Congestive heart failure is a pathophysiological condition in which the heart cannot supply the blood (especially oxygen) it needs from body tissues or organs for several reasons.
Heart failure can be acute or chronic. Heart failure is often due to a variety of causes, including other heart conditions, such as chronic high blood pressure, coronary artery disease, mechanical defects in the valves, and chronic arrhythmias (atrial fibrillation is the most common).
Heart failure can be acute or chronic. Heart failure is often due to a variety of causes, including other heart conditions, such as chronic high blood pressure, coronary artery disease, mechanical defects in the valves, and chronic arrhythmias (atrial fibrillation is the most common).
Cause
As you age, your heart's function decreases, increasing your risk of developing congestive heart failure. Congestive heart failure occurs in 3-5% of the population over 65 years of age. This disease accounts for about 5% of adult hospitalizations.
Coronary artery disease, which leads to irreversible damage
to the myocardium and myocardial infarction, is the most common cause of heart
failure. Hyperthyroidism (which increases the need for oxygen by increasing
metabolism) or severe anemia can also cause heart failure.
Symptom
Common symptoms of congestive heart failure include general weakness, fatigue, difficulty with even little exercise, central nervous system symptoms (confusion, insomnia, headache), tachycardia, nocturia, and cyanosis. In addition, systemic congestion, pulmonary congestion, peripheral hypoperfusion, and symptoms due to increased sympathetic nerve activity appear. In most cases, left ventricular failure occurs first, which increases the burden on the right ventricle, eventually resulting in right ventricular failure.
. An early symptom of left ventricular failure is difficulty breathing at rest or during physical activity that previously did not cause any discomfort. Shortness of breath is especially pronounced when the person is lying down (sitting respiration). Shortness of breath is relieved when the patient sits up. Therefore, raising the pillow may relieve symptoms.
Acute paroxysmal nocturnal dyspnea is a form of dyspnea in left heart failure. Patients wake up 2-4 hours after falling asleep with a feeling of suffocation. With careful interviewing, you may have nightmares of strangulation or drowning just before the onset of distinct signs and symptoms of seizures. Acute paroxysmal nocturnal dyspnea, accompanied by wheezing and asthma-like breathing, is called 'cardiac asthma. Also in acute pulmonary edema, pink foamy sputum appears.
A man coughing with shortness of breath
Right
ventricular insufficiency The hallmark of right
ventricular insufficiency is systemic venous congestion and edema. Left
ventricular failure is often the cause of right ventricular failure. However,
right ventricular failure is also caused by pulmonary hypertension, pulmonary
embolism, pulmonary artery stenosis, and atrial septal defect. Jugular venous
pressure rises, accompanied by peripheral edema.
The right ventricle is unable to accommodate the
increased blood flow, resulting in increased venous pressure. This causes
congestion in the abdomen (especially the liver). Gastrointestinal symptoms
(bloating, loss of appetite, nausea, vomiting, constipation, and abdominal
pain) and ascites may also occur. In addition, the amount of perfusion of the
kidneys is low, which can lead to decreased urine output and azotemia.
Diagnosis
Congestive heart failure can be diagnosed by
combining clinical symptoms, a physical examination, and simple tests
(electrocardiogram, chest X-ray). When heart failure occurs, the pulse rate
increases (more than 100 beats per minute) to compensate for the decrease in
cardiac output. Auscultation of the heart area produces a gallop sound, similar
to that of a horse running. The jugular venous pressure in the neck is
elevated. On chest percussion, the heart is enlarged. Edema can be observed in
the legs.
Echocardiography is required to confirm heart
failure and to develop a treatment plan. An echocardiogram can confirm heart
failure and, in many cases, even find the cause.
The left ventricle is the most important part of
the heart because it circulates blood throughout the body. Therefore, cardiac
function is represented by the left ventricular ejection fraction. If the left
ventricular ejection fraction is greater than 55%, it is considered normal, and
if it is lower than this, it is considered abnormal. In general, if the left
ventricular ejection fraction falls below 40-45%, treatment is necessary even
if there are no symptoms of heart failure. If the left ventricular ejection
fraction is less than 35%, severe heart failure is diagnosed.
Man undergoing echocardiography
1. Drug therapy
General principle
Drug therapy includes diuretics, angiotensin
blockers (angiotensin-converting enzyme blockers [ACE inhibitors], angiotensin
receptor blockers [ARB], and angiotensin-neprilysin inhibitors [ARNI], beta-blockers,
ivabradine, vasodilators, cardiac drugs) [Digitalis]), etc. can be used. Drugs
are selected in consideration of blood pressure, heart rate, and renal function
status. Combination therapy with diuretics including angiotensin blockers and
beta blockers should be considered.
In Korea, the intake of salt is very high.
According to the nutritional recommendations for Koreans published by the
Korean Nutrition Society, the average salt intake in Korea is about 5.1 to 6.3
g of sodium. This should be reduced by 1/3 to 1/4. In particular, you should
limit your intake of foods high in salts, such as salty side dishes and kimchi.
Depending on the severity of heart failure,
physical activity should be limited. However, restricting physical activity too
severely can further reduce a person's motor skills, leading to psychological
problems. Therefore, it is recommended to regularly engage in aerobic exercise
that is tolerated by the patient.
Emotional and physical rest is important.
Medications such as tranquilizers may be used for severe anxiety or insomnia.
In patients with pulmonary edema or hypoxia, 4 to 6 liters of oxygen per minute
can relax the arterioles of the lungs, reducing right ventricular insufficiency.
2. Diuretics
A diuretic is used to reduce excess fluid
retention and control body weight. Inhibits the reabsorption of sodium in the
renal tubules and increases the secretion of sodium to increase urine output.
