Congestive Heart Failure Basics
Congestive Heart Failure
Congestive heart failure (CHF) is a condition that develops as a result of other disease processes occurring in the body that eventually affects the heart’s function to adequately pump blood to the rest of the body. “Congestive heart failure is a chronic, progressive condition in which the heart gradually becomes unable to pump enough blood to needs of the body” (Davidson & Cataldo, 2011).
A patient can develop more then one type of heart failure. Two types of heart failure exist: right and left heart failure. When the left ventricle can’t pump out enough blood, blood gets backed up in the lungs, causing pulmonary edema, a build up of fluid in the lungs. This fluid in the lungs makes patients wheeze, cough, and become short of breath. This excess fluid or congestion explains the term congestive heart failure. When the right ventricle cannot pump out enough blood, it causes fluid to back up into the veins and capillaries of the body. Because of the backup, fluid leaks out of the capillaries and builds up in tissues causing systemic edema (Quinn, 2006).
Heart failure is not a disease but develops as a result of other conditions that damage the heart. “Ischemic heart disease and hypertension are the most important predisposing risk factors” (Huether & McCance, 2012).
Types of Heart Failure
- Heart failure is a chronic, progressive condition which the heart gradually becomes unable to pump enough blood to meet the needs of the body
- Two types of heart failure can occur. A patient can have one or both types.
- Left sided Heart Failure
- Right sided Heart Failure
- Heart Failure itself is not a disease, but develops as a result of other conditions that damage the heart
Congestive Heart Failure Statistics
- About 5 Million Americans have CHF with about 500,000 new cases annually
- Men ages 40-75 are more likely than women to develop the condition
- After age 75 the percentage of men and women CHF is about equal
- African Americans are 1.5 times more likely to die of CHF than white Americans.
- Patients 65 and older are hospitalized more for complication s of CHF than any other medical condition, accounting for about 875,000 hospital admissions each year
- Costs of treatment for patients in the United States is between $10 Billion and $30 Billon dollars
- More than a quarter of a million deaths in the United States each year
- Most common cause of death of people over 65 years of age!
Who is getting CHF??
Congestive heart failure continues to increase among American’s and the world as a result of chronic conditions. “About 5 million Americans have CHF with a bout 500,000 new cases diagnosed each year. Men ages 40-75 are more likely to have CHF than women but after age 75, the percentage of men and women with CHF is equal” (Davidson & Cataldo, 2011). This condition does not discriminate against ethnic groups either. “African Americans are 1.5 times more likely to die of CHF than White Americans” (Davidson & Cataldo, 2011). Other ethnic groups, primary African Americans tend to develop the disease process more often then White Americans. This could be as a result of not only hereditary influence but life styles. “ African Americans experience heart failure twice as often as Caucasians” (Quinn, 2006).
Congestive heart failure is a condition that can cause frequent trips to the hospital if not managed well in the community setting by physicians. Because of this, “Patients 65 and older are hospitalized for complications of CHF more often and any other medical condition, accounting for about 875,000 hospital admission each year” (Longe, 2006). This condition does not come without its burden of increased cost to private insurance, Medicare and out of pocket expenses for patients in the United States. “Cost of treatment for patients in the United States is between $10 billion and $30 billion dollars” (Longe, 2006). Congestive heart failure leads eventually leads to mortality after it continues to progress to its final stages and treatments stop working for patients. “It accounts for more than a quarter of a million deaths in this country and is the most common cause of people of over sixty-five” (Quinn, 2006).
The reason I have chosen to do this presentation on congestive heart failure is because as a hospice nurse I care for many elderly patients that are at the end stages of this condition. I typically care for patients who are at the very end stages of CHF and are typically classified on the New York Heart Association (NHYA) scale Class III and Class IV. Overall, it is a condition that I continue to see more of in my practice along with other complications such as renal failure related to long use of diuretic therapy to manage the symptoms of this condition.
Anatomy of the Heart
Left vs. Right Symptoms
- Left sided heart failure - results in fluid collecting in the lungs causing pulmonary edema and increased shortness of breath
- Right sided heart failure - causes collection of fluid in the feet and legs causing increased edema (swelling)
The science behind the condition!
