causes,signs and symptoms of congestive heart failure

Congestive heart failure/congestive cardiac failure (CCF)/ biventricular cardiac failure

CCF results from the failure of the heart to eject blood effectively, thus it is the most common manifestation of heart failure. It is clinically useful to divide the heart failure into the syndromes of left and right cardiac failure, but it is rare for any part of the heart to fail in isolation.

Most commonly, there is a pre-existing Left heart failure followed by Right heart failure.

Left heart failure

Causes include:
*ischaemic heart disease: causing infarction of the heart walls, such as the myocardium hence the ventricles cannot contract efficiently thus reducing cardiac output.
*systemic hypertension: the heart has to pump harder to overcome the arterial pressure thus increases the afterload resulting in hypertrophy of the heart thus leading to CCF.
*mitral and aortic valve disease: incompetent valves leads to the heart having to pump harder, leading to hypertrophy of heart. i.e in mitral regurgitation, there is excessive preload
*Cardiomyopathy: can cause dilation and failure of the heart

Symptoms
*Fatigue (due to inadequate systemic perfusion, or lack of sleep because of paroxysmal dyspnoea)
*exertional dyspnoea ( breathlessness)
orthopnoea ( shortness of breath when lying down due to fluid in the chest cavity. this is relieved by sitting up.)
*paroxysmal nocturnal dyspnoea ( sudden breathlessness at night)
*wheeze
*nocturnal cough with or without pink sputum

Signs
*LV third or fourth heart sound ( S3 and S4)
*Tachycardia
*Crackles are heard at lung bases( pulmonary oedema)
*Peripheral cyanosis ( due to insufficient cardiac output leading to poor circulation in the peripheries)








Right heart failure

Causes include:
*left heart failure and others


symptoms
*fatigue
*peripheral oedema (the left ventricle is pumping more blood than the right heart can handle on return thus there is an accumulation of fluid in the peripheries)
*nausea
*anorexia
*pulsation in neck and face (raised right heart pressure)


signs
*jugular venous distension
*ascites ( development of abdominal fluid, systemic oedema)




Other causes of CCF also include

Drugs
beta blockers causing inadequate heart rate
negatively inotropic ( decrease heart contractility) drugs
excessive alcohol intake resulting in high BP leading to cardiomyopathy

Congenital defects in cardiac structure