CONGESTIVE HEART FAILURE

DEFINATION

Congestive heart failure (CHF) is a chronic progressive condition that affects the pumping power of your heart muscles. While often referred to simply as “heart failure,” CHF specifically refers to the stage in which fluid builds up around the heart and causes it to pump inefficiently.
Heart failure does not mean the heart has stopped working. Rather, it means that the heart's pumping power is weaker than normal. With heart failure, blood moves through the heart and body at a slower rate, and pressure in the heart increases. As a result, the heart cannot pump enough oxygen and nutrients to meet the body's needs. The chambers of the heart may respond by stretching to hold more blood to pump through the body or by becoming stiff and thickened. This helps to keep the blood moving, but the heart muscle walls may eventually weaken and become unable to pump as efficiently. As a result, the kidneys may respond by causing the body to retain fluid (water) and salt. If fluid builds up in the arms, legs, ankles, feet, lungs, or other organs, the body becomes congested, and congestive heart failure is the term used to describe the condition.
ANATOMY
You have four heart chambers. The upper half of your heart has two atria, and the lower half of your heart has two ventricles. The ventricles pump blood to your body’s organs and tissues, and the atria receive blood from your body as it circulates back from the rest of your body.
CHF develops when your ventricles can’t pump enough blood volume to the body. Eventually, blood and other fluids can back up inside your:
Lungs
Abdomen
Liver
Lower body
CHF can be life-threatening. If you suspect you or someone near you has CHF, seek immediate medical treatment.
TYPES OF CHF
Results of these tests help doctors determine the cause of your signs and symptoms and develop a program to treat your heart. To determine the most appropriate treatment for your condition, doctors may classify heart failure using two systems:
New York Heart Association classification. This symptom-based scale classifies heart failure in four categories. In Class I heart failure, you don't have any symptoms. In Class II heart failure, you can perform everyday activities without difficulty but become winded or fatigued when you exert yourself. With Class III, you'll have trouble completing everyday activities, and Class IV is the most severe, and you're short of breath even at rest.
American College of Cardiology/American Heart Association guidelines. This stage-based classification system uses letters A to D. The system includes a category for people who are at risk of developing heart failure.
For example, a person who has several risk factors for heart failure but no signs or symptoms of heart failure is Stage A. A person who has heart disease but no signs or symptoms of heart failure is Stage B. Someone who has heart disease and is experiencing or has experienced signs or symptoms of heart failure is Stage C. A person with advanced heart failure requiring specialized treatments is Stage D.
Doctors use this classification system to identify your risk factors and begin early, more aggressive treatment to help prevent or delay heart failure.
These scoring systems are not independent of each other.



CAUSES OF CHF

                                                                RISK FACTORS
      CHF may result from other health conditions that directly affect your cardiovascular system. This is why it’s important to get annual checkups to lower your risk for heart health problems, including high blood pressure (hypertension), coronary artery disease, and valve conditions

• HYPERTENSION
  When your blood pressure is higher than normal, it may lead to CHF. Hypertension has many different causes. Among them is the narrowing of your arteries, which makes it harder for your blood to flow through them.
• CORONARY ARTERY DISEASE
  Cholesterol and other types of fatty substances can block the coronary arteries, which are the small arteries that supply blood to the heart. This causes the arteries to become narrow. Narrower coronary arteries restrict your blood flow and can lead to damage in your arteries.
• VALVE CONDITIONS
  Heart valves regulate blood flow through your heart by opening and closing to let blood in and out of the chambers. Valves that don’t open and close correctly may force your ventricles to work harder to pump blood. This can be a result of a heart infection or defect.

• OTHER CONDITIONS
  While heart-related diseases can lead to CHF, there are other seemingly unrelated conditions that may increase your risk, too. These include diabetes, thyroid disease, and obesity. Severe infections and allergic reactions may also contribute to CHF.

SYMPTOMS OF CHF   

                                                        symptoms of CHD

                                       
In the early stages of CHF, you most likely won’t notice any changes in your health. If your condition progresses, you’ll experience gradual changes in your body.

