Clinical Symptoms Due To Fluid Congestion

HEART FAILURE
Heart failure is a progressive disorder in which damage to the heart causes

weakening of the cardiovascular system. It manifests by fluid congestion or
inadequate blood flow to tissues. Heart failure progresses by underlying heart injury
or inappropriate responses of the body to heart impairment.
Heart failure may result from one or the sum of many causes. It is a progressive
disorder that must be managed in regard to not only the state of the heart, but the
condition of the circulation, lungs, neuroendocrine system and other organs as well.
Furthermore, when other conditions are present (e.g. kidney impairment,
hypertension, vascular disease, or diabetes) it can be more of a problem. Finally,
the impact it can have on a patient psychologically and socially are important as
well.
Heart failure is a cumulative consequence of all insults to the heart over someone's
life. It is estimated that nearly 5 million Americans have heart failure. The
prevalence of heart failure approximately DOUBLES with each decade of life. As
people live longer, the occurrence of heart failure rises, as well as other conditions
that complicate its treatment. Even when symptoms are absent or controlled,
impaired heart function implies a reduced duration of survival. Fortunately, many
factors that can prevent heart failure and improve outcome are known and can be
applied at any stage.
HALLMARKS OF HEART FAILURE
Fluid Congestion
If the heart becomes less efficient as a pump, the body will try to compensate for it.
One way it attempts to do this is by using hormones and nerve signals to increase
blood volume (by water retention in the kidneys). A drop in blood flow to the
kidneys will also lead to fluid retention. Blood and fluid pressure backed up behind
the heart result in excess salt water entering the lungs and other body tissues.
However, it is important to note that not all swelling due to fluid retention is a
reflection of heart failure.
Clinical symptoms due to fluid congestion:

• shortness of breath
• edema (pooling of fluid in lungs and body)
Reduced Blood Flow to the Body

The heart's inability to pump blood to the muscles and organs isn't always apparent
in early stages of heart failure. Often times, it is unmasked only during increases in
physical activity. In advanced heart failure, many tissues and organs may not even
receive the oxygen they require for functioning at rest.
Clinical symptoms due to poor blood flow to the body:

• difficulty exercising
• fatigue
• dizziness (due to low blood pressure)
HEART FAILURE CLASSIFICATIONS

The symptoms and physical changes of heart failure have several different
classifications based on their location and mechanism.
Right vs. Left Sided Heart Failure

1. Right Heart Failure - The inability of the right side of the heart to
adequately pump venous blood into the pulmonary circulation. This causes a
back-up of fluid in the body, resulting in swelling and edema.
2. Left Heart Failure - The inability of the left side of the heart to pump into
the systemic circulation. Back-up behind the left ventricle causes
accumulation of fluid in the lungs.
As a result of those failures, symptoms can be due to:

1. Forward Heart Failure - The inability of the heart to pump blood at a
sufficient rate to meet the oxygen demands of the body at rest or at exercise.
2. Backward Heart Failure - The ability of the heart to pump blood at a
sufficient rate ONLY when heart filling pressures are abnormally high.
3. Congestive Heart Failure - Fluid in the lungs or body, resulting from
inadequate pumping from the heart and high heart filling and venous
pressures.
CAUSES OF HEART FAILURE
For heart failure to occur, there must be an unresolved impairment of the heart that
compromises its ability to work as a pump. The source of this can be a cutoff of
blood supply, an increase in workload due to high blood pressure caused by non-
functioning valves or a genetic predisposition. Heart failure can be worsened by a
poor diet and lifestyle. Its development follows the scheme below:
CONDITIONS THAT MAY LEAD TO HEART FAILURE

Coronary Artery Disease (CAD)
This is the most common cause of heart failure in the U.S. today. CAD causing
obstruction to the coronary arteries prevents blood flow and, therefore, oxygen
delivery to the heart. CAD is a manifestation of atherosclerosis, which can affect
any artery of the body. Risk factors for CAD also include smoking, high cholesterol,
hypertension, and diabetes.
Hypertension
This is more commonly known as high blood pressure. It is a condition that is
treatable and simple to diagnose with a blood pressure cuff. Although most
individuals will not have symptoms, hypertension is detected by a simple
measurement with a blood pressure cuff and stethoscope. It is also a risk factor for
CAD, stroke, peripheral vascular disease, or kidney impairment.
Valvular Heart Disease

A condition that occurs when the valves between the chambers of the heart are
faulty, either due to birth defect or injury.
Cardiomyopathy
A disease of the heart muscle. This can be one of many varieties. It can arise
because of genetic causes, a viral infection, or consumption of toxins (lead, alcohol,
etc.). In peripartum cardiomyopathy, women who have recently given birth can
develop heart muscle impairment. In many cases, the condition is called
"idiopathic", which means it has occurred of uncertain origin or cause.
In addition to those causes above, the following factors also can play a role in
determining if heart failure will affect you:
1. family history of heart failure
2. diabetes
3. marked obesity
4. heavy consumption of alcohol, or drug abuse
5. failure to take medications
6. large salt intake in diet
7. sustained rapid heart rhythms
Many other conditions can actually simulate heart failure symptoms - it is important
to seek evaluation from a medical professional for a definitive diagnosis. Some of
these are:
1. lung impairment
2. anemia
3. kidney impairment
4. pericardial disease (rare)
SIGNS AND SYMPTOMS
Swollen Ankles or Legs

