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General Illness Information

Common Name:

Heart Failure, Dropsy

Medical Term:

Congestive Heart Failure
Description:

Inability of heart to pump sufficient blood to meet normal body requirements.

Results in accumulation of fluid in lungs (left heart failure) or fluid in liver and extremities (right heart failure).

This is the main complication of heart disease, and accounts for the majority of heart disease admissions to hospital.

Causes:

* Coronary artery disease.

* High blood pressure.

* Heart-valve disease.

* Irregular heart beat (atrial fibrillation, flutter).

* Congenital heart disease.

* Cardiomyopathy.

* Heart tumor (rare).

* Heart muscle infection.

* Severe obstructive lung disease.

* Overactive thyroid state.

* Severe anemia.

Prevention:

Treatment of underlying disorders when possible.

Signs & Symptoms

* Shortness of breath, especially with exertion or when lying flat in bed (orthopnea).

* Fatigue, weakness or faintness.

* Cough (usually with sputum).

* Swelling of the  legs and ankles (edema).

* Swelling of the abdomen with fluid (ascites)

* Rapid or irregular heartbeat.

* Low blood pressure.

* Distended neck veins.

* Enlarged liver.

Late stage congestive failure:
Cerebral dysfunction

Abdominal bloating (ascites)

Cyanosis

Hypotension

Pulsus alternans

Frothy and/or pink sputum

Cardiac cachexia

Cheyne-Stokes respirations

Risk Factors

Inappropriate reduction of intensity of therapy

Inappropriate sodium and/or fluid excess

Patient non-compliance

Intercurrent arrhythmia, e.g., atrial fibrillation

Intercurrent infection such as pneumonia

Administration of drugs which reduce the pumping action of the heart.

Inappropriate physical, emotional, or environmental stress

Thyrotoxicosis, pregnancy, or any condition associated with increased metabolic demand.

Diagnosis & Treatment

Diagnostic tests may include laboratory blood studies and urinalysis, echocardiography, heart-catheterization studies; angiography, X-ray of the heart, lungs and blood vessels; radioactive studies of heart muscle efficiency


General Measures:
When severe, admission to hospital is necessary.

Immediate treatment of the heart failure

Search for underlying correctable conditions

Eliminate contributing factors when possible

Supplemental oxygen

Antiembolism stockings

Fluid and sodium restriction. Education about this is imperative for long term control. Daily weights guide overall therapy.

Identify and control underlying correctable conditions 

Surgery may be advised for surgically correctable conditions.

Medications:
Diuretics, usually in combination with digitalis are used to initiate therapy. ACE inhibitors have become a mainstay of therapy. For acute pulmonary edema, IV morphine remains cornerstone of therapy.

Small dose Beta-Blockers, and IV Nitroglycerin is also used, with caution.

Activity:
During severe stage, bed rest with elevation of head of bed and anti-embolism stockings to help control leg edema

Gradual increase in activity with walking will help increase strength.

Diet:
Sodium (salt) restriction.

Weight reduction diet if appropriate

Low fat diet to retard coronary artery disease

Appropriate fluid restriction

 

Possible Complications :
Electrolyte disturbance

Atrial and ventricular arrhythmias

Mesenteric insufficiency

Protein enteropathy

Digitalis intoxication

Prognosis

Result of initial treatment is usually good, whatever the cause

Long-term prognosis variable. 

Mortality rates range from 10% with mild symptoms to 50% with advanced, progressive symptoms.