Congestive heart failure is a long-term condition that happens when your heart can't pump blood well enough to give your body a normal supply. Blood and fluids collect in your lungs and legs over time.

1. CONGESTIVE
HEART
FAILURE (CHF)
PREPARED BY
MRS. SONAM MISHRA
ASSISTANT PROFESSOR
FACULTY OF PHARMACEUTICAL DEPARTMENT
RAMA UNIVERSITY

2. Introduction
▪ Congestive heart failure (CHF), also known as heart failure, is a
medical condition in which the heart is unable to pump blood
effectively, leading to an inadequate supply of oxygen and
nutrients to the body's tissues and organs. This condition can
result from various underlying heart problems that weaken the
heart muscle or impair its ability to fill or contract properly.

3. Types of congestive heart failure:
▪ Systolic heart failure: In this type, the heart muscle becomes weak and is
unable to contract with enough force to pump blood adequately out of the
heart's chambers.
▪ Diastolic heart failure: This type occurs when the heart muscle becomes
stiff and cannot relax properly during the resting phase (diastole), leading to
difficulty in filling the heart with enough blood.

4. Pathophysiology of Congestive Heart Failure (CHF):
1. Cardiac Stressors:
1. CHF typically begins with some form of cardiac stress, which can be due to factors such
as hypertension, coronary artery disease, heart valve abnormalities, myocardial infarction
(heart attack), or cardiomyopathy.
2. Reduced Cardiac Output:
1. The primary hallmark of CHF is reduced cardiac output, which means the heart's ability to
pump blood to meet the body's demands is compromised.
2. The reduced cardiac output triggers compensatory mechanisms to maintain adequate
blood flow.

5. Continue______
3. Activation of Neurohormonal Response:
3. Reduced cardiac output leads to decreased perfusion of tissues, activating the sympathetic
nervous system and the renin-angiotensin-aldosterone system (RAAS).
4. Sympathetic nervous system activation causes the release of catecholamines (epinephrine and
norepinephrine), resulting in increased heart rate and contractility in an attempt to improve
cardiac output.
5. RAAS activation leads to the secretion of aldosterone, causing sodium and water retention to
increase blood volume and preload.
4. Increased Preload:
3. As the heart pumps less efficiently, blood accumulates in the chambers, causing an increase in
preload (end-diastolic volume).
4. This increased preload results in ventricular dilation and increased wall tension, further
weakening the heart muscle

6. Continue_____
▪ 5. Ventricular Remodeling:
1. Chronic overstretching of the ventricles triggers a process called ventricular remodeling, leading to
structural changes in the heart muscle.
2. The heart tries to compensate by increasing muscle mass (hypertrophy) and rearranging the muscle
fibers. However, this ultimately compromises the heart's contractile function.
▪ 6. Decreased Contractility:
1. The failing heart muscle becomes less efficient at contracting, further reducing cardiac output.
▪ 7. Pulmonary Congestion:
1. The reduced ability of the left ventricle to pump blood leads to blood backing up into the left atrium
and then into the pulmonary circulation.
2. This causes pulmonary congestion and edema, leading to symptoms such as shortness of breath,
cough, and crackles on auscultation.
▪ 8. Systemic Congestion:
1. With reduced cardiac output, blood is also backed up into the systemic circulation, leading to
peripheral edema and congestion of organs, such as the liver and kidneys.
2. Patients may experience peripheral edema, abdominal distension, and weight gain.

7. Continue____
9. Impaired Oxygen Delivery and Tissue Hypoxia:
• The decreased cardiac output and impaired circulation lead to reduced oxygen delivery to tissues and
organs, resulting in tissue hypoxia.
• This can further exacerbate the stress on the heart and initiate a vicious cycle of worsening CHF.
10. Clinical Manifestations:
• The pathophysiological changes in CHF give rise to various clinical manifestations, including dyspnea,
fatigue, orthopnea, paroxysmal nocturnal dyspnea, and exercise intolerance.
▪ Remember that a flow chart visually represents the sequential steps in a process, so you can arrange
these pathophysiological events in a logical order with arrows connecting the steps. You may also
include additional factors or subcategories to make the flow chart more comprehensive. Software like
Microsoft PowerPoint, Visio, or Lucidchart can help you create the actual flow chart.

