what is heart failure?
Heart failures means that
the heart pumping power is weaker than normal.
In heart failure bloods moves through the heart at a slower rate,
and the pressure in the heart increases
therefore, the heart become congested.
As the result, the heart cannot pump enough oxygen
to meet the body's demand.
We can divide the heart failure
into the left side heart failure,
which includes the 'Left Atrium' and the 'Left Ventricle'.
Or the right side of heart failure,
which includes the 'Right Atrium' and the 'Right Ventricle'.
Now heart failure can be either due to systolic dysfunction,
which is the inability of the heart
to contract and push out the blood
Or diastolic dysfunction,
which is the inability of the heart to relax.
So here is some of the risk factors for congestive heart failure;
CAD, in which the major blood vessels that supply the heart muscles
with blood and oxygen
become narrowed or diseased
leading to damage to the heart muscles.
Myocardial infarction or heart attack
which is the death of the heart muscles
due to an ischemic event.
Cigarette smoking,
Hypertension,
which leads to left ventricle hypertrophy
which makes it harder to oxygenate the heart muscles.
and can eventually lead to ischemic damage to the heart muscles.
Obesity and diabetes,
which can both lead to CAD.
Heart valve disease such as aortic stenosis
which can eventually lead to
left ventricle hypertrophy and ischemic changes
similar to hypertension.
Cardiomyopathy,
which is another name for heart muscle disease
for example;
dilated cardiomyopathy
in which heart's ability to pump blood is decreased
because the heart's main pumping chamber
the left ventricle is enlarged
and it's associated with alcohol and viral infection.
Hypertrophic cardiomyopathy,
which is associated with
thickening of the heart muscle
most commonly at the septum
between the right and the left ventricle.
Restrictive cardiomyopathy,
which is the condition in which
the walls of the heart are abnormally rigid
and lack flexibility
to expand as the ventricle fills with blood
and it's associated with,
amyloidosis and sarcoidosis and fibrosis.
Even though both the left and the right sided heart failure
pretty much have the same clinical features
The left sided heart failure
present with symptom associated with pulmonary edema
which is due to the failure of left ventricle
to sufficiently remove blood from the pulmonary circulation.
This leads to fluid accumulation in the lungs
and the clinical features such as dyspnea
or shortness of breath,
paroxysmal nocturnal dyspnea,
which is the sudden worsening of dyspnea at night during sleep
and orthopnea,
which is shortness of breath that occurs when lying flat
and improves when sitting up or standing.
And also,
Since the heart is not pumping out enough blood
there is going to be decreased forward perfusion.
This leads to activation of
Renin-Angiotensin-Aldosterone System
which causes fluid retention
and worsens the symptoms of congestive heart failure.
The most common cause of right sided heart failure
is actually the left sided heart failure.
and the common clinical features include;
dyspnea, since the right heat is unable to pump blood into the lungs
to get oxygenated.
Jugular venous distention,
since the jugular veins cannot empty their blood
into the congested right atrium.
pitting edema,
which is due to fluid overload
and increased hydrostatic pressure
ascites,
which is due to fluid accumulation
in the peritoneal cavity.
Nutmeg liver,
which is due to chronic passive congestion of the liver
and as you can see here
it resembles a cut nutmeg.
In order to diagnose congestive heart failure
we can use echocardiogram
which distinguishes systolic from diastolic dysfunction
by measuring the ejection fraction.
It can also determine if an acute myocardial ischemia
is causing heart failure
by showing abnormal wall motions
as well as identifying any valve diseases.
We can also measure
B-type Natriuretic Peptide or BNP
which are secreted by the ventricles of the heart
in response to excessive stretching of the heart muscle cells.
and it can be also be used to differentiate between
causes of dyspnea due to heart failure
from other causes of dyspnea.
We can also use chest x-rays
which can show us cardiomegaly
which is enlargement of the heart.
EKG can be also used
to identify any arrhythmias
ischemic heart diseases,
right and left ventricular hypertrophy
and conductive delay or abnormalities
such as left bundle branch block (LBBB).
In order to properly treat congestive heart failure
we must first focus on modifying patient's lifestyle
by encouraging the patient to lose weight,
stop smoking,
exercising,
limiting their alcohol intake
and having a healthier diet
which are all equally effective
in preventing diastolic and systolic heart failure.
The pharmacological management for
systolic dysfunction heart failure includes;
ACE inhibitors,
and/or Angiotensin Receptor Blockers
Beta-blockers,
spironolactone,
diuretics,
and if nothing else works we can give them digoxin.
Medical therapies for diastolic dysfunction heart failure
are not as well defined as therapies
for systolic heart failure.
Some of the medications that are used include;
Beta-blockers,
calcium channel blockers,
ACE inhibitors,
and diuretics.