Congestive Heart Failure (CHF)

Question 1

What is Congestive Heart Failure?

Answer 1

Pump failure divided into right- and left- failure

Question 2

What are the causes of left sided heart failure?

Answer 2

-Ischemia, HTN (concentric left ventricular hypertrophy), dilated cardiomyopathy (muscle can’t contract as well), myocardial infarction and restrictive cardiomyopathy

Question 3

What causes the clinical features of left sided heart failure?

Answer 3

• Decreased forward perfusion

- Pulmonary congestion

Question 4

What does pulmonary congestion cause?

Answer 4

Pulmonary edema

• Results in dyspnea, paroxysmal nocturnal dyspnea (due to increased venous return when lying flat), othopnea, and crackles
• Small, congested capillaries may burst, leading to idntraalveolar hemorrhage; marked by hemosiderin-laden macrophages (‘heart-failure’ cells)

Question 5

What does decreased forward perfusion cause?

Answer 5

Decreased flow to the kidneys which leads to activation of renin-angiotensin system.
-Fluid retention exacerbates CHF

Question 6

What is the main treatment for Left CHF?

Answer 6

ACE inhibitor!

Question 7

What causes right sided heart failure?

Answer 7

Left sided heart failure most commonly

-Other important causes: left-to-right shunt and chronic lung disease (cor pulmonae)

Question 8

What are the clinical features of right sided heart failure? What causes these?

Answer 8

Congestion causes them:

• Jugular venous distention
• Painful hepatosplenomegaly with characteristic ‘nutmeg’ liver; may lead to cardiac cirrhosis
• Dependent pitting edema (due to increased hydrostatic pressure)