CONGESTIVE HEART FAILURE (CHF)
CONGESTIVE HEART FAILURE (CHF):
It is the inability of heart to cop with the blood supply requirement of the body due to its inability to pump with enough force which is necessary for fulfillment of body’s metabolic demands.
The rough estimate is of 3 million people around the world who are suffering from this disease.
It is also called systolic heart failure.
STAGES OF CHF:
There are four stages in which CHF is classified. Each one has symptoms such as:
In this stage patient doesn’t feel abnormal tiredness, palpitation or shortness of breath upon normal physical activities.
Patient at rest doesn’t feel a thing. But upon physical activity patient suffers from shortness of breath, palpitation and fatigue.
These patients are also symptom free when at rest but even little activity they suffer from shortness of breath and fatigue, palpitation.
Patient suffers from fatigue, palpitation and shortness of breath even at rest.
WHAT CAUSES CHF:
- Cigarette smoking
- Renal failure
- History of heart diseases like myocardial infarction, valvular heart disease etc.
- History of hypertension
- History of diabetes
SIGNS & SYMPTOMS:
- Respiratory distress
- Rales/Crakles on auscultation
- Shortness of breath
- Paroxymal Nocturnal Dyspnea
- Pink frothy sputum
PATHOPHYSIOLOGY OF CHF (Internal conditions of your body):
Reduced heart contractility
Preload or left ventricular end diastolic volume (LVEDV) increases
LVEDV causes dilation of ventricle and further increase in LDEDV
ASSESMENT OF CHF:
- Heart sounds are assessed
- Daily weights are monitored
- Pink frothy sputum is checked
- Lung sounds are also assessed like rales/crackle and wheezes
Echocardiogram (ejection fraction less than 50%)
Chest X-ray (Fluid around lungs, enlargement of heart)
Blood test (BNP: B-Naturetic Peptide greater than 100pg/ml)
First of all pain management is necessary to make patient comfortable, reduce anxiety and decrease cardiac oxygen demand.
Then airway support is attended to. Supplemental oxygen, intubation and bipap are given.
Intra-aortic balloon pump will increase cardiac output by approximately 15-20%
It is used in refractory CHF
PTCA is used when cause is ST elevation myocardial infarction or non STEMI
Diuretic treatment for edema is given i.e. Lasix
Vasodilators to “open up the tank” are given e.g. Nitroglycerin
Vasopressors are given to increase LV function e.g. Dobutamin
Milrinone is given to increase heart contractility and decrease pulmonary vascular resistance.
TREATMENT OF CHRONIC CHF:
Cardiac glycosides like digoxin are given
Diuretics like Lasix and spironolactone are given
Beta blockers like Lopressor and atenolol are given
Coronary artery bypass grafting (CABG) is done if required
Valve repair is done
Heart transplant is done
LIFE STYLE CHANGES:
Some life style changes are required to get the life of the patient on the right track.
Walk, diet, smoking cessation, weight reduction, controlling blood pressure, diabetes and cholesterol is most important.