Introduction
There
has been an increasing rise in the number of patients being admitted for
cardiac failure with its prevalence increasing with an increase in age.
According to the National Heart, Lung, and Blood Institute (2011), cardiac
failure pose a health risk today and attributed as a major cause of death among
elderly people especially above 65 years of age. Though there are advancements
in the methods of treatment of the diseases its mortality rate is still high. This
study seeks to explain the causes and development of CCF and how it manifests
in patients including other underlying factors that contribute to the
development of the disease. It will also highlight the clinical manifestation
and the diagnostic procedures in relation to the management of the disease.
Etiology of CCF disease
Etiology
is the study of the causes of the underlying disease condition. Congestive
Cardiac Failure (CCF) also called Congestive Heart Failure (CHF) is a
progressive disease of the heart that arises due to the failure of the cardiac muscles
of the heart to pump adequate blood from the heart to meet the body needs. The
disease comes as an end result due to several factors whose interaction lead to
development of the disease. These factors include functional, biological,
hereditary and lifestyle. Functionally, the heart pumps blood to all parts of
the body a process which supplies nutrients and oxygen for the proper
functioning of the organs while taking away the waste products to elimination
points. Blockage of the arteries that supply the muscles with oxygen and
nutrients may lead to development of diseases like Coronary Heart Disease. All diseases arising within the heart lower
the general capability of the heart to carry out its functions thus contribute
to development of CCF. They include hypertension, diseases of the heart valves,
disorders of the heart rhythm and thyroid caused by viral infections. Other
factors include lifestyle, idiopathic and medication. Certain medications are
known to worsen or lead to development of heart failure. Examples are drugs
that cause sodium retention or affect the power of the heart to pump blood.
They include the nonsteroidal anti inflammatory drugs (NSAIDs) like ibuprofen,
naproxen, some diabetic drugs like rosiglitazone, pioglitazone.
Pathophysiology and symptoms of CCF
Pathophysiology is the study of the functional changes
in the body occurring in response to the underlying disease. The development and manifestation of the CCF
disease can be both symptomatic and asymptomatic. Symptomatic cases of abrupt
myocardial infarction may alert an individual of the possibility of the disease
developing else it may have a gradual onset experienced due to developing hypertension.
There are two pathophysiologic types of CCF, the systolic and the diastolic
failure. The coronary heart disease and myocarditis cause the weakening of the
cardiac muscles to contract and relax thus pumping and receiving blood. This
failure means no oxygen is reaching the muscles thus it becomes difficult to
walk and one ends stationary. The body organs fail to get oxygen and blood and
as a result shut down their functions. When the left ventricle can not pump
blood out of the body as fast as it returns from the lungs, the blood begins to
back up in the lung blood vessels and some of the fluid in the blood begin to
accumulate in the lungs breathing space causing shortness of breath and in the
peripheral tissues causing edema characterized by swelling of the feet, ankles
and legs due to lack of pumping pressure of the heart. These fluids retained in
the body causes frequent urination as a means of elimination. The need of the
heart to supply the body requirements through the blood and the inability of
the heart to pump blood causes the heartache a condition called angina
pectoralis.
Assessment
and diagnosed of CCF
A
patient’s symptoms and signs provide important insight to the presence of heart
failure. Proper diagnosis of heart failure requires knowledge on the medical
history of the patient, physical examination and laboratory tests. The medical
history of the patient reveals the presence of symptoms and signs the patient
had previously experienced in relation to the presence ones. Examples are
previous case of the coronary heart disease, shortness of breath, alcohol use
and diabetes among others. The physical examination of the patient will reveal
the presence of fluids retained in the body. (Jessup M, 2009). This can be
noted through the sound produced when breathing, leg and hand swellings and the
swollen blood veins in the neck region. Characteristics of the heart including
the heart rate, size and heart sounds can be measured using a stethoscope. Similarly, there are various diagnostic tests
that can help in diagnosis of heart failure. They include Electrocardiogram
(ECG), Chest X- ray and Echocardiogram.
The
electrocardiogram is mostly performed in patients who show shortness of breath;
complain of chest pains and those who report having cardiac disease. This procedure will detect patterns of
abnormal electric activity of the heart, cases of increase in the heart mass.
The echocardiogram uses the sound waves of the pumping heart to generate images
that will help identify any abnormalities in the heart valves and muscles. It
also measures the amount of blood the ventricles are holding and pumping at any
given time. The physician use of a catheter insertion into the heart via a
blood vessel can be useful in measuring blood pressure and amount of blood
pumped by the heart.
