Thursday, February 7, 2013

Congestive Cardiac Failure (CCF)

Congestive Cardiac Failure (CCF)
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.

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; 117:2544.
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. Accessed Oct. 12,   2011.
Lindenfield J, 2010 HFSA Comprehensive practice guideline. Journal of Cardiac Failure. 2010;    16:475.