Congestive Heart Failure: Types, Causes, Risk Risks, Symptoms, Diagnosis, Treatment, Outlook and Prevention

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Congestive Heart Failure

1Overview

Anatomy and Physiology of the Heart

The heart pumps blood throughout the body delivering oxygen to the organs to maintain optimum functionality. Located at the thoracic cavity midline and posterior to the sternum. The apex of the heart is slightly deviated towards he left the side.  The heart is like the size of the fist. It has 4 chambers mainly the right and left atrium and the right and left ventricles.

Chambers of the Heart

  • Right Atrium. This is the part of the heart that receives unoxygenated blood from the superior and inferior vena cava.
  • Left Atrium. The part of the heart that receives oxygenated blood from the lungs.
  • Right Ventricle. The area in the heart that pumps blood through the pulmonary artery and into the lungs.
  • Left Ventricle. The heart part that can Pump blood through the aorta and into the organs of the body.

The Heart Wall

The heart wall is consist of 3 layers:

  • Endocardium. The inner layer of the heart wall. Prevents blood from sticking into the wall.
  • A muscular layer called the cardiac muscle that is responsible for the pumping of blood.
  • Epicardium or the Pericardium. The outermost layer of the heart that protects the heart. Consist of a serous membrane that lubricates the heart and this layer has space that allows the heart to expand when it is full.

Valves

  • Semilunar valves. These consist of the pulmonary valve which prevents the back flow of blood to the right ventricle. The aortic valve prevents the blood to go back to the left ventricle.
  • Atrioventricular valves. Located between the right atrium and right ventricle, the tricuspid valve, has 3 cusps which prevent regurgitation of blood. The Bicuspid valve consists of 2 cusps located in between the left atrium and left ventricle.

Understanding The Circulatory System

The Right Atrium pumps deoxygenated blood from the superior and inferior vena cava which passes through the tricuspid valve to the right ventricle then goes to the pulmonary artery and enters the capillaries in the lungs to be oxygenated.

The oxygenated blood then goes back through the pulmonic veins and enters the left atrium down to the bicuspid valve and into the left ventricle, it passes through the aortic valve to the aorta and to the systemic circulation.

Problems may arise if parts of the heart are not functioning well, from conduction to the pumping of the heart. One disorder is particularly prevalent today, the Congestive Heart Failure (CHF) which is one of the disorders of the heart that affects greatly the population.

What Is Congestive Heart Failure?

The inability of the ventricles (Left ventricle) to pump blood into the systemic circulation resulting in inadequate blood supply to the vital organs. Not meeting the needs of the organs may cause fluid to leak from blood vessels, this may lead to other complications.

Classifications

Class I– Asymptomatic. Can do activities of daily living without any problems.

Class II- Fatigue may be felt when doing normal activities.

Class III- Confined to limited activities. Shortness of breath is present.

Class IV– cannot do normal activities without being tired even when at rest.

2Types

Right-sided heart failure

The blood stays in the right ventricle because of its inability pump effectively to the lungs. When this happens fluid retention will be noticeable in your legs and abdomen.

Left Sided heart failure

The force needed to pump the blood into the systemic system should be enough. But if there is any weakness in the pumping action fluid may go up in your lungs, causing symptoms like shortness of breath, crackles may be heard through auscultation.

  • Systolic heart failure

The left ventricle is not pumping enough, indicating problems as heard through a stethoscope.

  • Diastolic failure or diastolic dysfunction

The muscle in the left ventricle contracts and doesn’t go back to its original relaxed state. If this happens, space will not be enough for the blood, thus there will be an inadequate supply of blood delivered to the organs.

3Causes

Chronic Heart failures (CHF) can have many causes that can contribute to the condition.

Myocardial Infarction

Also known as heart attack. It occurs when the vessels in the heart are blocked, causing a sudden interruption of blood flow to the muscles of the heart. It may weaken the muscles because of low or no supply of oxygen and can have a permanent damage in the heart.

Coronary Artery Disease

Atherosclerotic plaque (fatty deposits) may develop on the sides of the blood vessels, causing a narrow passage for the blood to flow. Lifestyle and diet are the common cause for this disease.

Hypertension

It occurs when the pressure in your arteries increases caused by the narrowing of the vessels. Over time, the heart will compensate by pumping harder for the blood to be delivered adequately throughout the body making the muscles of the heart to thicken.

