Congestive Heart Failure

Congestive Heart Failure

Congestive Heart Failure, also known as "cardiac decompensation, cardiac insufficiency, and cardiac incompetence," (Basic Nursing 1111) is an imbalance in pump function in which the heart is failing and unable to do its work pumping enough blood to meet the needs of the body's other organs. To some people, heart failure is defined as a sudden and complete stoppage of heart activity--i.e. that the heart just stops beating. This is an inaccuracy. Heart failure usually develops slowly, often over years, as the heart gradually loses its pumping ability and works less efficiently. CHF is a syndrome that affects individuals in different ways and to different degrees. It is usually a chronic disease. It gradually becomes worse. By the time someone is diagnosed with it, the heart may have been losing pumping capacity for quite some time. Many people are not even aware of their condition until symptoms appear years after the heart began its decline.

Nearly 5 million Americans are currently living with the condition, with 550,000 new cases diagnosed each year. CHF is responsible for 250,000 deaths each year, most of them occurring suddenly. CHF affects people of all ages from children to senior citizens, although it is more common among older people. It is believed to be the number one case of death in those over 65. "Half the people diagnosed with CHF will be dead within five years" (www.nhlbi.nih.gov).

Causes

CHF is usually divided into two categories--left-sided and right-sided heart failure. Left sided heart failure happens when the left ventricle (lower chamber) becomes weak, dilates like an inflated balloon, and is unable to generate sufficient force to create proper blood flow (called systolic failure). In some patients diastolic dysfunction is the culprit. With this condition, the left ventricle becomes thick and stiff and does not relax adequately for blood to flow into it during the resting period between beats.

In right ventricle heart failure, the right atrium (upper chamber) receives the "used" blood that returns to the heart through the veins; there the right ventricle pumps it into the lungs to be replenished with oxygen. Right-sided heart failure occurs as a result of left-sided heart failure. When the left ventricle fails, increased fluid pressure is transferred back through the lungs, eventually damaging the heart's right side.

Pulmonary edema, the most severe manifestation of CHF, develops when fluid backs up in the lungs and body, causing shortness of breath and swelling in the legs, ankles, and arms.

Everyone loses pumping ability in their heart as they age. The serious case of heart failure develops when other heart conditions cause the heart to work harder or become damaged due to increased stress. For this reason, CHF is often called the "final common pathway of heart disease" (Heart Disease Sourcebook 14). All of the behaviors that are associated with heart attacks--such as smoking, being overweight, eating a diet high in fat and cholesterol, alcohol or drug abuse, and lack of exercise--can also cause heart failure. In some cases, however, behavior has absolutely nothing to do with it. For example, some people who develop heart failure were born with structural heart defects, while others may have contracted a virus that damaged the heart muscle.

Risk Factors

If someone experiences CHF, chances are they have or had one or more of the following. Some of these can be present without the person realizing it.

 Hypertension

The heart has to pump harder than normal to keep the blood circulating when pressure within the blood vessels is too high. Hypertension doubles a person's risk of developing heart failure.

 Lung Disease

When the lungs don't work properly, the ehart must work harder to get the available oxygen to the rest of the body.

 Diabetes

The risk for heart failure increases when diabetes puts additional strain on the heart. Those suffering from diabetes also tend to be overweight and have hypertension and high cholesterol--all of which make the heart work harder.

 Hyperthyroidism

This condition causes the body to move at a faster pace, and the heart can become overworked.

 Severe anemia

If there aren't enough red blood cells to carry oxygen, the heart will try to move the small number of cells at a faster rate and overtax itself.

 Coronary artery disease

Cholesterol and fatty deposits build up in the heart's arteries, causing less blood to reach the heart muscle. The muscle becomes damaged and the remaining heart tissue has to work harder.

 Arrhythmia or dysrhythmia

If the heart beats too fast, too slow or irregularly, it may not be able to pump enough blood to all of the body.

 Myocardial infarction

A heart attack occurs when an artery that supplies blood to the heart becomes blocked. The loss of oxygen and nutrients damage the heart's muscle tissue, causing the remaining healthy tissue to pump even harder to keep up.

 Abnormal heart valves

Disease, endocarditis or a congenital defect can result in heart valve problems. When the valves don't open or close properly during each heartbeat, the heart muscle has to pump harder to keep blood moving.

 Cardiomyopathy or myocarditis

Any damage to the heart muscle increases the risk of heart failure.

 Congenital heart disease

If the heart and its chambers aren't formed correctly prior to birth, the healthy parts have to work all the harder.

Some additional risk factors include:

 Elevated Cholesterol

For individuals with coronary artery disease, "LDL-cholesterol should be les than 100 mg/dL. For individuals with two or more risk factors for cardiovascular disease, LDL-cholesterol should be less than 130 mg/dL. Triglycerides should be less than 200 mg/dL. HDL-cholesterol should be greater than 40 mg/dL