2.

Clinical Condition of the Heart

Congestive Heart Failure (CHF)

Congestive Heart Failure is the long-term condition in which the heart loses its pumping capacity. Yes, the
heart is still functioning however it cannot handle the amount of blood in the body leading to blood build
up in other parts of the body, namely the liver and lungs. (Griffith, 2012) Most common types of CHF are
left-sided and right-sided, but patients can have both sided CHF. (Macon, 2023)

Signs and symptoms of CHF

Signs and symptoms depend on severity of Congestive Heart failure (CHF) and can develop overtime.
Depending on the severity signs and symptoms present as shortness of breath, especially with exertion or
lying flat in bed; chest pain; fatigue, weakness and faintness; wheezing and a cough usually with sputum;
swelling of abdomen, legs and ankles; rapid and irregular heartbeat; low blood pressure; distended neck
veins; and enlarged liver. It is important to note that signs and symptoms of CHF may come and go and
unfortunately get worse overtime. (Griffith, 2012)

How does it affect the normal anatomy of the structure:

In a heart that is correctly working, it pumps blood rich in oxygen and vital hormones and substances
around the body in order to meet metabolic demand and controls the blood pressure as well as heart rate.

In CHF, the heart may not be able to provide tissues with enough rich blood to meet their metabolic
demands. This is also because CHF causes an increase in pulmonary or systemic venous pressures.
This disorder can be brought on by issues with either the systolic or diastolic functions, or frequently both.
(Fine, 2022)

Heart failure can cause changes in the heart's size and function. These changes may damage heart
valves and cause irregular heartbeats. (Mayo Clinic Staff, 2023)

Changes in cardiomyocyte function can be a major abnormality, and the extracellular matrix's collagen
turnover can also vary. Congestive Heart failure (CHF) can also be brought on by heart structural
problems such as congenital flaws or valve illnesses, rhythm problems of consistently high heart rate, and
high metabolic demands such as those brought on by thyrotoxicosis. (Fine, 2022)

Why does CHF occur?

Coronary artery disease (CAD), reduction of size or blockage of the small blood vessels that supply blood
and oxygen specifically to the heart.This weakens the heart muscles gradually or suddenly. Cholesterol
and other fatty substances can cause this narrowing in coronary arteries. (Macon, 2023)

High blood pressure that is not assessed and controlled, leading to problems of stiffness which increase
pressure in your arteries and eventually myocardial weakening. (Macon, 2023)

Heart Valves open and close to regulate the blood flow through the chambers of the heart. When valves
are not functioning correctly, like leaky or narrowed valves, it forces ventricles to work more forcefully to
pump blood. This results in infection or defect. (Macon, 2023)
Other diseases may also cause or contribute to CHF which are important to note. These being severe
anaemia, too much iron, emphysema, diabetes, thyroid disease or underactive thyroid,

Does CHF affect other parts of the body?

The body tries its best to keep blood flow to the heart and brain, leaving less blood for your lungs, kidneys
and liver. As mentioned before, fluid buildup and reduced blood flow to organs can lead to serious
problems.

When blood backs up, there is raised pressure in the veins inside of the lungs,pushing fluid back into your
air sacs. This build up of fluid causes pulmonary oedema which makes it very difficult for the patient to
breathe. (WebMD Editorial Contributors and Beckerman J, 2022). This is why patients show chest pain,
coughing and wheezing. Exercise for long periods of time becomes difficult.

Kidneys are supposed to filter waste and extra fluid out of the blood and need a good supply of blood to
work optimally. Remove this steady blood supply and they will not be able to remove enough waste from
the blood and body leading to kidney failure. (WebMD Editorial Contributors and Beckerman J, 2022)
There is a rise in blood pressure due to the accumulation in salt as well as the overproduction of renin,
damaging blood vessels. (Mayo Clinic Staff, 2023)

Anaemia is in turn induced by kidney damage. Anaemia is the lack of concentration of Red Blood
Cells(RBCs) that move oxygen throughout your body to tissues and organs. Hence, the body may not get
enough oxygen. The kidneys are in charge of the production of the Erythropoietin(EPO) protein, helping
your body make new RBCs. Kidney damage from CHF reduces your body’s production of making enough
EPO.(WebMD Editorial Contributors and Beckerman J, 2022)

The liver breaks down toxins to be able to remove them and also stores a digesting fluid called bile.CHF
starves the liver of the rich blood it needs to function. The fluid build up puts extra pressure on the portal
vein, causing cirrhosis of this organ to the point where it does not function properly. (WebMD Editorial
Contributors and Beckerman J, 2022)

3. Surgical and Non-surgical Treatment for CHF

Treatment of Congestive Heart failure depends on which stage of Heart Failure the patient is on. CHF is
categorised as Stage A, B, C and D. Stage A is asymptomatic but has a high risk of CHFdue to
underlying factors like genetics, hypertension. Stage B is diagnosed by echocardiogram with some sort of
structural heart disease. Stage C, the patient experiences symptoms of CHF like wheezing and fatigue.
Stage D, better known as the end stage CHF, is when the heart becomes unresponsive to treatment.
Types treatment of Congestive Heart failure depends on severity and on which stage of Heart Failure the
patient is on. (Mayo Clinic Staff, 2023)

Non-surgical Treatment of CHF:

Heart failure patients are considered chronic and medicines will have to be taken long-term. Doctors will
prescribe certain combinations of heart medications depending on the type of heart failure the patient has.