3. Angiotensin inhibitors
Angiotensin-converting enzyme inhibitors (ACEi), angiotensin receptor blockers (ARBs), and angiotensin-neprilysin inhibitors (ARNI) are drugs that inhibit the angiotensin system. They are important agents that modulate the neurohormonal system, which is important for the exacerbation of heart failure. It is used without any special contraindications. It is known as a drug that improves the survival rate of patients with heart failure. Recently, angiotensin-neprilysin inhibitors (ARNIs) are known to improve survival.
Beta-blockers
blockers are known to
improve the survival rate of patients with heart failure. If there are no
special contraindications to using this drug, it can be used.
Ivabradine Ivabradine
is known to improve
survival rates in patients with heart failure. This drug may be used if heart
failure progresses despite other medications.
Cardiovascular Agent
① Digitalis
This is a drug that has
been used for a long time to increase the contractility of the heart. This drug
acts directly on the myocardium to increase contractility. When there is a
severe organic disorder in the myocardium itself, it is difficult to expect an
effect. It is very effective in case of heart failure due to excessive load on
the myocardium, such as hypertension, heart valve disorder, and
arteriosclerosis. Helps in heart failure with atrial fibrillation. However, the
safe area is narrow, so you need to be careful when using it.
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② Sympathetic
stimulant Dobutamine or dopamine is used in combination for acute heart failure. This drug stimulates sympathetic receptors, resulting in a cardiogenic and diuretic effect.
2. Antiarrhythmic therapy
Sudden arrhythmia accounts for about 50% of deaths due to congestive heart failure. Therefore, the treatment of arrhythmias is important in reducing mortality. Patients with congestive heart failure who have experienced fatal arrhythmias or who have developed symptoms of arrhythmias should take antiarrhythmic drugs. However, antiarrhythmic drugs should be used with caution because they inhibit myocardial contractility and may cause arrhythmias as a side effect.
3. Vaccination
Infections often cause acute exacerbations of heart failure. Therefore, influenza and pneumococcal vaccinations are reduced.
1)
Heart transplantation
For patients with
end-stage heart failure who do not respond to drug therapy, as a last resort,
heart transplantation may be performed, in which the patient's diseased heart
is removed and replaced with a healthy heart from a brain-dead person.
Rejection is low when immunological markers such as the blood types of the patient and the donor match. To prevent transplant rejection, drugs such as corticosteroids or anti-thymocyte globulin are used that suppress the body's natural immunity.
2) Implantable Ventricular Assist Devices
Implantable ventricular assist devices have been covered by insurance since October 2018. Ventricular assist devices are used as a preliminary step in heart transplantation in patients with acute heart failure and chronic end-stage heart failure who do not respond to drug therapy.
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Congestive heart failure
is more common in men than in women. Mortality rates depend on the cause and
severity of heart failure. The 5-year survival rate is approximately 50%.
Severe heart failure has a one-year mortality rate of about 50%.
In order to treat congestive heart failure, it is important to treat the cause of the disease, guide the medication, remove the exacerbating factors of heart failure, and guide the lifestyle and diet. Drug therapy can increase survival rates. For terminally ill patients, a heart transplant may also be considered.
About 40% of people with heart failure develop unexpected arrhythmias and die suddenly. Ventricular tachycardia in a condition of reduced heart function can be fatal. In addition, 40% of patients die from progressively worsening heart failure, with very poor pumping ability. The remaining 20% of patients die from other diseases or accidents.
Precautions
Therapeutic concentrations in the blood of digitalis are typically 1 to 2 mcg/mL. Generally, levels above 2 mcg/mL are toxic. Digitalis poisoning can be life-threatening. Therefore, when using this drug, the presence or absence of intoxication symptoms should be observed at an early stage, and serum concentrations and electrocardiography should be performed.
Symptoms of digitalis poisoning include ectopic contractions, fatal arrhythmias, nausea, vomiting, confusion, blurred vision, headache, and fatigue. Toxicity is exacerbated by hypokalemia, hypomagnesemia, hypercalcemia, alkalemia, hypothyroidism, and hypoxia. If toxicity occurs, the drug should be stopped or the dose reduced. Any arrhythmias or electrolyte abnormalities should be treated.
Risk factors and prevention
1. Control your
blood pressure.
2. Always check
your health
Sudden weight gain can mean that a lot of water and salt
stays inside the body. It also means your heart failure is getting worse,
so you should weigh yourself every day to see if you're gaining weight. If
you continue to gain weight, you should consult your doctor.
3. Quit smoking
and alcohol.
If a person with heart failure continues to smoke, it not
only worsens arrhythmias or heart failure symptoms but also interferes with
blood circulation in the coronary arteries, which can lead to angina pectoris
or myocardial infarction. Excessive drinking can damage the heart muscle. Therefore,
excessive drinking is absolutely prohibited in heart failure patients. However,
alcohol consumption in small amounts is not known to be harmful.
4. Reduce your
stress.
Excessive stress or anger can stimulate the body's
sympathetic nervous system, leading to excessive secretion of substances that
exacerbate heart failure. Therefore, it can cause heart failure symptoms
and should be avoided. Count to 10 when you're angry. It will help
you calm down.
5. Take your
medicine exactly as directed by your doctor.
Medications improve symptoms in people with heart failure
by improving the heart's pumping function and reducing stress on the heart. Be
sure to take the medicine exactly as directed by your doctor and consult with
your doctor if you experience any side effects from the medications you are
taking.
6. Visit the
hospital regularly.
You can manage heart failure more effectively by visiting
the hospital regularly and checking the patient's condition and taking
appropriate medications.
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