The science or "pathophysiology" behind congestive heart failure (CHF) can be confusing at times. Left sided heart failure causes pulmonary edema and increased shortness of breath, leading to the condition called congestive heart failure. This article will continue to focus on the pathophysiology of left side heart failure and not right side heart failure, though the condition exists. Two types of left side of heart failure can occur. Systolic heart failure and diastolic heart failure.
Systolic heart failure is “the inability of the heart to generate adequate cardiac output to perfuse vital tissues” (Huether & McCance, 2012). This results in the disruption of myocardial cell activity. “When contractility is decreased, stroke volume falls and left ventricular end-diastolic volume (LVEDV) increases. This cause dilation of the heart and increased preload” (Huether & McCance, 2012).Because of these developments, afterload on the heart is going to be affected, specifically by increased peripheral resistance and other disease processes. “Increased afterload is most commonly a result of increased peripheral vascular resistance, such as that seen with hypertension. It also can be the result of aortic valvular disease” (Huether & McCance, 2012).
Diastolic heart failure is “also known as heart failure with preserved systolic function or heart failure with normal ejection fraction (HFNEF). Diastolic heart failure can occur singly or along with systolic heart failure. It results from decreased compliance of the left ventricle and abnormal diastolic relaxation such that a normal left ventricular end-diastolic volume result in an increased left ventricular end-diastolic pressure” (Huether & McCance, 2012).
More of the Science!
As the heart fails to pump enough blood to meet the needs of body, the heart tries to compensate by making changes to the heart. “Sometimes the heart tries to compensate for its lack of pumping ability by becoming hypertrophic” (Longe, 2006). “Pathologically, the heart muscle exhibits gradual changes in myocyte structure and function with apoptosis of cells, deposition of fibrin and remodeling of the myocardium such that contractility and cardiac output decline” (Huether & McCance, 2012). As a direct result from this remodeling of the heart muscle changes in preload and afterload occur and ultimately a decrease in ejection fraction occurs. “A vicious cycle of decreasing contractility, increasing preload, and increasing afterload develops, causing the progressive worsening of symptoms associated with left heart failure” (Huether & McCance, 2012).
So you are probably asking what is an ejection fraction. Well, ejection fraction is, “the measure of the percentage of blood that is ejected from the main pumping chamber of the heart with each beat. A normal heart pumps out or ejects only about 50 to 65 percent of the blood inside. If the heart is damaged, the ejection fraction frequently falls below 40 percent” (Quinn, 2006).
Normal heart vs. Congestive Heart
So what causes CHF?
Multiple disease processes can lead to the development of congestive heart failure. Some of them are modifiable by life style changes. Some can be congenital and have a genetic component but most of them can be modified by improved lifestyle changes. “Coronary artery disease (CAD) is the most common cause of heart failure. The arteries that supply the heart muscle with blood begin to narrow over time. Eventually, they may be come completely blocked” (Longe, 2006). This can lead to a myocardial infarction. “Some common conditions contributing the CHF that make the heart work harder and can increase the risk of CHF include: uncontrolled hypertension, heart valve abnormalities, prolonged heart arrhythmias, endocarditis, obesity, and congenital heart defects” (Cataldo, 2011). The use of drugs and alcohol along with smoking and diabetes increases a person’s risk for development of CHF.
The clinical manifestations of left heart failure are the result of pulmonary vascular congestion and inadequate perfusion of the system circulation. Individuals experience dyspnea, orthopnea, cough of frothy sputum, fatigue, decreased urine output, and edema. Physical examination often reveals pulmonary edema (cyanosis, inspiratory crackles, pleural effusions), hypotension or hypertension, and S3 gallop and evidence of underlying CAD or hypertension (Huether & McCance, 2012).
Increased dizziness and fatigue are also symptoms a patient with congestive heart failure may experience related to inadequate oxygenation because of compromised lung function from pulmonary edema. “When body tissues fail to get the oxygen and nutrients they require, they begin to lose their efficiency, causing increased dizziness and fatigue” (Longe, 2006).