Alteration in physiology associated
with CCF
When
the arteries supplying the heart muscles block and no or little nutrients and
oxygen reach the muscles, the heart weakens and as a result there is little
activity of the heart pumping blood to all parts of the body. The most affected
parts of the heart are the ventricles; the right and the left. The ventricles
stiffen and thus unable to contract and relax, processes that allow filling and
emptying of the heart. The left part of the heart is responsible for the
pumping of blood to all parts of the body while the right side is responsible
for receiving blood from body tissues. Sometimes, there can be a dysfunction in
the left ventricle where the heart fails to receive and pump blood to body
organs at a rate equal to the receiving of blood in the right ventricle. For
this reason the all body organs functions are impaired the blood already in the
lungs cause flow of fluids into the breathing spaces causing difficulty in
breathing. This is called the left side heart failure and majorly affects the
left ventricle. Mann DL (2001) Alternatively when
the right ventricle fails to receive and contract to send blood to the lungs
for oxygenation at the rate equal to the left ventricle, there id retention of
the blood and body fluid in the peripheral body organs causing edema. This is
called the right side heart failure. In general, contraction of the left side
of the heart is responsible for pumping blood to all parts of the body.
Therefore if there is a failure in the activity the patient is said to have
systolic heart failure else if it occurs on the right side, it is called
diastolic heart failure.
Treatment of CCF
Tintinalli,
J.E. (2003) noted that once the underlying disease has been detected, it is becomes
obvious that intervention strategies like medication are required to help the
patient improve and resume normal duties normal. Treatment of CCF involves
working towards eliminating the causes of the disease or treating the diseases
that contribute to worsening or development of cardiac failure. In some cases,
heart failure may be due to a clot in the heart arteries. These can be done by
administering antiplatelet medication to prevent blood clot, anti coagulant
drugs to prevent growth of blood clots in arteries. The medication required here is meant to open
up the artery by dissolving the clot to restore the blood flow. The
interventions available include both pharmacological and non pharmacological
approaches. Pharmacologically, there are a number of medications that have
proved useful in the treatment of CCF. They include anti diuretic drugs which
help in elimination of water and salts retained with the body fluids through
frequent urination. Statin has proved effective in reduction of cholesterol.
Sometimes
Non
pharmacological approaches have proved useful in reducing heart failure. These
approaches do not require the use of medications and greatly contribute to the
general development of the disease. They include total change in lifestyle
including quitting smoking, drug abuse and alcohol, change of diet by reducing
the amount of salt taken as it will help in elimination of water and other body
fluids thus reducing edema. Constant light exercises can help in maintaining
the health of the patient though this requires the advice of the doctor.
Surgery could be use to treat heart failure by removing a dysfunctioning heart.
Complications associated with heart
failure.
The CCF is caused by a
significant damage to the heart muscles and as the pumping of the blood to body
organs is impaired, so are their functions.
The general outlook of a person depends on the state of health, age and
the cause of the heart failure in an individual. According to Lindenfield J,
(2010), there are several complications that arise
due to heart failure and are categorized into acute (short term) and chronic
(long) complications. Acute complications include those lives threatening
disease instances whose occurrence pose a great risk and may cause instant
death of the patient. They include heart attack and stroke due to the clots in
the blood vessels, shortness of breath. These can be treated by administering
anticoagulant medication to prevent clotting and supplemental oxygen to improve
breathing. Other complications develop slowly and may be due to continuous lack
of blood supply. They include liver damage which develops due to the increasing
accumulation of the fluids that put to much pressure on it leading to scarring.
As a result the normal functioning of the liver is impaired; kidneys lacking
blood and oxygen for a prolonged time may eventually fail to perform normally
thus the elimination of fluid from the body are affected.
Future disease occurrence
Schocken DD (2008),
advices that as part of the intervention strategies for the prevention of heart
disease and complications associated with, there should be change or
modifications of lifestyle. From the patient’s medical history, the patient
used to smoke and is still drinking wine. Reducing and completely quitting
smoking will be useful in reducing heart complications. The patient should be advised to take
exercises as advised by the physician and reduce the amount of salt taken
through the food as this will reduce the body retention capacity of the body
fluids.
References
Mann
DL. Mechanisms and models in heart failure. A combinatorial approach.
Circulation 2001;
100:999–1008.
Schocken DD, Prevention
of heart failure: A scientific statement from the American Heart Association. Circulation. 2008;
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Rich
MW, Brooks K, Luther P. Temporal trends in pharmacotherapy for congestive
heart failure at an academic medical
center. Am Heart J. 2008; 135:367–72.
Tintinalli, J.E. Emergency
Medicine: A Comprehensive Study Guide. 6th ed. McGraw-Hill, 2003.
Jessup M, 2009 Focused
update: ACCF/AHA guidelines for the diagnosis and management of heart failure in adults. Circulation. 2009;
119:1977.
What is heart failure?
National Heart, Lung, and Blood Institute.http://www.nhlbi.nih.gov/health/health-topics/topics/hf/.
Accessed Oct. 12, 2011.
Lindenfield J, 2010
HFSA Comprehensive practice guideline. Journal of Cardiac Failure. 2010; 16:475.
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