Congestive Heart Failure Overview

Congestive Heart Failure (CHF)

• CHF occurs when the heart cannot pump blood efficiently, resulting in insufficient oxygen-rich blood reaching vital organs.
• The left ventricle becomes congested with blood due to reduced pumping capacity.
• This leads to several consequences, including:
  • Increased blood volume due to salt and water retention in the kidneys, thereby increasing blood pressure.
  • Pulmonary edema (fluid buildup in the lungs), causing shortness of breath.
  • Increased heart rate (HR) and blood vessel constriction (vasoconstriction) due to sympathetic nervous system stimulation.
  • Activation of the renin-angiotensin system.
  • Reduced cardiac output (CO) and consequently lower oxygen delivery to vital organs like the brain, heart, and kidneys.

CHF Symptoms

• Common symptoms include coughing, tiredness, dizziness, and visual disturbances.
• Pulmonary edema, manifesting as shortness of breath, is a notable symptom.
• Swelling in the abdomen (ascites), legs, and ankles may occur.
• Fluid buildup around the lungs (pleural effusion) is also a potential symptom.
• Weakened myocardial (heart muscle) function may also occur.

CHF Treatment: Drug Therapy Goals

• Dual goals of drug therapy include:
  • Symptom relief: Aiming to alleviate congestion and improve cardiac performance.
    • Inotropic drugs: Digoxin, dopamine, dobutamine (increase heart contractility).
    • Vasodilators: ACE inhibitors/AT1 antagonists, hydralazine, nitrates (relax blood vessels).
    • Beta-blockers: Metoprolol, bisoprolol, carvedilol (regulate heart rate and reduce workload on the heart).
  • Disease progression prevention/reversal: To enhance long-term survival.
    • ACE inhibitors/AT1 antagonists: (reduce blood pressure, protect the heart).
    • Beta-blockers: (contributing to heart protection and survival).
    • Aldosterone antagonists (e.g., spironolactone): (manage fluid retention).

CHF Treatment: Non-Pharmacological Measures

• Rest and salt restriction are crucial non-pharmacological components of CHF management.