Congestive Heart Failure
Congestive heart failure (CHF) is the principal complication of heart disease. It is a pathophysiologic state produced by an abnormality in cardiac pump function (either transient or prolonged). The heart is unable to transport blood in a sufficient flow to meet the metabolic needs of the peripheral tissues. This produces a wide variety of clinical circumstances ranging from acute left ventricular dysfunction (due to tachyarrhythmia, bradyarrhythmia, and acute myocardial infarction) to chronic left ventricular dysfunction (due to chronic volume/pressure overload as seen in valvular heart disease)
Two physiologic components explain most of the clinical findings of CHF: an inotropic abnormality which results in diminished systolic emptying (systolic failure); a compliance abnormality in which the ability of the ventricles to accept blood is impaired (diastolic failure). Most cases of heart failure have findings consistent with both mechanisms.
Causes of congestive heart failure include: Myocardial infarction; High output states; Rheumatic heart disease (mitral and aortic valvular disease); Cardiomyopathy - alcohol and non-alcohol related; Hypertensive heart disease; Aortic stenosis or regurgitation; Volume overload; Beta-blockers or other cardiac depressants
Risk factors for congestive heart failure include: Iatrogenic inappropriate reduction of intensity of therapy; Patient non-compliance; Intercurrent arrhythmia; Pulmonary embolism; Administration of cardiac agent with negative inotropic effect; Inappropriate physical, emotional, or environmental stress; Thyrotoxicosis, pregnancy, or any condition associated with increased peripheral metabolic demand.
Chest X-rays (CXRs) are frequently used to aid in the diagnosis of CHF. Signs include: Vascular redistribution; Peribronchial cuffing/interstitial edema (bat-shaped); Kerley B lines; Consolidation of lower lung fields; and Cardiomegaly.
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