Dean Handimulya UIEU 2005 Congestive Heart Failure Dean Handimulya, M.D.

Dean Handimulya UIEU 2005

Congestive Heart Failure

Dean Handimulya, M.D


Summary

Heart failure (sometimes known as congestive heart failure [CHF]) is a serious condition in which the heart is not pumping efficiently. It is a chronic condition that is the result of other cardiac conditions.


In the late stages of heart failure, the heart is unable to meet the body’s demand for oxygen. In addition, it may cause congestion in the lungs or other problems throughout the body. As a result of the lack of oxygen–rich blood flowing to the body, the heart tries to work harder, which only makes the problem worse.


In the early stages, heart failure may not have any symptoms. In the later stages, the patient may have severe symptoms because their weakened heart is unable to pump enough oxygen–rich blood with each contraction to satisfy the body. These symptoms may include shortness of breath (dyspnea) that initially occurs only during exercise, and later even while at rest.


Heart failure is a chronic and complex condition. By itself, heart failure is not considered a disease. Rather, it is the result of other conditions that damaged the heart. These other conditions include diseases of the coronary arteries that lay on the surface of the heart, heart valve disorders, high blood pressure and damage to the heart muscle itself.


Condition That Could Lead to Heart Failure

Coronary artery disease (CAD) Arrhythmia Heart attack (myocardial infarction) High blood pressure (hypertension)


Condition That Could Lead to Heart Failure

Cardiomyopathy Valvular heart disease Congenital heart disease Pulmonary hypertension


Types and Differences of Heart Failure

Heart failure may be classified by which side of the heart it affects :

Left–sided heart failure Right–sided heart failure


Heart failure is also commonly defined by which portion of the cardiac cycle is affected:

Systolic heart failure Diastolic heart failure


In addition to these classifications, heart failure may be defined by how it affects patients. The new York heart association has developed a system that defines heart failure by the functional limitation it imposes on the patient. These levels are as follows (with approximate percentage of patients)


New York Heart Association

Class I: no obvious symptoms, no limitations on patient physical activity (35 percent of heart failure patients).

. Class II: some symptoms during or after normal

activity, mild physical activity limitations (35 percent of heart failure patients).

.


Class III: symptoms with mild exertion, moderate to significant physical activity limitations (25 percent of heart failure patients).

. Class IV: significant symptoms at rest, severe to

total physical activity limitations (5 percent of heart failure patients).


The AHA/ACC Stages

Stage A: the patient at high risk for heart failure, but has no heart abnormalities.

. Stage B: the patient has structural

abnormalities of the heart, particularly the left ventricle, but no symptoms.

.


The AHA/ACC Stages

Stage C: the patient has past or present symptoms associated with heart failure.

. Stage D: the patient has end–stage heart

disease, requiring specialized treatment (e.G., Continuous intravenous (IV) drug therapy, left ventricular assist device, heart transplant) or severely symptomatic heart failure.


Signs and Symptoms of Heart Failure

Shortness of breath (dyspnea). Swelling (edema) of the legs. Swollen neck veins. Abdominal discomfort such as swelling,

pain or nausea.


Signs and Symptoms of Heart Failure

Mental confusion. Racing or pounding heartbeat (

palpitations)..

Kidney malfunction or failure (in the later stages of heart failure).


Physical Examination

Heart murmur A crackling sound of fluid in the lungs

(rales), A rapid heartbeat (tachycardia) or

abnormal heart rhythm (arrhythmias).


Physical Examination

Swelling and fluid retention (edema) in the liver or gastrointestinal tract (in advanced stages of heart failure).

Hypertrophy or enlargement of the heart.

Liver malfunction.


Diagnosis Methods for Heart Failure

Medical history Physical examination Blood tests Echocardiogram Electrocardiogram (EKG) Exercise test stress. Radionuclide imaging tests Chest x-ray

Dean Handimulya UIEU 2005 Congestive Heart Failure Dean Handimulya, M.D.

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