Congestive Heart Failure

To date, one of the main problems of cardiovascular diseases is congestive heart failure, which is an inevitable consequence of the progression of every cardiovascular disease. The increased incidence of heart failure around the world has taken epidemic proportions, especially among the elderly (Puckett, Shapiro, & Goodlin, 2013). Congestive heart failure is a clinical syndrome that manifests itself in impairment of the pumping function of the heart. Heart failure, the symptoms of which can manifest in many different ways, is characterized by the fact that it constantly progresses. Patients gradually lose the ability to work adequately and face significant deterioration in their quality of life. This paper will discuss the course, manifestations, diagnostics, and treatment of the congestive heart failure.

The Course of the Disease

Typically, heart failure develops slowly. The mechanism of its development involves many stages. Diseases that the patient already has and that lead to congestive heart disease cause an increased strain on the left ventricle (Acton, 2012). The heart muscle hypertrophies to cope with the increased cardiac workload and supports normal blood circulation for a while. However, the hypertrophied heart muscle impairs food and oxygen delivery because the vascular system of the heart cannot manage its growing volume. This results in muscular sclerosis and a set of other changes that eventually lead to dysfunction of the heart muscle, especially in the reduction of the heartbeat, causing failure in ejection of blood into vessels (Acton, 2012). For some time, the body tries to help the heart by changing the amount of hormones in the blood, narrowing small arteries, and changing the workload of the kidneys, lungs, and muscles.

In the further course of the disease, resources of compensatory possibilities of the body are depleted. The heart begins to beat faster. It does not have time to pump all the blood from the systemic circulation at first and then from the pulmonary circulation (Acton, 2012). Then, there is shortness of breath, especially at night when lying down, due to stagnation of blood in the lungs. In turn, stagnation of blood in the systemic circulation leads to the patient’s hands and feet feeling cold. The liver increases and the right upper quadrant starts hurting (Acton, 2012). As a result, congestive heart failure can lead to a sudden cardiac death, thrombosis and thromboembolism, rhythm and conduction disturbances, and liver failure.

Clinical Manifestations

The main and most visible manifestation of congestive heart failure is shortness of breath (also known as dyspnea), which sometimes occurs even at rest or with minimal exertion. Besides, heart palpitations, fatigue, low physical activity, and excess fluid in the body cause the possibility of heart failure (Clarke, Shah, & Sharma, 2011). Inadequate blood supply to the body lies at the basis of such signs of heart failure as blue nails and blue nasolabial triangle (cyanosis) at normal air temperature. These signs indicate a lesion of the right ventricle. In addition, there are bad cerebral blood flow, dizziness, dark circles under the eyes, and fainting (Clarke et al., 2011). At the last stage of the disease, skin becomes thinned, flabby, abnormally shiny, and smoothed with edemas covering the whole body.

Dyspnea occurs as the result of intensive work of the respiratory system. In the early stages of heart failure, shortness of breath occurs during exercise, but it also occurs in less stressful activity and even at rest as the disease progresses (Clarke et al., 2011). Activation of lungs receptors leads to rapid breathing, the work of the respiratory muscles intensifies, and the supply of oxygen decreases (Clarke et al., 2011). Thus, dyspnea is the most common symptom of heart failure.

One needs to make sure that the above symptoms are associated with heart disease rather than the disease of some other systems and organs. Symptoms of heart failure may be aggravated due to several factors such as transient myocardial ischemia, tachycardia, bradyarrhythmias, pulmonary embolism, an increase in the degree of mitral regurgitation, renal dysfunction, thyroid disease, side effects of medicines, and excessive intake of salt and water (Clarke et al., 2011).Important factors of symptomatic aggravation include acute respiratory infection and alcohol abuse. According to Ashton Acton (2012), dyspnea and cardiomegaly, as well as radiographic signs of pulmonary congestion are of great importance in terms of diagnostics. These signs indicate that the patient has a high risk of congestive heart disease.

