Congestive Heart Failure

Heart failure symptoms are traditionally and somewhat arbitrarily divided into "left" and "right" sided, recognising that the left and right ventricles of the heart supply different portions of the circulation. Heart failure is not exclusively backward failure (in the part of the circulation which drains to the ventricle). There are several other exceptions to a simple left-right division of heart failure symptoms. The most common cause of right-sided heart failure is left-sided heart failure. The result is that patients commonly present with both sets of signs and symptoms.

• Congestive heart failure

Heart failure may also occur in situations of "high output," where the amount of blood pumped is more than is typical and the heart is unable to keep up. This can occur in overload situation (blood or serum infusions), kidney diseases, chronic severe anemia, beriberi (vitamin B₁/thiamine deficiency), hyperthyroidism, Paget’s disease, arteriovenous fistulae, or arteriovenous malformations. Viral infections of the heart can lead to inflammation of the muscular layer from the heart and subsequently contribute to the development of heart failure. Heart damage can predispose a person to develop heart failure later in life and has many causes including systemic viral infections (e.g., HIV), Chemotherapeutic agents, and abuse of drugs such as alcohol and methamphetamine. Additionally, infiltrative disorders such as amyloidosis and connective tissue diseases such as Systemic lupus have similar consequences. Obstructive sleep apnea (a condition of sleep wherein disordered breathing overlaps with obesity, hypertension, and/or diabetes) is regarded as an independent cause of heart failure.

• Acute decompensation

Chronic stable heart failure may easily decompensate. This most commonly results from an intercurrent illness (such as pneumonia), a heart attack, abnormal heart rhythms uncontrolled hypertension, or a patient's failure to maintain a fluid restriction, diet, or medication. Other well recognized factors that may worsen CHF include the following: anemia and hyperthyroidism which place additional strain on the heart muscle, excessive fluid or salt intake, and medication that causes fluid retention such as NSAIDs. NSAIDs in general increase the risk twofold.

• Sleep apnea

There is an increasing evidence that sleep apnea has a link with heart failure. When one has central apnea, the situation can be more dangerous compared with people who have obstructive apnea. Most individuals with central sleep apnea have heart failure, and they also have an increased risk of death. The severity of sleep apnea goes hand in hand with the severity of heart failure. As you probably know, sleep apnea can: increase blood pressure, impair ventricular function, increase pulmonary artery pressure, Cause diabetes, when your risk for heart failure can be eight times greater that of someone who doesn't have diabetes.

The signs of heart failure often appear after physical activity, and as the disease gets more severe, the symptoms last longer. Here are the most common symptoms of heart failure:

• shortness of breath, or difficulty breathing,
• tiredness and weakness,
• swelling of the ankles, feet, legs, or abdomen,
• weight gain from water build-up,
• Coughing, especially at night or when lying down, including bloody spit.

Treatment options for heart failure are:

• opositive airway pressure, or CPAP
• ooxygen supplementation
• ooptimize treatment of heart failure

• Acute decompensation

In (ADHF), the immediate goal is to re-establish adequate perfusion and oxygen delivery to end organs. This entails ensuring that airway, breathing and circulation are adequate.

Immediate treatments usually involve some combination of vasodilators such as nitroglycerin, diuretics such as furosemide, and possibly noninvasive positive pressure ventilation (NIPPV).

• Chronic management

The goals of treatment for people with chronic heart failure are the prolongation of life, the prevention of acute decompensation and the reduction of symptoms, allowing for greater activity. Heart failure can result from a variety of conditions. In considering therapeutic options, it is important to first exclude reversible causes, including thyroid disease, anemia, chronic tachycardia, alcohol abuse, hypertension and dysfunction of one or more heart valves. Treatment of the underlying cause is usually the first approach in treating heart failure.

However, in the majority of cases, either no primary cause is found or treatment of the primary cause does not restore normal heart function. In these cases, behavioural, medical and device treatment strategies exist which can provide significant improvement in outcomes, including the relief of symptoms, exercise tolerance, and a decrease in the likelihood of hospitalisation or death.

• Lifestyle

Behavioural modification is a primary consideration in any chronic heart failure management program, with dietary guidelines regarding fluid and salt intake being of particular importance. Exercise should be encouraged and tailored to suit individual capabilities.

The inclusion of regular physical conditioning as part of a cardiac rehabilitation program can significantly improve quality of life and reduce the risk of hospital admission for worsening symptoms however there is no evidence for a reduction in mortality rates as a result of exercise. Furthermore, it is not clear whether this evidence can be extended to people with heart failure with preserved ejection fraction (HFpEF) or to those whose exercise regimen takes place entirely at home. Home visits and regular monitoring at heart failure clinics reduce the need for hospitalisation and improve life expectancy.

• Medication
• Minimally invasive therapies and Surgical therapies