Heart Failure/Congestive Heart Failure (CHF)
Common serious clinical syndrome due to an imbalance in the pump function of the heart failing to maintain the circulation of the blood adequately fluid retention. Characterised by inadequate tissue perfusion and volume overload syndrome of dyspnoea, fatigue and oedema. Common final state for many cardiovascular disorders.
Usually a complication of other diseases – hypertension; ischaemic heart disease; valvular heart disease; arrhythmias; cardiomyopathy; congenital defects; pulmonary hypertension; connective tissue diseases; endocrine and metabolic disorders.
Oedema – due to reduced renal blood flow increase in circulating angiotensin II retention of Na and water oedema in lungs and lower limb
1) High output failure (output is normal or increased when needs are increased – failure occurs when cardiac output fails to meet the need; due to anaemia, hyperthyroidism, Paget’s disease, arteriovenous malformation)
2) Low output failure (output of heart is not adequate to meet needs; due to excessive preload (eg mitral regurgitation, fluid overload), failure of heart pump (eg ischaemic heart disease, cardiomyopathy, constrictive pericarditis, beta-blockers, hypertension)
3) Left or right ventricular failure (if left to pulmonary oedema; if right peripheral oedema)
Initially only apparent during exercise later classical symptoms of oedema, breathlessness and lethargy occur during everyday activity.
Acute symptoms – tachycardia; dyspnoea; poor tolerance of exercise
Chronic symptoms – cardiac arrhythmia’s; hypertension and oedema
Lower limb implications:
• oedema irritation and shoe fitting problems; higher risk of skin breakdown
• stasis dermatitis and ulcers
New York Heart Association Functional Classification :
• Class 1 – no limitations; ordinary physical activity does not cause undue fatigue, dyspnoea or palpitations
• Class 2 – slight limitation of physical activity; such patients are comfortable at rest; ordinary physical activity results in fatigue, palpitations, dyspnoea or angina
• Class 3 – marked limitation of physical activity; although patients are comfortable at rest, less than ordinary activity will lead to symptoms
• Class 4 – inability to carry on physical activity without discomfort; symptoms of congestive heart failure are present even at rest; with any physical activity, increased discomfort is experienced
Initial assessment – ECG to evaluate left ventricular function
• restricted salt intake; avoidance of excessive fluids; weight reduction if obese; limit alcohol intake
• exercise training (walking or cycling)
ACE inhibitors (dilate arteries and veins reduces cardiac afterload increase in stroke volume and cardiac output); diuretics if blood volume high (reduce blood volume decrease venous pressure, afterload, peripheral oedema); beta blockers; cardiac glycoside