• Symptoms you may notice first Symptoms that indicate your condition has worsened
• Symptoms that indicate a severe heart condition
• fatigue
• irregular heartbeat
• chest pain that radiates through the upper body
• swelling in your ankles, feet, and legs
• a cough that develops from congested lungs
• rapid breathing
• weight gain
• wheezing skin that appears blue, which is due to lack of oxygen in your lungs
• increased need to urinate, especially at night
• shortness of breath, which may indicate pulmonary edema
• fainting
• Chest pain that radiates through the upper body can also be a sign of a heart attack. If you experience this or any other symptoms that may point to a severe heart condition, seek immediate medical attention.

SYMPTOMS OF HEART FAILURE IN CHILDREEN 
It can be difficult to recognize heart failure in infants and young children. Symptoms may include:

• Poor feeding
• Excessive sweating
• Difficulty breathing
• These symptoms can easily be misunderstood as colic or a respiratory infection. Poor growth and low blood pressure can also be signs of heart failure in children. In some cases, you may be able to feel a resting baby’s rapid heart rate through the chest wall.

DIAGNOSIS OF CHD

After reporting symptoms to doctor, they may refer you to a heart specialist, or cardiologist.
Cardiologist will perform a physical exam, which will involve listening to your heart with a stethoscope to detect abnormal heart rhythms. To confirm an initial diagnosis, cardiologist might order certain diagnostic tests to examine your heart’s valves, blood vessels, and chambers.
There are a variety of tests used to diagnose heart conditions. Because these tests measure different things, doctor may recommend a few to get a full picture of your current condition.

• ELECTROCARDIOGRAM
  An electrocardiogram (EKG or ECG) records heart’s rhythm. Abnormalities in your heart’s rhythm, such as a rapid heartbeat or irregular rhythm, could suggest that the walls of your heart’s chamber are thicker than normal. That could be a warning sign for a heart attack.
• ECHOCARDIOGRAM
  An echocardiogram uses sound waves to record the heart’s structure and motion. The test can determine if you already have poor blood flow, muscle damage, or a heart muscle that doesn’t contract normally.
• MRI
  An MRI takes pictures of your heart. With both still and moving pictures, this allows doctor to see if there’s damage to you heart.
• STRESS TEST
  Stress tests show how well your heart performs under different levels of stress. Making your heart work harder makes it easier for doctor to diagnose problems.
• BLOOD TEST
  Blood tests can check for abnormal blood cells and infections. They can also check the level of BNP, a hormone that rises with heart failure.
• CARDIAC CATHETERISATION
  Cardiac catheterization can show blockages of the coronary arteries. Doctor will insert a small tube into blood vessel and thread it from your upper thigh (groin area), arm, or wrist.
•  
• CORONARY ANGIOGRAM. In this test, a thin, flexible tube (catheter) is inserted into a blood vessel at your groin or in your arm and guided through the aorta into your coronary arteries. A dye injected through the catheter makes the arteries supplying your heart visible on an X-ray, helping doctors spot blockages.

Myocardial biopsy. In this test, your doctor inserts a small, flexible biopsy cord into a vein in your neck or groin, and small pieces of the heart muscle are taken. This test may be performed to diagnose certain types of heart muscle diseases that cause heart failure.
MEDICATIONS
Doctors usually treat heart failure with a combination of medications. Depending on your symptoms, you might take one or more medications, including:
ANGIOTENSIN CONVERTING ENZYME (ACE) INHIBITOR- These drugs help people with systolic heart failure live longer and feel better. ACE inhibitors are a type of vasodilator, a drug that widens blood vessels to lower blood pressure, improve blood flow and decrease the workload on the heart. Examples include enalapril (Vasotec), lisinopril (Zestril) and captopril (Capoten).
ANGIOTENSIN 2 RECEPTOR BLOCKER -These drugs, which include losartan (Cozaar) and valsartan (Diovan), have many of the same benefits as ACE inhibitors. They may be an alternative for people who can't tolerate ACE inhibitors.
BETA BLOCKERS- This class of drugs not only slows your heart rate and reduces blood pressure but also limits or reverses some of the damage to your heart if you have systolic heart failure. Examples include carvedilol (Coreg), metoprolol (Lopressor) and bisoprolol (Zebeta).
These medicines reduce the risk of some abnormal heart rhythms and lessen your chance of dying unexpectedly. Beta blockers may reduce signs and symptoms of heart failure, improve heart function, and help you live longer.