Diagnostics

As a rule, medical interview and examination of the patient are used to detect heart failure. That is quite enough for diagnostics, but instrumental methods always give more information. For example, chest X-ray can reveal signs of heart failure such as venous hypertension in the lungs or accumulation of free fluid in the pleura. Furthermore, X-ray helps to identify tuberculosis, lung cancer, and inflammation, which may also be manifested through dyspnea (Clarke et al., 2011). Another instrumental method is an ultrasound of the heart. Primarily, it provides an opportunity to measure the pumping function of the heart, which is better known as ejection fraction. Normally, it is between 55% and 75% (Lam & Pieske, 2014, p. 504). If ejection fraction is reduced below 40%, then it is a clear sign of heart failure (Lam & Pieske, 2014, p. 504). In addition, the method gives information about the condition of the heart valves and cavities, the changes of which may lead to cardiac failure. It also excludes or confirms the myocardial infarction the patient might have had in the past. The last method is electrocardiography. There are no specific instructions, but just like ultrasound it may provide information on the diseases the patient might have suffered from (Clarke et al., 2011). In addition, electrocardiography carries information about the utility or the harmfulness of certain groups of medications when selecting treatment regimens.

Treatment

There are surgical treatment and drug treatment therapy. The objectives of drug treatment are to relieve or control the symptoms of heart failure, improve daily activities and quality of life, slow down the disease progression, and reduce the likelihood of complications, hospitalizations, and premature deaths. It is often necessary to receive a combination of medications to control symptoms and slow down the progression of heart failure.

Some medications are used to treat problems with the pumping function, while others are used for the treatment of problems associated with filling of the heart with incoming blood. In any case, the most common medicines used in the treatment of congestive heart failure include angiotensin converting enzyme (ACE) inhibitors, angiotensin II receptor blockers (ARBs), diuretics, aldosterone receptor antagonists, beta blockers, vasodilators, and digoxin (Puckett et al., 2013). ACE inhibitors and ARBs allow blood vessels to relax and widen, facilitating the flow of blood through the vessels (Puckett et al., 2013). Diuretics stimulate the kidneys to remove more water and salt from the body (Puckett et al., 2013). Aldosterone receptor antagonists cause the kidneys to remove excess salt and fluids as well, but they also keep the potassium level normal by inhibiting the action of the hormone aldosterone (Puckett et al., 2013). Beta blockers, vasodilators, and digoxin control heart failure symptoms by slowing the heart rate, lowering blood pressure, and dilating blood vessels, thereby facilitating the normal blood flow (Puckett et al., 2013). Different patients take different medicines depending on the cause of heart failure and other related conditions.

As for the surgical treatment, coronary artery bypass grafting or angioplasty can be carried out to open clogged arteries in people who suffer from heart failure in combination with pain in the chest or those who have had a heart attack in the past. In some cases, a surgical procedure may be performed to treat specific causes of heart failure such as damaged valves (Puckett et al., 2013). The heart failure’s reason that can be cured by surgery significantly improves or eliminates the symptoms of the disease. Doctors may also consider the option of heart transplant if the patient has a severe stage of the disease when the disease does not respond to other available therapies and limits the patient’s participation in the society (Puckett et al., 2013). Thus, the main surgical treatment options include coronary artery bypass grafting, angioplasty, or heart transplant.

Other treatment options include pacemakers, an implantable cardioverter defibrillator, left ventricular assist device implantation, and others. Biventricular pacemakers may be the best approach to the treatment of heart failure. This type of pacemaker allows patients to feel better and be more active. It can also allow them to avoid hospitalization and help them live longer. In some cases, a doctor can install the pacemaker in combination with the device that uses an electric pulse to returns the heart to a normal rhythm when it beats with the life-threatening rate (Puckett et al., 2013). This device is called an implantable cardioverter defibrillator and it is another possible approach to the treatment of patients with heart failure. A cardioverter defibrillator constantly scans the heart for a life-threatening rapid heart rate (Puckett et al., 2013). If the heart is in such a rhythm, the device gives an electrical pulse to the heart to stop the deadly rhythm of its heartbeat and return the heart to a normal rhythm. Unfortunately, the device cannot relieve the symptoms of heart failure, but it can prevent the development of sudden death (Puckett et al., 2013). In the treatment of congestive heart failure, it can be used alone or in combination with pacemakers. Thus, the treatment of congestive heart failure is not confined to a single option and it is always possible to choose the most appropriate ones to address every issue associated with the disease.

Conclusion

Congestive heart failure is an acute or chronic condition caused by the weakening of myocardial contractility and systemic and pulmonary stagnation. It manifests itself in dyspnea at rest or low physical activity, fatigue, edema, cyanosis of nails, and nasolabial triangle. The disease develops slowly and can lead to a set of severe implications and even death. Interview and examination of the patient in combination with instrumental methods such as chest X-ray are used to identify heart failure. The treatment of the disease includes surgical treatment and medical treatment, which are used either separately or in combination.