Angiotensin converting enzymes(ACE)/angiotensin II receptor Blockers(ARBs) relax blood vessels to put

less strain on your heart and make it easier to pump blood around the body.
Angiotensin receptor-neprilysin inhibitors (ARNIs) manage blood pressure and remove excess fluid.

Beta Blockers slow heart rate, allowing it to pump more efficiently.

Mineralocorticoid Receptor antagonists (MRAs) help prevent or reduce damage and changes to the heart
as well as regulate the blood pressure.

Sodium-glucose cotransporter 2 (SGLT2) inhibitors improve symptoms of heart failure reducing excess
fluid and help manage blood sugar levels with patients who have CHF and diabetes.

Diuretics get rid of extra fluid, specifically in the lungs, abdomen and lower limbs. This is done by
increasing the amount of urine made and this hepls patient feel better by reducing swelling. This improves
patient respiration.

Changes in diet and lifestyle is also imperative. Eat a heart-healthy diet with plenty of fruits, vegetables
and whole grains. Exercise moderately for at least 150 minutes per week. Limit your sodium intake. Quit
smoking and/or using tobacco products and avoid secondhand smoke. (Mayo Clinic staff, 2023)

Surgical Treatment of CHF:

Some patients who have severe heart failure or serious arrhythmias need implantable cardioverter
defibrillators, or ICDs. These devices are surgically placed and detect life-threatening arrhythmias. When
they do, they convey a shock to the heart to reset its rhythm so it can proceed in normal functioning.
Some newer pacemakers can also work as ICDs. (American Heart Association editorial Staff. 2023)

Patients with heart failure develop arrhythmias and this can reduce how well the heart’s ventricles can
function. Cardiac resynchronization therapy, also known as biventricular pacing, may be needed. In this
procedure, a special pacemaker makes the ventricles contract at the same time. This helps the ventricles
pump and relax together. (American Heart Association editorial Staff. 2023) This therapy can improve
heart function, reduce hospitalisation risk and increase survival.

The left ventricle is large and muscular and pumps blood out to the body. An Left Ventricular Assist
Device (LVAD) is a mechanical pump-type device. This is often considered a short-term fix if surgery or a
heart transplant is needed. (American Heart Association editorial Staff. 2023)

A patient's healthcare team might recommend surgery when they identify a correctable problem that’s
causing heart failure, such as a defect, including a heart valve or a blocked coronary artery.

Surgery may also be needed if heart failure is so severe that it cannot be fixed with medications and
lifestyle changes. (American Heart Association editorial Staff. 2023)

Patients with severe, congestive heart failure that cannot be helped by medications, other devices and
procedures, or eating and lifestyle changes. In such cases, a heart transplant could be the only effective
treatment option. Surgeons replace the damaged heart with a healthy one from an organ donor while
alive and have been declared brain dead. It can take several months to find a donor heart that closely
matches the tissues of the person receiving the transplant. But this matching process is essential to
reduce the chances of rejection. A heart-lung machine replaces the patient's heart and lungs during the
transplant surgery by attaching the patient to it. The surgeon next removes the sick heart and inserts the
donor heart in its place. After reconnecting the main blood veins, the new heart is prepared to function.
(American Heart Association editorial Staff. 2023)

References:

Griffith, H.W. 2012. Complete Guide to Symptoms, Illness & Surgery: Updated and Revised. 6th Edition.
Perigree.
Accessed: 28 September 2023

Macon, B. 2023. Congestive Heart Failure. Healthline.

https://www.healthline.com/health/congestive-heart-failure.
Accessed: 1 October 2023

WebMD Editorial Contributors and Beckerman J. 2022. What Problems Can Heart Failure Cause?.
WebMD. https://www.webmd.com/heart-disease/heart-failure/heart-failure-complications.
Accessed: 1 October 2023

Mayo Clinic Staff. 2023. Heart Failure. Mayo Clinic.

https://www.mayoclinic.org/diseases-conditions/heart-failure/symptoms-causes/syc-20373142.
Accessed: 2 October 2023.

American Heart Association editorial Staff. 2023. Devices and Surgical Procedures to Treat Heart Failure.
American Heart Association.
https://www.heart.org/en/health-topics/heart-failure/treatment-options-for-heart-failure/devices-and-surgica
l-procedures-to-treat-heart-failure.
Accessed: 3 October 2023.