Congestive heart failure is a condition in which the heart's function as a pump to deliver oxygen rich blood to the body is inadequate to meet the body's demand. Congestive heart failure can be caused by weakness or stiffening of heart muscles

 

Classification

• Right sided or left sided heart failure
• Systolic or diastolic dysfunction
• Low out failure or high output failure

Functional classification- New York Heart Association Functional Classification

• Class I- No limitation is experienced in any activities; there are no symptoms from ordinary activities.
• Class II- Slight, mild limitation of activity; the patient is comfortable at rest or with mild exertion.
• Class III- Marked limitation of any activity; the patient is comfortable only at rest.

• Class IV- Any physical activity brings on discomfort and symptoms occur at rest.

Clinical signs and symptoms

Left sided heart failure

• Shortness of breath (dyspnea on exertion), and even dyspnea at rest in severe cases.
• Increasing breathlessness on lying flat- Orthopnea
• A sudden nighttime attack of severe breathlessness, usually several hours after going to sleep- paroxysmal nocturnal dyspnea or cardiac asthma
• Easy fatigability
• Exercise intolerance

Right sided heart failure

• Pedal edema or anasarca
• Frequent nighttime urination
• Fluid accumulation in the abdominal cavity causing swelling

• Enlargement of liver

Causes

• Ischaemic Heart Disease
• Cigarette Smoking
• Hypertension (high blood pressure)
• Obesity
• Diabetes

• Valvular Heart Disease

Rare causes of heart failure

• Viral Myocarditis
• Infiltrations of the muscle such as amyloidosis
• HIV cardiomyopathy
• Connective Tissue Diseases such as SLE
• Abuse of drugs such as alcohol
• Pharmaceutical drugs such as chemotherapeutic agents

• Arrhythmias

Tests and diagnosis

• Echocardiography
• Chest X-ray
• Serum electrolytes
• Renal function test
• Liver function test
• BNP

• Angiogram

Treatment

Acute decompensated heart failure

• Ensure airway, breathing and circulation is adequate.
• Vasodilators- Nitroglycerine, Diuretics
• Ionotrophic agents- Dopamine and Dobutamine

• Non invasive positive pressure ventilation- NIPPV

Chronic management

• Loop diuretics

• Beta blockers

• ACE inhibitors and angiotensin converting enzyme