.Right heart failure compromises pulmonic flow to the lungs.
Left ventricular failure is a life-threateningcondition.The left side of the heart receives blood rich inoxygen from the lungs and pumps it to theremainder of the body. As the ability to pumpblood forward from the left side of the heart isdecreased, the remainder of the body does notreceive enough oxygen especially whenexercising, this results in fatigue.causes congestion of the pulmonary vasculature,and so the symptoms are predominantlyrespiratory in natureAlternative name: Congestive left heart failure
Drinking too much alcoholHeart attackHeart muscle infectionsHigh blood pressure-volume overload: high output status-pressure overload: systemic hypertension, outflowobstructionHypothyroidismLeaking or narrow heart valvesAny other disease that damages the heart musclePoor left-side heart function due to prior heartattacks
Over time left sided failure increases in workload will producechanges to the heart itself:-Neuhormonal: sympathetic activity,vasopressin.-Cellular changes-program cell death(apoptosis),increase amount offibrous tissue.-Hemodynamic-Reduced contractility, or force of contraction, due to overloadingof the ventricle, as the ventricle is loaded with blood to the pointwhere heart muscle contraction becomes less efficient, this isdue to reduced ability to cross-link actin and myosin filaments inover-stretched heart muscle.-A reduced stroke volume, as a result of a failure of systole, diastoleor both. Increased end systolic volume is usually caused by reducedcontractility. Decreased end diastolic volume results from impaired ventricularfilling – as occurs when the compliance of the ventricle falls
-Hypertrophy (an increase in physical size) of the myocardium,caused by the terminally differentiated heart muscle fibresincreasing in size in an attempt to improve contractility This may contribute to the increased stiffness and decreased abilityto relax during diastole.-The general effect is one of reduced cardiac output and increasedstrain on the heart. This increases the risk of cardiac arrestSymptomsCough (produces frothy or blood-tinged mucus)Decreased urine productionDifficulty lying down; need to sleep with the head elevated to avoidshortness of breathFatigue, weakness, faintnessIrregular or rapid pulseSensation of feeling the heartbeat (palpitations)Shortness of breathWaking up due to shortness of breath (paroxysmal nocturnaldyspnea)Weight gain from fluid retention
SignsLeft-sided failureCommon respiratory signs are tachypnea (increasedrate of breathing) and increased work of breathing(non-specific signs of respiratory distress).Rales or crackles, heard initially in the lung bases, andwhen severe, throughout the lung fields suggest thedevelopment of pulmonary edema (fluid in thealveoli). Cyanosis which suggests severe hypoxemia,is a late sign of extremely severe pulmonary edema.Additional signs indicating left ventricular failureinclude a laterally displaced apex beat, may be heardas a marker of increased blood flow, or increasedintra-cardiac pressure. Heart murmurs may indicatethe presence of valvular heart disease, either as acause or as a result of the heart failure
Echocardiography- is commonly used to support aclinical diagnosis of heart failure, uses ultrasound todetermine the stroke volume, end diastolic volume.Chest X-rays- are frequently used to aid in the this mayshow visible enlargement of the heart,in leftventricular failure, there may be evidence of vascularredistribution, cuffing of the areas around thebronchi, and interstitial edema.electrocardiogram (ECG)- is used to identify ischemicheart disease, right and left ventricular hypertrophy,and presence of conduction delay or abnormalities.Blood test-An elevated B-type natriuretic peptide (BNP)is a specific test indicative of heart failure, BNP canbe used to differentiate between causes of dyspneadue to heart failure
Treatment of congestive heart failure consists of acombination of non-drug and drug strategies.Lifestyle changes include the following:Stay active as possible under limitations set by a doctorSchedule relaxation and rest periods throughout the dayAvoid excessive fluid intakeDo not drink alcoholKeep a diary of daily weightMedication:Digoxin – helps the heart beat more efficiently to reduce thesymptoms of CHF. It may also help to control certainabnormal heart rhythms.Beta blockers – slow the heart down and reduce the risk ofabnormal heart rhythms.Verapamil – is a calcium channel blocker that is especiallyuseful in the treatment of diastolic CHF.