Heart Failure

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 appropriat;
  • Low fat diet to retard coronary artery diseas;
  • 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.

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