8. Pathophysiology of Congestive Heart Failure (CHF):
Congestion(Fluid accumulation in the lungs, lower extremities, and other organs)
fluid retention (Due to decreased cardiac output and kidney response )
Decreased Cardiac Output (Inability of the heart to pump effectively)
Increased Cardiac Workload (Increased preload and afterload)
Compensatory Mechanisms (Activation of sympathetic nervous system, Renin- angiotensin-
aldosterone system, Ventricular hypertrophy)
Impaired Cardiac Function (e.g., due to MI, HT
Heart dysfunction

9. Causes of congestive heart failure can include:
▪ Coronary artery disease: Narrowing or blockage of the coronary arteries that supply blood to the heart
muscle, often due to atherosclerosis, can lead to heart muscle damage.
▪ High blood pressure (hypertension): Prolonged high blood pressure can strain the heart and cause it to
weaken over time.
▪ Heart valve problems: Conditions such as valvular stenosis (narrowing) or regurgitation (leakage) can
place extra stress on the heart and lead to heart failure.
▪ Cardiomyopathy: This is a condition in which the heart muscle becomes enlarged, thickened, or stiff,
impairing its ability to pump effectively.
▪ Myocardial infarction (heart attack): A heart attack can cause damage to a portion of the heart muscle,
reducing its pumping capacity.
▪ Congenital heart defects: Some individuals are born with structural abnormalities in their hearts that can
lead to heart failure later in life

10. Symptoms of congestive heart failure may include
• Shortness of breath (dyspnea): Shortness of breath, especially during physical
activity or when lying flat
• Fatigue and weakness: CHF often feel tired and weak, even with minimal physical
exertion.
• Edema: Swelling in the legs, ankles, and feet (edema)
• Enlarged liver: In severe cases of right-sided heart failure, the liver may become
enlarged and tender due to fluid backup in the abdomen.
• Cyanosis: In severe cases, the skin may take on a bluish tint (cyanosis) due to poor
oxygenation.

11. Continue______
• Decreased urine output
• Rapid or irregular heartbeat
• Persistent cough or wheezing, sometimes with pink or white frothy sputum
• Weight gain due to fluid retention
• Reduced ability to exercise or engage in physical activities

12. Diagnosis and evaluation of congestive heart
failure(CHF)
▪ Medical history: The first step is to gather information about the patient's symptoms,
medical history, family history, and any risk factors for heart disease.
▪ Physical examination: A thorough physical examination is conducted to assess signs
and symptoms of congestive heart failure.
▪ Blood tests: Blood tests are performed to assess various parameters such as electrolyte
levels, kidney function, liver function, and blood cell counts.
▪ Electrocardiogram (ECG/EKG): An ECG records the electrical activity of the heart,
helping to identify abnormalities in heart rhythm or signs of prior heart attacks.
▪ Chest X-ray: A chest X-ray can reveal if the heart is enlarged and check for signs of
congestion or fluid in the lungs.

13. Continue_____
▪ Echocardiogram:. It helps assess the heart's pumping ability, valve function, and any structural
abnormalities.
▪ Stress testing: If appropriate, a stress test may be conducted to evaluate the heart's performance
under physical exertion.
▪ Cardiac catheterization: In some cases, a cardiac catheterization may be necessary to directly
measure pressures within the heart and assess coronary artery disease.
▪ Other imaging tests: Additional imaging tests, such as cardiac MRI or CT scan, might be performed
for more detailed evaluation if needed.
▪ Holter monitoring: This test involves wearing a portable device that records the heart's activity over
24 hours or more.

14. Medication Management:
• Diuretics: Help reduce fluid buildup and swelling.
• ACE inhibitors (Angiotensin-Converting Enzyme inhibitors) or ARBs (Angiotensin
Receptor Blockers): These medications dilate blood vessels, reduce blood pressure, and
decrease the workload on the heart.
• Beta-blockers: Slow the heart rate and reduce the force of contraction, easing the heart's
workload.
• Aldosterone antagonists: Help in managing fluid retention and potassium balance.
• Digitalis: Increases the strength of the heart's contractions and improves heart function.
▪ Other medications may be prescribed depending on the individual's specific condition and
needs.