Causes and Symptoms
Coronary Artery Disease
Heart Valve Disorders
Drugs & Alcohol
Shortness of Breath
Weakness & Fatigue
Irregular Heart Beat
3D Video animation for CHF
New York Heart Association Classification for Heart Failure
The New York Heart Association Classification for heart failure is a tool that is widely used for assessment by nurses and physicians to monitor changes in level of symptoms and condition related to heart failure. “The most widely used classification system for CHF is the New York Heart Association (NYHA) classification system. According to this system, a patient’s heart failure is rated on a scale of I to IV with “class I” patients having the mildest symptoms and “class IV” patients having the worst symptoms” (Quinn, 2006).
- Class I – pt has no limitation of physical activity. No shortness of breath, fatigue, heart palpations with physical activity
- Class II – pt has slight limitation of physical activity. Has shortness of breath, fatigue, or heart palpitations with ordinary physical activity, but is comfortable at rest
- Class III – pt experiences marked limitation of activity. Shortness of breath, fatigue, or heart palpitations with less then ordinary physical activity, but comfortable at rest
- Class IV – pt suffers from severe to complete limitation of activity. Shortness of breath, fatigue or heart palpitations with any exertion and symptoms appear even at rest including chest pains
Summary & Conclusion
Overall, there is an increased incidences of death with this condition that becomes terminal at the very end stages. “It accounts for more than a quarter of a million deaths in this country and is the most common cause of death in people over 65” (Quinn, 2006).In summary, this condition known as congestive heart failure (CHF) continues to increase and affect more American’s each year and is becoming one of the most costly health conditions seen in this country. Dr. Quinn writes, “CHF is the single most costly heath care problem in the United States and the second leading reason for hospitalization in patients of 65 years of age. CHF cost exceed those for treating myocardial infarctions and cancers combined”.
In conclusion, “About 50% of patients diagnosed with CHF live for at least five years with the condition” (Longe, 2006). Lastly, modifying life styles and habits can prevent other disease processes and conditions that lead to CHF and its complications and it is all about decreasing the preload and after load on the heart.
This article was written by James Constanzer, registered nurse and owner of VitalLifeSenior.com an online retail store for senior that provide them and their families and caregivers with the best medical supplies, mobility equipment, vitamins and supplements they need to maintain a healthy, independent lifestyle.
References & Disclaimers
Chernyavskiy, A. M., Marchenko, A. V., Lomivorotov, V. V., Doronin, D., Alsov, S. A., & Nesmachnyy, A. (2012). Left Ventricular Assist Device Implantation. Texas Heart Institute Journal, 39(5), 627-629.
Davidson, T., Cataldo, L.(2011). “Congestive heart failure.” Gale Encyclopedia of Medicine. Detroit, MI: Gale.
Huether, S. E. & McCance, K. L. (2012). Understanding pathophysiology (5th ed.). St. Louis, MO: Elsevier.
Longe, J., “Heart Failure”(2006). Gale Encyclopedia of Nursing and Allied Health. Detroit, MI: Thompson Gale.
National Heart Lung and Blood Institute. (2012). “What is a ventricular assist device?”. Retrieved from: http://www.nhlbi.nih.gov/health/health-topics/topics/vad/
Quinn, C. (2006). 100 Questions & answers about congestive heart failure. Sudbury, MA: Jones & Bartlett
Though the author of this information is a licensed nurse, the information provided above is FOR EDUCATIONAL USE ONLY, and DOES NOT CONSTITUTE MEDICAL ADVICE/OPINION, is not meant to diagnose or treat any illness or disease, and is not a substitute for the medical advice of your (or your loved one's) primary care physician or other medical professional. While striving to be factual and exact, no warranties are made with regards to the accuracy of the information provided above. You are always advised to talk with your (or your loved one's) doctor about any health concerns that you have and about any of the information provided above. Sole reliance on the information provided above is not advised and would be solely at your own risk and liability.