Definition of Terms

Congestive heart failure (CHF) is a disorder in which the heart is unable to pump an adequate amount of blood to meet the
metabolic demands of the body at rest or during exercise. The amount of blood coming out of the heart is decreased, which
leads to inadequate blood flow and inadequate delivery of oxygen to organs and tissues throughout the body (decreased tissue
perfusion). In response to decreased tissue perfusion, the body activates certain normal, compensatory mechanisms at the
cellular level and in interactions between organs in an attempt to restore cardiac performance. However, these complex
mechanisms (e.g., release of norepinephrine, dilation of the cardiac chambers, or activation of the sympathetic nervous system)
may result in increased pressure and congestion in the vessels (hence the term "congestive heart failure"). Eventually, as the
compensatory mechanisms are overwhelmed, the heart begins to fail, resulting in circulatory failure and increased morbidity and
death.

Predisposing and Precipitating Factor

Predisposing factors:

Advancing Age

Heart failure is the most common reason for hospitalization in the elderly, and as the population ages, the incidence of heart
failure is rising dramatically. According to one report, it occurs at a rate of about 10 per 1,000 people after age 65. The positive
implication is, however, that people are living longer with heart failure.

Gender

Men are at higher risk for heart failure than women, although the difference narrows with age. Women also have a better
survival rate than men do when heart failure is caused by valvular heart disease, high blood pressure, or alcohol abuse. (Some
studies indicate that this is because men may be more susceptible to the process of heart muscle-cell remodeling, a damaging
effect of hypertension.)

The survival rates of women and men are more similar, however, when heart failure evolves from coronary artery disease or
heart attack. Women are much more likely to develop heart failure after a heart attack than men. In such cases, some evidence
suggests that the reasons for this may include less aggressive approach to treatment for the initial heart conditions.
Ethnicity

African-Americans are at higher risk for heart failure than Caucasians, and studies have reported that they tend to do much
worse. In a 2003 study, however, in which Caucasians and African-Americans had comparable treatment, African-Americans
actually had lower 1-year mortality rates (with slightly higher rates of rehospitalizations). Still, more studies are needed to
determine if there are actual biologic differences in specific patients. Some evidence, for example, suggests that African-
Americans are more often likely than Caucasians to develop diastolic heart failure (a failure of the heart muscle to relax
normally), which is often a precursor to systolic heart failure (impaired ability to pump blood). Caucasians tend to develop
systolic heart failure first. In one study comparing Caucasian and African-Americans who only had diastolic heart failure,
African-Americans had a 30% higher mortality rate.

Family History and Genetics

A family history of early heart failure caused by cardiomyopathies (diseases that damage the heart muscle) may predispose
people to the disease. Researchers are also looking for changes in specific genes that might regulate systems involved in heart
failure and so increase susceptibility in certain populations.

Chronic Alcohol Abuse

Chronic alcohol abuse can damage the heart muscles, can cause hypertension, and may prove to be one cause of idiopathic
dilated cardiomyopathy. Moderate alcohol consumption, on the other hand (generally defined as two drinks a day for men and
one for women), may protect against heart failure. Non-drinkers, though, are not advised to begin drinking.

Coronary Artery Disease

Individuals with coronary artery disease are most at risk for developing congestive heart failure. Coronary artery disease occurs
when cholesterol builds up in the heart's arteries, a process known as atherosclerosis. The build-up narrows the passageways
available for blood flow, so the heart must work harder to pump blood through. In addition, coronary heart disease continually
deprives the heart of oxygenated blood.

Hypertension
Chronic hypertension, or high blood pressure, makes the heart work harder than necessary. Gradually, the heart muscle will
weaken and may become thicker, which in turn makes pumping blood more difficult. Eventually, the heart muscle may not be
able to pump blood effectively because of muscle weakness and stiffness.
Cardiomyopathy
Cardiomyopathy, or damage to the heart muscle, may occur as the result of infections, alcoholism or illicit drug use. Diseases
such as those affecting the thyroid and lupus also may cause cardiomyopathy. Other diseases with the potential to cause heart
damage include diabetes, emphysema, severe anemia, hemochromatosis and amyloidosis. Damaged heart muscle may lose its
ability to pump blood properly, leading to congestive heart failure.
Other Risk Factors
Individuals with damaged heart valves may be at risk for congestive heart failure. Luckily, heart valves can often be repaired.
Congenital heart defects may also put individuals at risk of developing congestive heart failure, as well as myocarditis, or heart
inflammation as the result of a virus. In addition, individuals who have heart arrhythmias may develop congestive heart failure
over time.

Precipitating Factors:
  
 Making lifestyle changes can often help relieve signs and symptoms of heart failure and prevent the disease from
worsening. These changes maybe among the most important and beneficial you can make

 Smoking. Smoking harms nearly every organ of the body. Some of the possible ways smoking is thought to harm kidneys
are by:

 Reducing blood flow in the kidneys

 Increasing production of angiotensin II (a hormone produced in kidney)
 Narrowing the blood vessels in the kidneys
 Damaging arterioles (branches of arteries)
 Forming arteriosclerosis (thickening and hardening) of the renal (kidney) arteries
 Accelerating loss of kidney function

 Restrict sodium.
Sodium is a component of salt. Too much sodium contributes to water retention, which makes your heart work harder and cause shortness
of breath and swollen legs, ankles and feet. For people with hear tfailure, the recommended sodium intake is no more than 2,000milligrams a day.
 Limit alcohol and fluid excessive use of alcohol can directly weaken your heart muscle or increase your risk of abnormal
heart rhythms that may worsen existing heart failure. Alcohol may also interact with some medications used to treat heart
conditions. Your doctor likely will advise yout o abstain from alcohol if you have heart failure. If you have severe heart
failure, your doctor may also suggest you limit your total intake of fluids.

 Exercise.
Exercise was once forbidden for people with heart failure. But, moderate exercise helps keep the rest of your body healthy and
conditioned, reducing the demands on your heart muscle. Before you start
 
 Reduce stress.
When you're anxious or upset, your heartbeats faster and you breathe more heavily. This can make heart failure worse, since
your heart is already having trouble meeting the body's demands. Find ways to reduce stress

Signs and Symptoms

Signs and Symptoms Rationale

Dyspnea Occurs because of increased effort of breathing.

Dyspnea occurs initially upon exertion, but in advanced CHF may

occur at rest.
Paroxysmal (nocturnal) dyspnea sudden-onset of severe shortness of breath and coughing, awakening the
patient

Ascites  Pleural effusion results from increased pulmonary capillary hydrostatic

pressure and the attendant movement of fluid into the pleural cavity

Jaundice

fatigue Is caused by the decreased blood supply and O2 in the different parts of
the body.

Nausea Due to increased urea in the blood or due to decrease potassium in the
 blood. Cause of gastrointestinal venous congestion

a r r h y t h m i a s usually have to be severe and

prolonged, with a rapid rate of more than 140 beats per minute,
and must often occur in
the presence of an already weakened heart. They change the
pattern of filling and