CASE CONGESTIVE HEART FAILURE

STUDY MARY TRIANA XH/26

DEFINITION
Heart failure is a state of
reduced cardiac output, in
which the heart cannot pump
blood around the body
effectively. Congestive heart
failure (CHF) is
a chronic progressive
condition that affects the
pumping power of
your heart muscles. While
often referred to simply as
“heart
failure,” CHF specifically
refers to the stage in which
fluid builds up around
the heart and causes it to EPIDEMIOLOGY
pump inefficiently.
The overall prevalence of heart failure is 1 to 2% in middle-
aged and older adults, reaches 2 to 3% in patients older than
ETIOLOGY age 65 years, and is 5 to 10% in patients beyond age 75
years.
The most common causes of
heart failure are coronary
artery disease and high
blood pressure. Coronary
artery disease is the
narrowing or hardening of
arteries that supply blood to
the heart muscle, usually
caused by a buildup of fats
and cholesterol. High blood
pressure is also called
hypertension.
PATHOPHYSIOLOGY
Congestive heart failure is a
syndrome that can be caused by a
variety of abnormalities, including
pressure and volume overload, loss of
muscle, primary muscle disease or
excessive peripheral demands such as
high output failure. In the usual form
of heart failure, the heart muscle has
reduced contractility.

CLINICAL SYMPTOMS

• Shortness of breath
(dyspnea) when you
• Increased need to urinate at night
exert yourself or when
• Swelling of your abdomen (ascites)
you lie down
• Very rapid weight gain from fluid retention
• Fatigue and weakness
• Lack of appetite and nausea
• Swelling (edema) in your
• Difficulty concentrating or decreased alertness
legs, ankles and feet
• Sudden, severe shortness of breath and coughing up pink,
• Rapid or irregular
foamy mucus
heartbeat
• Chest pain if your heart failure is caused by a heart attack
• Reduced ability to
exercise
• Persistent cough or
wheezing with white or
pink blood-tinged phlegm
TREATMENT
COMPLICATION
Treatment depends on severity
Treatments can include eating
less salt, limiting fluid intake and • Kidney damage or failure. Heart failure can reduce the
taking prescription medication. blood flow to your kidneys, which can eventually cause
kidney failure if left untreated. Kidney damage from heart
Lifestyle drug failure can require dialysis for treatment.
Physical exercise, Quitting
smoking, Weight loss, and Low
sodium diet • Heart valve problems. The valves of your heart, which
keep blood flowing in the proper direction through your
Medications heart, may not function properly if your heart is enlarged
Diuretic, Beta blocker, ACE
inhibitor, Antihypertensive drug, or if the pressure in your heart is very high due to heart
Dietary supplement, Blood failure.
pressure support, Vasodilator,
and Antianginal • Heart rhythm problems. Heart rhythm problems
(arrhythmias) can be a potential complication of heart
Medical procedure
Cardiac resynchronization failure.
therapy
• Liver damage. Heart failure can lead to a buildup of fluid
that puts too much pressure on the liver. This fluid
backup can lead to scarring, which makes it more difficult
for your liver to function properly

PREVENTION

The key to preventing heart failure is to reduce your risk factors. You can control or
eliminate many of the risk factors for heart disease — high blood pressure and
coronary artery disease, for example by making lifestyle changes along with the
help of any needed medications.like Not smoking,Staying physically active,Eating
healthy foods,Maintaining a healthy weight,Reducing and managing stress.
BASIC DIAGNOSIS
Family medical history:
• Brother had hypertension
Identity: • Father had heart attack
Name : M
Gender : male Habit history:
Age : 60 years old • Patient smoked 2 packs of ciggaretes a day since patient was 20
Weight : unknown(-) years old
Height : unknown (-) • Uncoordinated medication

Main complaint: swollen Physical examination:

legs(both sides),dyspnea • Compos mentis (concious)
d’effort(shortness of breath • Moderate illness
while doing a simple physical • Dyspnoe (shortness of breath)
activity),orthopnea(difficulty • Vital sign:
breathing while lying
flat),tachypnea(abnormal rapid
breathing) (± 7 days),weight
gain in the last few days.

Further anamnesis
information: • Neck: JVP 5 + 4 cm H2O (normal)
• patient has experienced • Thorax:
breathing difficulties for 4 -Percussion: left-right lung sonor (normal
months and had to be -Auscultation: fine crackles (ronki basah halus) (brief,
hospitalized discontinuous, popping lung sounds that are high-pitched)
• patient is suffering from They indicate excessive fluid on the lungs which could
anorexia be caused by aspiration.
• abnormal heartbeat • Heart:
sensation (+) -Inspection: ictus cordis 1 cm lateral LMCS ICS V
-Palpation: ictus cordis palpable in ICS V 1cm lateral LMCS
• weather and dust is
-Percussion; left border:1cm lateral LCMS ICS V
irrelevant to patient’s
-Auscultation: gallop sound (sign of left ventricle disfunction)
breathing
• Abdomen: palpable hepar 3cm BAC , non palpable lien
• nausea,vomit (-)
• Extremity: low part extremity has pitting oedema in pre tibal
• hypertension(+)
• X photo thorax: mild cardiomegaly,lung dam accompanied by
• chest pain (+)occurs
an obtuse costophrenicus angle
while climbing up the
stairs and disappears
while resting or when
taking nitrate s/l
Laboratory examination
• On laboratory
examination: Hemoglobin LAB TEST
15 g / di,
• Ht 46%
• Leukocytes 7200 / mm3
• Total Cholesterol 280 mg
• Renal Function
/ dl Renal function should be assessed as a rough guide to
• LDL Cholesterol 170 mg / the patient's intravascular volume status and renal
dl perfusion. A urinalysis is helpful in the assessment of
• HDL Cholesterol 35 mg the patient's volume status. Electrolyte assessment and
Idl. Tiglyceride 145 mg / the correction of electrolyte disturbances such
dl
as hypokalemia, hyperkalemia and hypomagnesemia is
• Sodium 136 mEg / L
• Potassium 3.6 mEq / L. critical in those patients treated
• Glucose 144 g / dl. with diuretics. Hyponatremia (due to poor stimulation of
• SGOT: 50 U / L the baroreceptors and appropriate ADH release and
• SGPT 58 U / L. free water retention) is associated with a poor
• Creatinin 0.9 mg / dl. prognosis.
• Ureum: 14 mg / dl, • Hematologic Studies
• Uric acid: 7.6 mg / dl.
• A complete blood count should be obtained to assess
• Troponin T: negative.
• NT proBNP> 2000 pg / ml.
for the presence of anemia which may exacerbate heart
failure and to assess the patients coagulation status
which may be impaired due to hepatic congestion.
• Thyroid Studies
RISK FACTOR • The assessment of thyroid function tests is particularly
important in the patient who is being treated with
• High blood pressure.
concomitant therapy with an agent such
as amiodarone.
• Coronary artery disease.
• Heart attack.
• Diabetes.
• Some diabetes
PROGNOSIS
medications.
• Certain medications t Although there have been recent improvements in congestive
• Sleep apnea. heart failure treatment, researchers say the prognosis for
people with the disease is still bleak, with about 50% having
• Congenital heart defects.
an average life expectancy of less than five years. For those
• Valvular heart disease. . with advanced forms of heart failure, nearly 90% die within
• Viruses. one year.
• Alcohol use.
• Tobacco use.
• Obesity.
• Irregular heartbeat
RECIPE

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