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  Congestive heart failure

Congestive Heart Failure is any physical or functional disorder that damages the hearts ability to contain, fill with or pump a sufficient amount of blood. Congestive Heart Failure is not the same as Cardiac Arrest or the stopping of the heartbeat. Congestive Heart Failure can often be undiagnosed because of the lack of a generally agreed upon definition, especially when the CHF is mild. Heart Failure is the preferred term because of the disagreement and difficulties in diagnosing CHF.

Congestive heart failure
Congestive heart failure

What Causes Heart Failure? Here are the most common causes of CHF:

• Genetic family history of CHF
• Ischaemic heart disease/Myocardial infarction (coronary artery disease)
• Arrhythmia
• Thyrotoxicosis (hyperthyroidism)
• Mitral valve disease
• Infection
• Aortic stenosis/regurgitation
• Pulmonary stenosis/Pulmonary hypertension/Pulmonary embolism all leading to cor pulmonale
• Alcohol ingestion
• Heartworms
• Anemia
• Hypertension
• Coarctation of the aorta
• Mitral regurgitation

The usual heart irritants can make CHF deadly: arterial plaque, stress, smoking, old age, lack of exercise, overworked heart, and obesity. In genetic family history of CHF, the cause is a weak heart having thinner muscle walls than usual, and often weakened further by one or more of the above heart irritants. Arterial plaque (caused by eating fatty or greasy foods) lines the inside of the arteries that supply the heart and the rest of the body, meaning less blood gets to the heart itself, as well as the heart having to work harder to push blood through the thinner systemic arteries. The result is irregular heart beats causing inefficient blood pumping and a tired heart.

How is Heart Failure Classified?

There are a few methods for classifying heart failure. Here are three: one side of the heart is involved – left v. right, contraction v. relaxation (systolic v. diastolic heart failure), and low blood output v. high blood output (or pumping).

The New York Heart Association’s functional classification is often used. This marks the progression of CHF in an individual patient based on how their lifestyle is impacted. This classification does not relate to any particular Heart Failure incident, but the life after an incident or diagnosis. Patients are not locked into one particular phase and depending on treatment may move up or down the scale. The NYHA functional assessment scale is: Class IV symptoms occur with no exertion, Class III symptoms occur with light exertion, Class II symptoms occur with heavy exertion and Class I symptoms occur at any level of exertion.

The American Heart Association also has guidelines that are based on Cardiac dysfunction v. symptoms as opposed to symptoms v. exertion level. The Stages A-D of the AHA guidelines are detailed below:
* Stage A: At risk for developing heart failure without evidence of cardiac dysfunction
* Stage B: Evidence of cardiac dysfunction without symptoms
* Stage C: Evidence of cardiac dysfunction with symptoms
* Stage D: Symptoms of heart failure despite maximal therapy

In this classification, unlike the NYHA classification, patients only progress from Stage A to D – reflecting the progression of heart failure.

What are the symptoms of Heart Failure?

Dyspnea – shortness of breath on exertion
Orthopnea shortness of breath when reclined fatigue
Paroxysmal nocturnal dyspnea – a.k.a. Cardiac Asthma – shortness of breath that occurs hours or minutes after lying down
Nighttime cough
Confusion, memory loss – (late stages)
Diaphoresis – cold hands and feet when at rest.

How is Congestive Heart Failure Treated?

Lifestyle Changes
Treatment focuses on the symptoms and indicator of Congestive Heart Failure. Treatment therefore focuses on preventing the progression of the disease. If the cause if CHF is reversible such as, infection, drinking alcohol, anemia, hypertension or bacterium, that should be addressed first. When the cause is reversible treatment may include reduction of salt intake, quitting smoking, decrease alcohol consumption, healthy diet, weight loss, fluid restriction and regular exercise.

Medication used for CHF are: diuretics, vasodilator agents, positive inotropes, ACE inhibitors, beta blockers and aldosterone antagonists. All medications must be prescribed by a health practitioner and patients should be monitored careflully.

Surgery and Devices
Different surgeries and devices are used depending on the diagnosis and severity of the CHF. Based on the level of the NYHA Class II and IV, patients may have a bi-ventricular pacemaker implanted. A pacemaker provides cardiac resynchronization therapy (CRT). CRT may also be achieved via surgical altering of the heart. These treatments may make patients feel better, improve their living and in some cases have reduced mortality.

Patients with NYHA class II, III or IV, may be implanted with a cardioverter-defibrillator or ICD. Left ventricular assist devices are battery operated pumps that take blood from the left ventricle and pump it through the aorta. They are battery operated and implanted in the patients lower chest, upper abdomen. They are often used when a patient is waiting for a heart transplant.

The final choice in treatment is when a patient does not positively respond to the other treatments available. A patient may receive an artificial heart or cardiac transplant surgery.

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