Congestive heart failure is a pathophysiological condition in which the heart cannot supply the blood (especially oxygen) it needs from body tissues or organs for several reasons. Heart failure can be acute or chronic. Heart failure is often due to a variety of causes, including other heart conditions, such as chronic high blood pressure, coronary artery disease, mechanical defects in the valves, and chronic arrhythmias (atrial fibrillation is the most common). Heart failure can be acute or chronic. Heart failure is often due to a variety of causes, including other heart conditions, such as chronic high blood pressure, coronary artery disease, mechanical defects in the valves, and chronic arrhythmias (atrial fibrillation is the most common). Cause As you age, your heart's function decreases, increasing your risk of developing congestive heart failure. Congestive heart failure occurs in 3-5% of the population over 65 years of age. This disease accounts for about 5% of adult hospitalizations. Coronary artery disease, which leads to irreversible damage to the myocardium and myocardial infarction, is the most common cause of heart failure. Hyperthyroidism (which increases the need for oxygen by increasing metabolism) or severe anemia can also cause heart failure. Symptom Common symptoms of congestive heart failure include general weakness, fatigue, difficulty with even little exercise, central nervous system symptoms (confusion, insomnia, headache), tachycardia, nocturia, and cyanosis. In addition, systemic congestion, pulmonary congestion, peripheral hypoperfusion, and symptoms due to increased sympathetic nerve activity appear. In most cases, left ventricular failure occurs first, which increases the burden on the right ventricle, eventually resulting in right ventricular failure. . An early symptom of left ventricular failure is difficulty breathing at rest or during physical activity that previously did not cause any discomfort. Shortness of breath is especially pronounced when the person is lying down (sitting respiration). Shortness of breath is relieved when the patient sits up. Therefore, raising the pillow may relieve symptoms. Acute paroxysmal nocturnal dyspnea is a form of dyspnea in left heart failure. Patients wake up 2-4 hours after falling asleep with a feeling of suffocation. With careful interviewing, you may have nightmares of strangulation or drowning just before the onset of distinct signs and symptoms of seizures. Acute paroxysmal nocturnal dyspnea, accompanied by wheezing and asthma-like breathing, is called 'cardiac asthma. Also in acute pulmonary edema, pink foamy sputum appears. A man coughing with shortness of breath Right ventricular insufficiency The hallmark of right ventricular insufficiency is systemic venous congestion and edema. Left ventricular failure is often the cause of right ventricular failure. However, right ventricular failure is also caused by pulmonary hypertension, and pulmonary embolis

1. Heart failure: A symptom in the stomach must not be
overlooked
Congestive heart failure is a pathophysiological condition in which the heart
cannot supply the blood (especially oxygen) it needs from body tissues or
organs for several reasons.
Heart failure can be acute or chronic. Heart failure is often due to a variety
of causes, including other heart conditions, such as chronic high blood
pressure, coronary artery disease, mechanical defects in the valves, and
chronic arrhythmias (atrial fibrillation is the most common).
Heart failure can be acute or chronic. Heart failure is often due to a variety
of causes, including other heart conditions, such as chronic high blood
pressure, coronary artery disease, mechanical defects in the valves, and
chronic arrhythmias (atrial fibrillation is the most common).
Cause
As you age, your heart's function decreases, increasing your risk of
developing congestive heart failure. Congestive heart failure occurs in
3-5% of the population over 65 years of age. This disease accounts for
about 5% of adult hospitalizations.

2. Coronary artery disease, which leads to irreversible damage to the
myocardium and myocardial infarction, is the most common cause of heart
failure. Hyperthyroidism (which increases the need for oxygen by
increasing metabolism) or severe anemia can also cause heart failure.
Symptom
Common symptoms of congestive heart failure include general weakness,
fatigue, difficulty with even little exercise, central nervous system symptoms
(confusion, insomnia, headache), tachycardia, nocturia, and cyanosis. In
addition, systemic congestion, pulmonary congestion, peripheral
hypoperfusion, and symptoms due to increased sympathetic nerve activity

3. appear. In most cases, left ventricular failure occurs first, which increases
the burden on the right ventricle, eventually resulting in right ventricular
failure.
. An early symptom of left ventricular failure is difficulty breathing at rest
or during physical activity that previously did not cause any discomfort. Shortness
of breath is especially pronounced when the person is lying down (sitting
respiration). Shortness of breath is relieved when the patient sits up. Therefore,
raising the pillow may relieve symptoms.
Acute paroxysmal nocturnal dyspnea is a form of dyspnea in left heart
failure. Patients wake up 2-4 hours after falling asleep with a feeling of
suffocation. With careful interviewing, you may have nightmares of
strangulation or drowning just before the onset of distinct signs and
symptoms of seizures. Acute paroxysmal nocturnal dyspnea, accompanied
by wheezing and asthma-like breathing, is called 'cardiac asthma. Also in
acute pulmonary edema, pink foamy sputum appears.
A man coughing with shortness of breath
Right
ventricular insufficiency The hallmark of right ventricular insufficiency is
systemic venous congestion and edema. Left ventricular failure is often the
cause of right ventricular failure. However, right ventricular failure is also
caused by pulmonary hypertension, pulmonary embolism, pulmonary artery

4. stenosis, and atrial septal defect. Jugular venous pressure rises,
accompanied by peripheral edema.
The right ventricle is unable to accommodate the increased blood flow,
resulting in increased venous pressure. This causes congestion in the
abdomen (especially the liver). Gastrointestinal symptoms (bloating, loss of
appetite, nausea, vomiting, constipation, and abdominal pain) and ascites
may also occur. In addition, the amount of perfusion of the kidneys is low,
which can lead to decreased urine output and azotemia.
Diagnosis
Congestive heart failure can be diagnosed by combining clinical symptoms,
a physical examination, and simple tests (electrocardiogram, chest X-ray).
When heart failure occurs, the pulse rate increases (more than 100 beats
per minute) to compensate for the decrease in cardiac output. Auscultation
of the heart area produces a gallop sound, similar to that of a horse
running. The jugular venous pressure in the neck is elevated. On chest
percussion, the heart is enlarged. Edema can be observed in the legs.

5. Echocardiography is required to confirm heart failure and to develop a
treatment plan. An echocardiogram can confirm heart failure and, in many
cases, even find the cause.
The left ventricle is the most important part of the heart because it
circulates blood throughout the body. Therefore, cardiac function is
represented by the left ventricular ejection fraction. If the left ventricular
ejection fraction is greater than 55%, it is considered normal, and if it is
lower than this, it is considered abnormal. In general, if the left ventricular
ejection fraction falls below 40-45%, treatment is necessary even if there
are no symptoms of heart failure. If the left ventricular ejection fraction is
less than 35%, severe heart failure is diagnosed.
Man undergoing echocardiography

6. 1. Drug therapy
General principle
Drug therapy includes diuretics, angiotensin blockers
(angiotensin-converting enzyme blockers [ACE inhibitors], angiotensin
receptor blockers [ARB], and angiotensin-neprilysin inhibitors [ARNI],
beta-blockers, ivabradine, vasodilators, cardiac drugs) [Digitalis]), etc. can
be used. Drugs are selected in consideration of blood pressure, heart rate,

7. and renal function status. Combination therapy with diuretics including
angiotensin blockers and beta blockers should be considered.
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