Swollen ankles or legs, known as peripheral edema, may be a result of right-sided
heart failure since fluid cannot be pumped to the lungs at an efficient rate. In right-
sided heart failure, fluid backs up in the veins, leaks out of capillaries and
accumulates in tissues. Also, a decrease in blood flow to the kidneys can lead to an
increase in fluid retention. Diuretics are often prescribed to get rid of this excess
fluid and reduce the strain on the heart.
In the absence of heart failure, peripheral edema may commonly be due to obesity
or venous insufficiency with stretched venous valves.
Shortness of Breath
Shortness of breath can be caused by congestion in the lungs. This congestion is
known as pulmonary edema. One sign to watch out for is whether your shortness of
breath is worse when you lay flat. Orthopnea is the shortness of breath which
occurs when blood kept in the legs by gravity returns to the chest when you lay
down.
Shortness of breath can also occur at night. Shortness of breath that comes on
suddenly at night is known as paroxysmal (par-ox-iz-mal) nocturnal dyspnea.
Angina
Angina is chest or arm discomfort due to a blockage of the coronary arteries. Heart
cells typically do not get enough oxygen when blood flow to the heart muscle is
reduced. Often, angina comes on with exertion and is relieved by rest. This is
because your heart may have an adequate blood supply when it is not working very
hard but not when under stress. Other common causes of chest pain unrelated to
the heart are chest muscle, bone or joint disease, and acid in the esophagus.
Fatigue
Fatigue is often attributed to getting old or being out of shape. However, if this
condition persists for long periods of time, it may be the result of heart failure.
Sluggishness may be the result of your organs not getting enough oxygen. You may
feel as tired after getting up in the morning as you did when you went to bed. Let
your doctor know if this happens on a regular basis.
Weight Gain or Loss

Excess fluid in the body may cause an increase in weight. Similarly, when excess
fluid is excreted, your weight may fall. Weight increases by about two pounds for
each extra quart of fluid. You may notice that your weight has risen before you
notice swelling of the ankles or extremities. Inform your doctor of changes of more
than five pounds.
Loss of Appetite
Fluid accumulation in the digestive organs can cause you to feel full. You may also
feel bloated. You may want to try eating smaller more frequent meals instead of the
traditional three large meals a day.
MEDICAL TESTS AND FINDINGS
Chest X-ray
Your doctor can use an x-ray to look at your heart, lungs, and blood vessels. He or
she can see if your heart is enlarged or if there is fluid around your lungs.
Pulmonary congestion shows up as cloudy areas on the x-ray. A chest x-ray requires
only a brief exposure to x-rays and is generally considered safe.
Echocardiogram
The echocardiogram is a procedure used to visualize the pumping action of the
heart. It is an ultrasound examination of the heart that can also measure blood flow
into and out of the heart.
Electrocardiogram
This test also known as an "ECG" or "EKG", measures the electrical activity of the
heart. An electrocardiogram can check the heart's rhythm, evidence of
enlargement, and the presence of a prior or recent heart attack. Electrical wires
with adhesive ends are attached to the skin on your chest, arms, and legs. The
electrical activity of the heart is then recorded on a piece of paper.
Tracer Studies
Radioactive tracers given through a hand or arm IV are another tool used in the
diagnosis of heart failure. Radioactivity is detected as the blood moves through the
heart. In this way, doctors can outline the chambers of the heart, measure the
ejection fraction, and assess blood flow to regions of the heart muscle.
Treadmill Test
This test is known as a "stress test" because your heart's activity is being
monitored with an electrocardiogram during exercise. By walking on a treadmill for
specific intervals of time at differing intensity levels, your doctor can see if your
symptoms are brought on by exertion and if they correlate with patterns on an
electrocardiogram.
Stress tests can be done using radioactive tracers such as thallium, Sesta MIBI, and
Myoview. First, the tracer is injected into an IV tube in the arm before and during
exercise on the treadmill. After exercise, pictures of the heart can be taken to see
where the tracer has been deposited, telling the doctor which areas are getting
enough blood and which are not.
Alternatively, stress testing can be done without exercise. The effects of stress on
heart blood flow can be simulated through the use of an IV drug such as adenosine
or persantine that dilates heart blood vessels, or dobutamine that increases heart
rate and function.
Catheterization
Doctors can insert a catheter, or small tube, into a leg (femoral) artery via a needle
stick and direct it to a region of the heart with x-ray guidance. Once in place, the
catheter can measure pressures in the heart and direct a dye used to visualize
heart chambers or blood vessels. This visualization technique is called angiography.
The x-rays show areas of narrowing or blockage. Catheters are also used to open
blocked heart arteries with angioplasty and stenting.
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HEART FAILURE

Heart failure is a progressive disorder in which damage to the heart causes

HALLMARKS OF HEART FAILURE

Clinical symptoms due to fluid congestion:

Reduced Blood Flow to the Body

Clinical symptoms due to poor blood flow to the body:

HEART FAILURE CLASSIFICATIONS

Right vs. Left Sided Heart Failure

As a result of those failures, symptoms can be due to:

CAUSES OF HEART FAILURE

CONDITIONS THAT MAY LEAD TO HEART FAILURE

Valvular Heart Disease

SIGNS AND SYMPTOMS

Swollen Ankles or Legs

Weight Gain or Loss

MEDICAL TESTS AND FINDINGS

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