Congestive Heart Failure (CHF) is a condition where the heart cannot pump blood effectively, leading to fluid buildup in the lungs and body. It results in fatigue, breathlessness, and swelling.
Types of CHF
Left-Sided Heart Failure:
HFrEF (Reduced EF < 40%) – Impaired contraction.
HFpEF (Preserved EF ≥ 50%) – Impaired relaxation.
Right-Sided Heart Failure: Causes systemic congestion (edema, ascites).
Biventricular Failure: Both sides fail.
Causes
Cardiac: Coronary artery disease, hypertension, valve disease, arrhythmias.
Non-Cardiac: Anemia, thyroid disorders, diabetes, renal dysfunction.
Pathophysiology
Reduced cardiac output triggers neurohormonal activation (RAAS, SNS) causing fluid retention and vasoconstriction.
Compensatory mechanisms (hypertrophy, dilation) worsen heart function over time.
Symptoms
Left-Sided Failure: Breathlessness, orthopnea, pulmonary edema.
Right-Sided Failure: Peripheral edema, ascites, hepatomegaly.
General Symptoms: Fatigue, nocturia, weight gain.
Diagnosis
BNP/NT-proBNP: Biomarker for heart failure.
Echocardiography: Assesses EF and structure.
ECG/X-Ray: Detects arrhythmias, hypertrophy, or congestion.
Treatment
Lifestyle Changes:
Low sodium, fluid restriction, weight monitoring, exercise.
Medications:
Diuretics: Relieve symptoms by reducing fluid overload.
RAAS Inhibitors (ACEI, ARBs, ARNIs): Lower mortality and afterload.
β-Blockers: Slow heart rate and improve survival.
Aldosterone Antagonists: Prevent fluid retention and fibrosis.
SGLT2 Inhibitors (Dapagliflozin): Reduce hospitalization and mortality.
Positive Inotropes (Digoxin, Dobutamine): Improve contractility (acute cases).
Ivabradine: Reduces heart rate in sinus rhythm.
Devices:
ICD: Prevents sudden death.
CRT: Synchronizes ventricular contractions.
VADs: Mechanical pumps for severe cases.
Prognosis and Complications
Prognosis: Depends on EF, treatment, and comorbidities.
Complications: Pulmonary edema, arrhythmias, renal failure, and cardiogenic shock.