Congestive Heart Failure

Congestive heart disease is a clinical condition which results from deficient cardiac stroke volume, relative to body need, with the inability of the cardiac output to keep pace with the venous return i-e, the heart is unable to pump all the blood coming to it. Heart failure does not mean the heart has stopped working. Rather, it means that the heart's pumping power is weaker than normal. About 670,000 people are diagnosed with heart failure each year. It is the leading cause of hospitalization in people older than age 65.

Etiology

Left Ventricular Failure

Volume overload

• Aortic regurgitation
• Mitral regurgitation
• Patent ductus arteriosus

Pressure overload

• Systemic hypertension
• Aortic stenosis

Myocardial diseases

• Ischemic heart disease
• Dilated cardiomyopathy
• Cardiomyopathy coronary artery disease

Right Ventricular Failure

Volume overload

• Atrial septal defect
• Tricuspid regurgitation

Pressure overload

• Pulmonary hypertension
• Pulmonary stenosis

Myocardial disease

• Cardiomyopathy (dysfunction of left and right ventricles)

Causes of Heart Failure

•  Coronary heart disease. A disease of the arteries that supply blood and oxygen to the heart, causes decreased blood flow to the heart muscle. If the arteries emerge as blocked or critically narrowed, the heart turns into starved for oxygen and vitamins.
• Cardiomyopathy. Damage to the heart muscle from causes other than artery or blood flow problem, such as from infections or alcohol or drug abuse.
• Decreased cardiac output ( Forward failure ). Decreased cardiac output due to decreased heart function results in diminished filling of the arterial tree. Therefore blood supply of the organs is reduced which may lead to ischemia.
• Damming of blood ( backward failure ). Heart fails to pump the whole blood coming to it resulting in blood damming back into the venous system. Accumulation of deoxygenated blood in the tissue venous system may produce disturbed organ function.
• Other conditions. Conditions including high blood pressure, valve disease, thyroid ailment, kidney ailment, diabetes, or coronary heart defects present at birth can all reason coronary heart failure. In addition, heart failure can occur when several disease or conditions are present at once.

Signs and Symptoms of Heart Failure

The symptoms can include:

• Congested lungs. Fluids amassed in the lungs can purpose shortness of breath with a workout or difficulty breathing at rest or whilst mendacity flat in bed. Lung congestion can also purpose a dry, hacking cough or wheeze.
• Dyspnea. A sense of breathlessness, initially on exertion than on rest also. The dyspnea is maximal when congestion of lung is greatest as in exercise.
• Orthopnea. Dyspnea on lying flat is called orthopnea. It results from increased amount of venous return to thorax from lower extremities when the patient is in lying position. 
• Paroxysmal nocturnal dyspnea. Dyspnea during sleep which awakens the patient with severe breathlessness, accompanied by a choking sensation and coughing is called paroxysmal nocturnal dyspnea.  

Signs

• Tachycardia. cardiomegaly, third heart sound, and fine crepts at the lung bases. 
• Chronic dilation of the left atrium may also occur which may be associated with atrial fibrillation.   

Types of Heart Failure

The coronary heart failure may be categorized in several approaches.

1. Chronic heart failure versus Acute heart failure 
2.  Biventricular failure, left as opposed to right ventricular failure
3. Forward as opposed to backward failure
4. Systolic as opposed to diastolic failure
5. Low output versus excessive output failure  

Investigations

ECG
ECG may show:

• Right or left ventricular hypertrophy
• Myocardial ischemia or infarction
• Arrhythmia

Echocardiography
Echocardiography is a very important tool for the diagnosis and cause of heart failure, it may demonstrate:

• Systolic or diastolic ailment of left or right ventricle
• Valve disease
• Local wall motion abnormalities in ischemic heart disease
• Cardiomyopathy
• Ejection fraction
• Intracardiac thrombus 

X-Ray Chest

It may show:

• Hilar congestion
• Cardiomegaly
• Evidence of pulmonary hypertension
• Pleural effusion