CONGESTIVE CARDIAC

FAILURE

BY
WARDAH KHALID
02 (M) : 2012-17
 INTRODUCTION
• Congestive cardiac failure describes the
condition of the body where the heart can’t
meet the demands of the body by not pumping
enough blood.

• Cardiac Output (CO)= Stroke Volume x Heart Rate

becomes insufficient to meet metabolic needs of

body.
 CCF DEMOGRAPHICS
• 5 million people in US

• Most rapidly increasing form of CV disease

– AHA estimates 450,000 new cases/year

– Increases with age _1 in every 100 adults
– Most common DX in hospitalized adults > 65
– Incidence equal in men and women
 TYPES OF CCF
SYSTOLIC HF: refers to systoli (pumping out)
• can’t pump out blood with enough force due
to weaker and smaller heart muscles

DIASTOLIC HF: refers to diastoli (filling phase)

• can’t fill with enough blood
• Bigger heart muscles less ventricular
space less filling less blood ejection
 How fast does heart failure develop?

– Usually an underlying disease

– The heart tries to compensate for the loss in
pumping function by:
• Developing more muscle mass
• Enlarging
• Pumping faster ( O2 demand )
 CAUSES
– Health conditions that either damage the
heart or make it work too hard
• Coronary artery disease
• Heart attack
• High blood pressure
• Abnormal heart valves
• Heart muscle diseases (cardiomyopathy)
• Heart inflammation (myocarditis)
 CAUSES
• Congenital heart defects
• Severe lung disease
• Diabetes
• Severe anemia
• Overactive thyroid gland
(hyperthyroidism)
• Abnormal heart rhythms
– Coronary artery disease ( Ischemic condition)
• Cholesterol and fatty deposits build up in the heart’s
arteries
• Less blood and oxygen reach the heart muscle
• This causes the heart to work harder and occasionally
damages the heart muscle

– Heart attack
• An artery supplying blood to the heart becomes blocked
• Loss of oxygen and nutrients damages heart muscle tissue
causing it to die
• Remaining healthy heart muscle must pump harder to keep
up
– HYPERTENSION
• Uncontrolled high blood pressure doubles a persons
risk of developing heart failure
• Heart must pump harder to keep blood circulating
• Over time, chamber first thickens, then gets larger and
weaker (muscular hypertrophy)

– Abnormal heart valves

– Heart muscle disease
• Damage to heart muscle due to drugs, alcohol or
infections
– Congenital heart disease
– Severe lung disease
–Diabetes
• Tend to have other conditions that make the heart work harder
• Obesity
• Hypertension
• High cholesterol

–Severe anemia
• Not enough red blood cells to carry oxygen
• Heart beats faster and can become overtaxed with the effort

–Hyperthyroidism
• Body metabolism is increased and overworks the heart

–Abnormal Heart Rhythm

• If the heart beats too fast, too slow or irregular it may not be able to pump
enough blood to the body
 CONCENTRIC HYPERTROPHY
• Aortic stenosis i.e. narrowing of the aortic valve opening
• Hypertrophic cardiomyopathy i.e. abnormal ventricular wall
thickening often from a genetic cause.

RESTRICTIVE CARDIOMYOPATHIES
• Stiffer and less compliant heart muscles, ventricles cant easily
stretch out and fill with as much blood , which leads to
diastolic HF.
RENIN-ANGIOTENSIN-ALDOSTERONE SYSTEM
blood supply to kidney activates R-A-A system
fluid retention heart filling and preload
contraction strength by FSM.

