Congestive heart failure

Question 1

Definition

Answer 1

Complex syndrome that can result from any structural damage or functional cardiac disorder that impairs the ability of the heart to function as a pump, to support a physiological circulation.

Occurs when the heart doesn’t pump blood as it should.

Question 2

Aetiology

Answer 2

Develops after other conditions have damaged or weakened the heart. (can also occur if the heart become too stiff).

Main causes:
- ischaemic heart disease (35-40%)
- cardiomyopathy (30-34%)
- hypertension (15-20%)
Other causes:
- valvar heart disease
- congenital heart disease
- alcohol and drugs
- tricuspid incompetence
- pericardial disease

The main pumping chambers of the heart may become too stiff and not fill properly between beats. The heart may become damaged and weak.
The heart cannot keep up with the demands that it needed.
Can involve the right and left ventricle.

Question 3

Epidemiology

Answer 3

Incidence is variable but increases with age.

Approx 26 million people have heart failure worldwide.

Question 4

Clinical presentations:

Answer 4

main clinical features:
- exertion dyspnoea (running out offer and not being able to breathe fast or deeply enough during physical activity)
- orthopnoea (breathlessness in recumbent position, relieved by standing)
- fatigue

signs:
- tachycardia
- elevated jugular venous pressure
- cardiomegaly
- pleural effusion (build up of fluid in the space between the lungs and the chest wall)
- ascites (where fluid collects in your abdomen)

Can be ongoing (chronic) or it may start suddenly (acute)

shortness of breath with activity or when lying down

fatigue or weakness

swelling in the legs, ankles and feet

rapid or irregular heartbeat

reduced ability to exercise

nausea and lack of appetite

difficulty concentrating or decreased alertness

Question 5

Prognosis

Answer 5

Improved over the past 10 years with evidence-based therapy, mortality rate remains high however.
50% of patients with heart failure dead at 5 years

Question 6

Acute heart failure

Answer 6

occurs with the rapid onset of symptoms and signs of heart failure secondary to abnormal cardiac function, causing elevated filling pressures.

leads to severe dyspnoea (difficult or laboured breathing) and pulmonary oedema.

Poor prognosis

Aetiology (similar to chronic heart failure)
– ischaemic heart disease
– valvar heart disease
– hypertension
– acute and chronic kidney disease
– atrial fibrillation