DIURETICS- Often called water pills, diuretics make you urinate more frequently and keep fluid from collecting in your body. Diuretics, such as furosemide (Lasix), also decrease fluid in your lungs so you can breathe more easily.
Because diuretics make your body lose potassium and magnesium, Doctor may also prescribe supplements of these minerals. If you're taking a diuretic, Doctor will likely monitor levels of potassium and magnesium in your blood through regular blood tests.

ALDOSTERON ANTAGONIST- These drugs include spironolactone (Aldactone) and eplerenone (Inspra). These are potassium-sparing diuretics, which also have additional properties that may help people with severe systolic heart failure live longer.
Unlike some other diuretics, spironolactone and eplerenone can raise the level of potassium in your blood to dangerous levels, so talk to your doctor if increased potassium is a concern, and learn if you need to modify your intake of food that's high in potassium.

INOTROPES- These are intravenous medications used in people with severe heart failure in the hospital to improve heart pumping function and maintain blood pressure.

DIGOXIN (Lanoxin) - This drug, also referred to as digitalis, increases the strength of your heart muscle contractions. It also tends to slow the heartbeat. Digoxin reduces heart failure symptoms in systolic heart failure. It may be more likely to be given to someone with a heart rhythm problem, such as atrial fibrillation.
You may need to take two or more medications to treat heart failure. Your doctor may prescribe other heart medications as well — such as nitrates for chest pain, a statin to lower cholesterol or blood-thinning medications to help prevent blood clots — along with heart failure medications. Your doctor may need to adjust your doses frequently, especially when you've just started a new medication or when your condition is worsening.
You may be hospitalized if you have a flare-up of heart failure symptoms. While in the hospital, you may receive additional medications to help your heart pump better and relieve your symptoms. You may also receive supplemental oxygen through a mask or small tubes placed in your nose. If you have severe heart failure, you may need to use supplemental oxygen long term.

SURGERY AND MEDICAL DEVICE
In some cases, doctors recommend surgery to treat the underlying problem that led to heart failure. Some treatments being studied and used in certain people include:
CORONARY BYPASS SURGERY- If severely blocked arteries are contributing to your heart failure, doctor may recommend coronary artery bypass surgery. In this procedure, blood vessels from your leg, arm or chest bypass a blocked artery in your heart to allow blood to flow through your heart more freely.
HEART VALVE REPAIR OR REPLACEMENT. If a faulty heart valve causes your heart failure, your doctor may recommend repairing or replacing the valve. The surgeon can modify the original valve to eliminate backward blood flow. Surgeons can also repair the valve by reconnecting valve leaflets or by removing excess valve tissue so that the leaflets can close tightly. Sometimes repairing the valve includes tightening or replacing the ring around the valve (annuloplasty).
Valve replacement is done when valve repair isn't possible. In valve replacement surgery, the damaged valve is replaced by an artificial (prosthetic) valve.
Certain types of heart valve repair or replacement can now be done without open heart surgery, using either minimally invasive surgery or cardiac catheterization techniques.
IMPLANTABLE CARDIOVERTER DEFIBRILLATOR (ICD)

