Congestive Cardiac Failure

CONGESTIVE CARDIAC FAILURE

 *Congestive Cardiac Failure*

Congestive cardiac failure is a clinical syndrome in which the heart fails to pump blood at the rate required by the metabolizing tissues or in which the heart can do so only with elevation in filling pressure

*ETIOLOGY*
It could be cardiac and non cardiac
Cardiac causes include
- Hypertension
- Coronary artery diseases
-Valvular diseases
- Arrhythmia e.t.c.
Non cardiac causes include
-Diabetes
-Respiratory diseases
-Thyroid diseases e.t.c.

*RISK FACTORS*
Some very important risk factors to note
- Age
- Sex
- Obesity
- Race
- Smoking
- Alcohol use e.t.c.

*PATHOPHYSIOLOGY*
Cardiovascular dysfunction usually result from either
1. Failure of the pump itself (myocardial diseases)
2. Obstruction of the ventricular outflow
3. Regurgitant flow
4. Arrhythmia
The compensatory mechanism helps increase blood volume and cardiac muscle mass to maintain the pumping function of the heart and to cause a redistribution of blood flow..

Inability of the heart to resume Normal activity,  there is a decline in the compensatory mechanism leading to worsening of the heart failure.. ..

*CLINICAL MANIFESTATION*

- Shortness of breath
-Easy fatiguability
- Weakness
- Cough
- Palpitations
- Chest pain
- Pedal edema
- Dizziness
- Ascites
- Hepatomegaly
-Tachycardia e.t.c

*DIAGNOSIS*

Diagnosis of CCF can be made using the Framingham Criteria.
The criteria is divided into Major and Minor.

To make a diagnosis of CCF, there should be 2 major symptoms or 1 major and 2 minors.

*MAJOR CRITERIA*
 - Paroxysmal nocturnal dyspnea
-Weight loss of 4.5kg in 5 days
-Neck vein distention
-Rales
-Acute pulmonary edema
-Hepatojugular reflux
-S3 gallop
-Central venous pressure > 16cm water
-Cardiomegaly
-Pulmonary edema


*MINOR CRITERIA*
-Noctural cough
-Dyspnea on ordinary exertion
-Decreased vital capacity
-Pleural effusion
-Tachycardia
-Hepatomegaly
-Bilateral ankle edema

*CLASSIFICATION //STAGES*

NYHA classification
Class I - No limitation of physical activity

Class II - Slight limitation of physical activity

Class III - Marked limitation of physical activity

Class IV - Symptoms at rest

*ACA Staging*

Stage A - High risk of  Heart failure but no structural heart disease or symptoms

Stage B - Structural heart disease but no symptoms

Stage C - Structural heart disease with symptoms

Stage D - Refractory heart failure



*TREATMENT*

*NON-PHARMACOLOGICAL*
- Dietary changes
- Decrease fluid intake
- Exercise
- Reduction of weight gain

*PHARMACOLOGYICAL MANAGEMENT*

*PHARMACOLOGICAL*
- Diuretic
Vasodilators
Ionotropic agents
Anticoagulants (used with caution)
Digoxin
Beta blockers

*SURGICAL MANAGEMENT*
Surgical therapy is underlying cause needs surgery