Myocarditis

Inflammation of the heart or heart muscles.

Cardiomyopathy

Substance abuse like the use of illegal drugs e.g. cocaine, alcohol abuse, diseases can damage the heart muscles. Cardiomyopathy can be inherited.

Congenital Heart Defects

A birth defect in the heart. If the heart valves don’t develop properly, the heart will compensate and pump harder to accommodate the insufficient supply of blood.

Other diseases

Diabetes, thyroid problems, HIV can also cause problems in the heart.

4Risk Factors

Having this risk factors may increase your chances to develop CHF:

Lifestyle

People who have a sedentary lifestyle can have a big impact on the body. Not getting enough exercise and eating foods rich in fat, carbohydrates can cause plaque build-up in the vessels. The use of Tobacco and also alcohol can also damage the heart.

Medical conditions

People who have Diabetes and Hypertension is at risk of developing heart failure if not managed properly.

Medications

Certain medications can affect the heart like prolonged use of Non- steroidal anti-inflammatory drugs (NSAIDs). Medications for high blood pressure, lung, and urological conditions. Do not self-medicate. Medicines should only be taken if they were prescribed by a licensed doctor.

Complications

Damage to organs can be the effect of having a Congestive Heart Failure. Kidney failure, liver damage will be one of the complications because of the inadequate supply of these major organs. Having Congestive Heart Failure may increase the chance of getting arrhythmias. Further damage to the heart valves may occur, extreme edema on the lower extremities will develop even in the abdominal cavity.

5Symptoms

Signs and symptoms may vary in individuals:

  • Fatigue and weakness when doing activities of daily living
  • Edema on the lower extremities
  • Crackles heard in the lungs upon auscultation
  • Weight gain
  • Nausea
  • Decrease in appetite
  • Shortness of breath

Immediate intervention is needed when these symptoms appear:

  • Chest pain
  • Sudden shortness of breath accompanied by pink, frothy sputum.
  • loss of consciousness

6Diagnosis

A thorough physical exam will be conducted by the doctor. Auscultation and Chest x-ray is done to determine if there is the presence of fluid in the lungs.

Electrocardiogram (ECG) – helps the doctor to see and determine the heart rhythms of the patient.

Magnetic resonance imaging (MRI) – creates images of the heart using radio waves.

Angiogram – The doctor will use a small tube or catheter and insert it into the heart. A dye will be introduced into the vessels to see if there are any blockages.

Stress test– the patient will be on a treadmill to see if the heart can compensate to increase activity.

7Treatment

Doctors can prescribe medications for CHF but always remember never to self-medicate and only take medicines as prescribed or recommended by a licensed doctor:

Beta blockers

Can reduce the signs and symptoms of CHF. It also aids in controlling the blood pressure of the patient.

Angiotensin converting enzyme (ACE) inhibitors

Dilates the blood vessels to lower blood pressure (Vasodilator).

Diuretics

Allows the patient to urinate thus lowering the blood pressure and also removing excess fluid in the lungs and lower extremities.

Digoxin

Strengthen the heart’s pumping action to promote better circulation in the body.

If medications are not working, the doctor may opt to have the patient undergo surgery like:

  • Heart valve replacement
  • Opens the vessels to increase the blood flow.
  • Heart transplants

Make sure the doctor explains the procedure and the risks of every procedure. Obtain consent before doing the surgery.

8Outlook

Congestive Heart Failure can be managed through different treatments. Some cases CHF will progress and the patient will need special treatment (Hospice care). It provides support to the patient may it be emotional, physical, spiritual. Advance directives will also be discussed even if it is difficult to the family.

9CHF and Genetics

Congestive Heart Failure is not technically passed down to generations but the predisposing factors the leads to CHF is hereditary like Hypertension, Diabetes, Valve abnormalities etc.

10Prevention

Lifestyle changes are a must to prevent Congestive Heart Failure (CHF). Having a proper diet, eat foods rich in vitamins and minerals, low in fats, low salt and low carbohydrates and exercising every week will help minimize the risk of having CHF.

Do not smoke, and drink alcohol moderately. If you have a family history of high blood pressure and diabetes, it is better to take precautions and have a regular check up with your doctor to keep a record of your health.