                                                                           ICD

An ICD is a device similar to a pacemaker. It's implanted under the skin in your chest with wires leading through your veins and into your heart.
The ICD monitors the heart rhythm. If the heart starts beating at a dangerous rhythm, or if your heart stops, the ICD tries to pace your heart or shock it back into normal rhythm. An ICD can also function as a pacemaker and speed your heart up if it is going too slow.
SYNCHRONISATION
CARDIAC RESYNCRHRONISATION THERAPY(CRT)- or biventricular pacing. A biventricular pacemaker sends timed electrical impulses to both of the heart's lower chambers (the left and right ventricles) so that they pump in a more efficient, coordinated manner.
Many people with heart failure have problems with their heart's electrical system that cause their already-weak heart muscle to beat in an uncoordinated fashion. This inefficient muscle contraction may cause heart failure to worsen. Often a biventricular pacemaker is combined with an ICD for people with heart failure.
VENTRICULAR ASSIST DEVICE (VADs)- A VAD, also known as a mechanical circulatory support device, is an implantable mechanical pump that helps pump blood from the lower chambers of your heart (the ventricles) to the rest of your body. A VAD is implanted into the abdomen or chest and attached to a weakened heart to help it pump blood to the rest of your body.
Doctors first used heart pumps to help keep heart transplant candidates alive while they waited for a donor heart. VADs may also be used as an alternative to transplantation. Implanted heart pumps can enhance the quality of life of some people with severe heart failure who aren't eligible for or able to undergo heart transplantation or are waiting for a new heart.
HEART TRANSPLANT. Some people have such severe heart failure that surgery or medications don't help. They may need to have their diseased heart replaced with a healthy donor heart.
Heart transplants can improve the survival and quality of life of some people with severe heart failure. However, candidates for transplantation often have to wait a long time before a suitable donor heart is found. Some transplant candidates improve during this waiting period through drug treatment or device therapy and can be removed from the transplant waiting list.A heart transplant isn't the right treatment for everyone.
PALLIATIVE CARE AND END OF-LIFE CARE
Doctor may recommend including palliative care in your treatment plan. Palliative care is specialized medical care that focuses on easing your symptoms and improving your quality of life. Anyone who has a serious or life-threatening illness can benefit from palliative care, either to treat symptoms of the disease, such as pain or shortness of breath, or to ease the side effects of treatment, such as fatigue or nausea.
It's possible that your heart failure may worsen to the point where medications are no longer working and a heart transplant or device isn't an option. If this occurs, you may need to enter hospice care. Hospice care provides a special course of treatment to terminally ill people.
HOSPICE CARE ows family and friends — with the aid of nurses, social workers and trained volunteers — to care for and comfort a loved one at home or in hospice residences. Hospice care provides emotional, psychological, social and spiritual support for people who are ill and those closest to them.
Although most people under hospice care remain in their own homes, the program is available anywhere — including nursing homes and assisted living centers. For people who stay in a hospital, specialists in end-of-life care can provide comfort, compassionate care and dignity.
If you have an implantable cardioverter-defibrillator (ICD), one important consideration to discuss with your family and doctors is turning off the defibrillator so that it can't deliver shocks to make your heart continue beating.
LIFE STYLE AND HOME REMEDIES
Making lifestyle changes can often help relieve signs and symptoms of heart failure and prevent the disease from worsening. These changes may be among the most important and beneficial you can make. Lifestyle changes your doctor may recommend include:
Stop smoking. Smoking damages your blood vessels, raises blood pressure, reduces the amount of oxygen in your blood and makes your heart beat faster.If you smoke, ask your doctor to recommend a program to help you quit. You can't be considered for a heart transplant if you continue to smoke. Avoid secondhand smoke, too.
Discuss weight monitoring with your doctor. Discuss with doctor how often you should weigh yourself. Ask doctor how much weight gain you should notify him or her about. Weight gain may mean that you're retaining fluids and need a change in your treatment plan.
Check your legs, ankles and feet for swelling daily. Check for any changes in swelling in your legs, ankles or feet daily. Check with your doctor if the swelling worsens.
Eat a healthy diet. Aim to eat a diet that includes fruits and vegetables, whole grains, fat-free or low-fat dairy products, and lean proteins.
Restrict sodium in diet. Too much sodium contributes to water retention, which makes your heart work harder and causes shortness of breath and swollen legs, ankles and feet.
Check with doctor for the sodium restriction recommended for you. Keep in mind that salt is already added to prepared foods, and be careful when using salt substitutes.
Maintain a healthy weight. If you're overweight, your dietitian will help you work toward your ideal weight. Even losing a small amount of weight can help.
Consider getting vaccinations. If you have heart failure, you may want to get influenza and pneumonia vaccinations.
Limit saturated or 'trans' fats in your diet. In addition to avoiding high-sodium foods, limit the amount of saturated fat and trans fat — also called trans-fatty acids — in your diet. These potentially harmful dietary fats increase your risk of heart disease.
Limit alcohol and fluids. Doctor may recommend that you don't drink alcohol if you have heart failure, since it can interact with your medication, weaken your heart muscle and increase your risk of abnormal heart rhythms.
If you have severe heart failure, doctor may also suggest you limit the amount of fluids you drink.
Reduce stress. When you're anxious or upset, your heart beats faster, you breathe more heavily and your blood pressure often goes up. This can make heart failure worse, since your heart is already having trouble meeting the body's demands.
Find ways to reduce stress in your life. To give your heart a rest, try napping or putting your feet up when possible. Spend time with friends and family to be social and help keep stress at bay.
Sleep easy. If you're having shortness of breath, especially at night, sleep with your head propped up using a pillow or a wedge. If you snore or have had other sleep problems, make sure you get tested for sleep apnea.