Congestive heart failure (CHF)

A. Idea of ​​the real

Heart failure is a global term for the physiological state in which cardiac output is insufficient for the needs of the body.

This happens most often during low cardiac output (often called "congestive heart failure").

Conversely, it can also occur when the body's need for oxygen and nutrients are increased, and demand exceeded what the heart can provide, (dubbed the "high output cardiac failure"). This can occur in the context of severe anemia, Gram-negative septicemia, beriberi (vitamin B 1 / thiamine deficiency), thyrotoxicosis, 'Paget's disease, arteriovenous fistula or arteriovenous malformations.

Excess fluid is a common problem for people with heart failure, but not identical with it. Patients with heart failure treated will often euvolaemic (the term for normal fluid status), or less frequently, dehydration.

1. Causes of Chronic Heart Failure

The dominance of the causes of heart failure is difficult to analyze because of challenges in diagnosis, differences in the population, and causes changes in prevalence with age.

Causes of failure jantug include:

• Viral Myocarditis (infection of the heart muscle)

• Infiltration of muscles such as amyloidosis

• HIV cardiomyopathy (caused by Human Immunodeficiency Virus)

• Connective tissue diseases such as systemic lupus erythematosus

• Abuse of drugs such as alcohol

• Pharmaceutical drugs such as chemotherapeutic agents.

• Arrhythmia

Apnea sleep disordered breathing conditions overlap with obesity, hypertension and diabetes and is regarded as an independent cause of heart failure.

2. Symptom

Symptoms of heart failure has traditionally and somewhat arbitrarily divided into "left" and "right" side, admitted that the left and right ventricular cardiac different parts of the supply of circulation. However, heart failure is not exclusive mundur''kegagalan''(in the circulation that flows into the ventricles).

There are some exceptions to a simple left-right division of heart failure symptoms. Maju''sisi''kegagalan time overlaps with the kanan''mundur''kegagalan. In addition, the most common cause of heart failure right-sided heart failure is left sided. The result is that patients usually present with both sets of signs and symptoms.

B. Pathophysiology

Heart failure is caused by conditions that reduce the efficiency of the myocardium, or heart muscle, through damage or overloading. Thus, it can be caused by a diverse array of conditions as myocardial infarction (in which the heart muscle deprived of oxygen and die), hypertension (which increases the strength of contractions needed to pump blood) and amyloidosis (in which the protein is stored in the heart muscle, causing it to be stiff). During this time an increase in workload will result in a change in his own heart:

• Reduce the power of contraction, due to overloading of the ventricles. In healthcare, improve the charging results in increased ventricular contractility (Frank-Starling law of the heart) and thus an increase in cardiac output. In heart failure this mechanism fails, because the ventricle is loaded with blood to the point where the contraction of heart muscle becomes less efficient. This is caused by reduced ability to cross-link actin and myosin filaments in cardiac muscle stretch-over.

• A reduced stroke volume, as a result of the failure of systole, diastole or both. Increase in end systolic volume is usually caused by reduced contractility. Decrease in the volume of impaired ventricular end-diastolic filling - as occurs when ventricular compliance decreased (ie, when the rigid wall).

• Reduce backup capacity.

• Increased heart rate

• hypertrophy (increase in physical size) of the myocardium, due to the terminally differentiated cardiac muscle fiber size increases in an effort to improve contractility.

• Enlarged ventricles, contributing to the enlargement and spherical shape of heart failure.

Systolic dysfunction

Heart failure caused by systolic dysfunction is more easily recognized. It can be simplistically described as a failure of cardiac pump function. It is characterized by decreased ejection fraction (less than 45%). Strength of ventricular contraction is attenuated and insufficient to create an adequate stroke volume, so cardiac output is inadequate.

Diastolic dysfunction

Heart failure caused by diastolic dysfunction is generally described as the failure of the ventricle to relax and usually indicates adequate ventricular wall stiffness. This leads to inadequate ventricular filling, and thus results in stroke volume is not adequate. The failure of ventricular relaxation also results in increased end-diastolic pressure, and the end result is identical to the case of systolic dysfunction (pulmonary edema in the left heart failure, peripheral edema in right heart failure.)

Diastolic dysfunction can be caused by processes similar to those that cause systolic dysfunction, particularly those affecting the causes cardiac remodeling.