>Congestive Heart Failure(CCF)

Congestive Heart Failure

Congestive heart failure is one of the most common conditions affecting the heart, thus, cementing its place in one of the top slots of cardiovascular diseases list. It is the failure of the heart to meet the body demands of adequate circulation for its metabolizing tissues. The different types of congestive heart failure are acute or chronic heart failure, high output or low output heart failure and left sided or right sided biventricular failure. There can also be compensated or decompensated heart failure.

Causes:

• Myocardial causes, where there is myocardial dysfunction leading to reduced contractile force of the heart. The causes of this include viral infections like viral pneumonia, rheumatic fever, beri-beri, coronary heart disease, hypertension, diphtheria, amyloidosis, and degenerative diseases involving the heart.
• Mechanical lesions of the heart where there is a volume overload, as seen in valvular heart disease (aortic and mitral disease), syphilitic heart disease, as seen in the third stage of syphilis.
• Diseases interfering with diastolic filling of the heart, like constrictive pericarditis, pericardial effusion restrictive cardiomyopathy.
• Rhythm disturbances, especially in a compromised heart, since they reduce the end diastolic volume due to reduction in diastolic interval. These include atrial tachycardias, atrial flutter, atrial fibrillation and heart block.
• Conditions where there is an increased pressure on the heart to pump out more blood, like high fever, pregnancy or thyrotoxicosis.

Signs of Congestive Heart Failure:

One of the earliest signs of congestive heart failure is fatigue, accompanied by the affected person’s diminished capacity to exercise. In fact, most people don’t even realize this reduction, with them usually compensating subconsciously by reducing their activities in order to adapt to this limitation.

With the body becoming congested with fluid, and the lungs becoming affected, resulting in shortness of breath, which impairs the ability to exercise and also when lying down flat. Sometimes, the affected person may wake up at night gasping for breath. Some even have to sleep sitting in an upright position. The excessive fluid in the body also results in an increase in urination, especially at night. When the fluids accumulate in the intestines and liver, it may result in a decrease in the appetite, pain in the abdomen, and nausea.

Symptoms:

Left Heart Failure Symptoms

• Progressive breathlessness, that is more marked on exertion.
• Paroxysmal nocturnal dyspnea attacks.
• Weakness, fatigue, palpitation and pain in the chest.
• Acute left heart failure is characterized by basal crepitations, tachycardia, cold extremities, facial pallor, hypertension and a galloping rhythm.

Right Heart Failure Symptoms

• Generalized fatigue and weakness including cough, breathlessness, anorexia, abdominal distension, pain and dragging sensation in the right hypochondrium.
• Headache, restlessness, insomnia, weight gain, swelling of legs and feet, oliguria and nocturia.
• Physical signs include cyanosis, warm extremities, engorged neck veins, elevated jugular venous pressure, enlarged liver and edema over legs and feet.
• The size of the heart is generally within normal limits. Pulmonary diastolic murmur is seen due to pulmonary hypertension. Signs of pleural effusion maybe present.

Treatment:

• Take adequate rest but maintain a certain minimum level of physical activity.
• A nutritious diet that is well balanced and is low in calories and salt is very important. Frequent but small meals should be consumed. Evening meals should be light and adequate time interval should be maintained between the evening meals and the time of sleep.
• Often after being diagnosed with congestive heart failure, the patient is confined to bed and the diet is either light and semi-solid or liquid. So a daily movement of bowels is desirable. Straining at stools must be avoided.
• In most cases there is need to take to drug therapy. They are mostly inotropic drugs that have a direct effect on the myocardium, by increasing the systolic contraction of the heart and thus increasing the cardiac output. Other drugs that are also used include diuretics and vasodilators.