FRANK-STARLING MECHANISM
Loading up ventricle with blood during diastole and stretching
out the cardiac muscles makes it contract with more force
which increases the Stroke volume during systole.
 Signs and Symptoms
– Shortness of Breath (dyspnea)
• WHY?
– Blood “backs up” in the pulmonary veins because
the heart can’t keep up with the supply an fluid
leaks into the lungs
• SYMPTOMS
– Dyspnea on exertion or at rest
– Difficulty breathing when lying flat
– Waking up short of breath
– Persistent Cough or Wheezing
• WHY?
– Fluid “backs up” in the lungs
• SYMPTOMS
– Coughing that produces white or pink blood-tinged sputum
– Edema
• WHY?
– Decreased blood flow out of the weak heart
– Blood returning to the heart from the veins “backs up”
causing fluid to build up in tissues
• SYMPTOMS
– Swelling in feet, ankles, legs or abdomen
– Weight gain
– Pulmonary edema
– Tiredness, fatigue
• WHY?
– Heart can’t pump enough blood to meet needs of bodies tissues
– Body diverts blood away from less vital organs (muscles in
limbs) and sends it to the heart and brain
• SYMPTOMS
– Constant tired feeling
– Difficulty with everyday activities

– Lack of appetite/ Nausea

• WHY?
– The digestive system receives less blood causing problems with
digestion
• SYMPTOMS
– Feeling of being full or sick to your stomach
– Confusion/ Impaired thinking
• WHY?
– Changing levels of substances in the blood
( sodium) can cause confusion
• SYMPTOMS
– Memory loss or feeling of disorientation
– Relative or caregiver may notice this first

– Increased heart rate

• WHY?
– The heart beats faster to “make up for” the loss in pumping
function
• SYMPTOMS
– Heart palpitations
– May feel like the heart is racing or throbbing
 Treatment Options

– The more common forms of heart failure

cannot be cured, but can be treated
• Lifestyle changes
• Medications
• Surgery
• Lifestyle changes
– Stop smoking
– Loose weight
– Avoid alcohol
– Avoid or limit caffeine
– Eat a low-fat, low-sodium diet
– Exercise
– Reduce stress
– Keep track of symptoms and weight and report any
changes or concern to the doctor
– Limit fluid intake
– See the doctor more frequently
• Medications used to treat Heart Failure
– ACE Inhibitors
• Cornerstone of heart failure therapy
• Proven to slow the progression of heart failure
• Vasodilator – cause blood vessels to expand lowering blood
pressure and the hearts work load

– Diuretics (water pills)

• Prescribed for fluid build up, swelling or edema
• Cause kidneys to remove more sodium and water from the
bloodstream, reducing blood pressure.
• Decreases workload of the heart and edema
• Fine balance – removing too much fluid can strain kidneys or
cause low blood pressure also less stretching of blood vessels.
• CALCIUM-CHANNEL BLOCKERS :
For diastolic HF
• Blocks calcium channel in smooth muscles
around arteries and heart muscles
• No signal means less constriction,
vasodilation, lowering blood pressure, easy to
pump out blood.
• Less contraction, more time to fill blood, more
pumping out function.
– Potassium
• Most diuretics remove potassium from the body
• Potassium pills compensate for the amount lost in
the urine
• Potassium helps control heart rhythm and is
essential for the normal work of the nervous
system and muscles
– Vasodilators
• Cause blood vessel walls to relax
• Occasionally used if patient cannot tolerate ACE
• Decrease workload of the heart
– Digitalis preparations
• Increases the force of the hearts contractions
• Relieves symptoms
• Slows heart rate and certain irregular heart beats

– Beta-blockers
• Lower the heart rate and blood pressure
• Decrease the workload of the heart

– Blood-thinners (coumadin)
• Used in patients at risk for developing blood clots in the
blood vessels, legs, lung and heart
• Used in irregular heart rhythms due to risk of stroke
– Surgery and other Medical Procedures
• Not often used in heart failure unless there is a
correctable problem
• SURGERY : Coronary artery bypass, Stents, Grafts
• Angioplasty
• Valve replacement
• Defibrillator implantation (Cardiac Resynchronization
Therapy, Pacemaker)
• Heart transplantation (end-stage HF)
• Ventricular assist device (VAD) helps in pumping,
works like bypass mechanism (BiVAD)
THANK YOU