Congestive Heart Failure (CHF)

A Congestive Heart Failure (CHF) is a syndrome that caused by impairment of the heart's function to pump blood.

• AKA: Heart Disease, Heart Failure (HF).
• Context:
  • It can range from being a Chronic Heart Failure to being an Acute Heart Failure.
  • It can range from being a Heart Failure due to Reduced Ejection Fraction (HFrEF) to being a Heart Failure with Preserved Ejection Fraction (HFpEF).
• Example(s)
  • Coronary Heart Disease (CHD),
  • High-Output Heart Failure,
  • …
• Counter-Example(s):
  • Chronic Lung Disease.
  • Chronic Kidney Disease.
• See: Ebers Papyrus, Jugular Venous Distension, Cardiology, Shortness of Breath, Fatigue (Medical), Edema, Myocardial Infarction, Oxford University Press, Society For Research on Nicotine And Tobacco, Echocardiogram, Diuretics, Syndrome.

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References

2022a

• (Wikipedia, 2022) ⇒ https://en.wikipedia.org/wiki/Heart_failure Retrieved:2022-11-13.
  • Heart failure (HF), also known as congestive heart failure (CHF), is a syndrome, a group of signs and symptoms, caused by impairment of the heart's function to pump blood. Symptoms commonly include shortness of breath, excessive tiredness, and leg swelling. It may cause shortness of breath when exercising or while lying down, and may wake a person up at night. Notably, chest pain including angina is not typically caused by heart failure, but can occur if the heart failure is caused by a heart attack. The severity of the heart failure is measured by the severity of symptoms with exercise. Other diseases that may have symptoms similar to heart failure include obesity, kidney failure, liver disease, anemia, and thyroid disease.

    Common causes of heart failure include coronary artery disease, heart attack, high blood pressure, atrial fibrillation, valvular heart disease, excessive alcohol use, infection, and cardiomyopathy. These cause heart failure by changing either the structure or the function of the heart, or both. There are different types of heart failure: right-sided heart failure that affects the right heart, left-sided heart failure that affects the left heart, and biventricular failure that affects both sides of the heart. Left-sided heart failure can occur with reduced ejection fraction or with a preserved ejection fraction. Heart failure is not the same as cardiac arrest in which blood flow stops altogether due to failure of the heart to pump effectively.

    Diagnosis is based on symptoms, physical findings, and echocardiography. Blood tests, and chest radiography may be useful to determine the underlying cause.

    Treatment depends on the severity and cause. In people with chronic stable mild heart failure, treatment commonly consists of lifestyle changes such as stopping smoking, physical exercise, and dietary changes, as well as medication. In those with heart failure due to left ventricular dysfunction, angiotensin-converting-enzyme inhibitors, angiotensin receptor blockers, or valsartan/sacubitril along with beta blockers are recommended. For those with severe disease, aldosterone antagonists, or hydralazine with a nitrate, may be used. Diuretics may also be prescribed to prevent fluid retention and its resulting shortness of breath. Sometimes, depending on the cause, an implanted device such as a pacemaker or an implantable cardiac defibrillator may be recommended. In some moderate or severe cases, cardiac resynchronization therapy (CRT) or cardiac contractility modulation may be of benefit. A ventricular assist device (for the left, right, or both ventricles), or occasionally a heart transplant may be recommended in those with severe disease that persists despite all other measures.

    Heart failure is a common, costly, and potentially fatal condition, and it is the leading cause of both hospitalization and readmission amongst older adults. Heart failure often results in more drastic detrimental health effects compared to failure of other similarly complex organs such as the kidneys or liver. In 2015, it affected about 40 million people globally. Overall around 2% of adults have heart failure and in those over the age of 65, this increases to 6–10% of those over the age of 65. Rates are predicted to increase. The risk of death is about 35% the first year after diagnosis, while by the second year the risk of death is less than 10% for those who remain alive. This degree of risk of death is similar to some cancers. In the United Kingdom, the disease is the reason for 5% of emergency hospital admissions. Heart failure has been known since ancient times, with the Ebers papyrus commenting on it around 1550 BCE.

2022b

• (Wikipedia, 2022b) ⇒ https://en.wikipedia.org/wiki/Heart_failure#Classification Retrieved:2022-11-13.
  • One historical method of categorizing heart failure is by the side of the heart involved (left heart failure versus right heart failure). Right heart failure was thought to compromise blood flow to the lungs compared to left heart failure compromising blood flow to the aorta and consequently to the brain and the remainder of the body's systemic circulation. However, mixed presentations are common and left heart failure is a common cause of right heart failure.

    More accurate classification of heart failure type is made by measuring ejection fraction, or the proportion of blood pumped out of the heart during a single contraction. Ejection fraction is given as a percentage with the normal range being between 50 and 75%. The two types are:

    1) Heart failure due to reduced ejection fraction (HFrEF): Synonyms no longer recommended are "heart failure due to left ventricular systolic dysfunction" and "systolic heart failure". HFrEF is associated with an ejection fraction less than 40%.

    2) Heart failure with preserved ejection fraction (HFpEF): Synonyms no longer recommended include "diastolic heart failure" and "heart failure with normal ejection fraction." HFpEF occurs when the left ventricle contracts normally during systole, but the ventricle is stiff and does not relax normally during diastole, which impairs filling.

    Heart failure may also be classified as acute or chronic. Chronic heart failure is a long-term condition, usually kept stable by the treatment of symptoms. Acute decompensated heart failure is a worsening of chronic heart failure symptoms, which can result in acute respiratory distress. High-output heart failure can occur when there is increased cardiac demand that results in increased left ventricular diastolic pressure which can develop into pulmonary congestion (pulmonary edema).

    Several terms are closely related to heart failure and may be the cause of heart failure, but should not be confused with it. Cardiac arrest and asystole refer to situations in which no cardiac output occurs at all. Without urgent treatment, these result in sudden death. Myocardial infarction ("Heart attack") refers to heart muscle damage due to insufficient blood supply, usually as a result of a blocked coronary artery. Cardiomyopathy refers specifically to problems within the heart muscle, and these problems can result in heart failure. Ischemic cardiomyopathy implies that the cause of muscle damage is coronary artery disease. Dilated cardiomyopathy implies that the muscle damage has resulted in enlargement of the heart. Hypertrophic cardiomyopathy involves enlargement and thickening of the heart muscle.

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