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What is Congestive Heart Failure? - NEET PG Medicine

Feb 3, 2023

If you’re having trouble understanding congestive heart failure, then you have landed on the right page. Here we will discuss everything you need to know about congestive heart failure stages, symptoms, and its treatment in detail.
Read further to upgrade your NEET PG preparation.
So, let’s get started with what is Cardiac Output?

Cardiac output = Heart rate X stroke volume

↑HR →↑Sympathetic drive

Clinical features

Let’s learn about the Clinical features of Congestive Heart Failure here:

1. Palpitations

2. Diaphoresis

3. Dyspnea on exertion/rest

4. Nocturnal cough

5. Paroxysmal nocturnal dyspnea (Orthopnea)

6. Pink frothy sputum

7. Effort intolerance

On examination

Tachycardia
- Maximum HR = 220 – Age

Left Ventricular failure

Right Ventricular failure

↓SBP leads to oliguria
S3 present: Ventricular gallop rhythm
B/L fine crepitation
↓ air entry B/L
↓ Vital capacity

[m/c/c of RVF is LVF]

JVP↑
Kussmaul signs → JVP ↑ on Inspiration
Abdomino – jugular reflux
Tender hepatomegaly
B/L pitting pedal edema

[Chronic CCF]

FRAMINGHAM CRITERIA: FOR DIAGNOSIS OF CHF

Minor Criteria

Dyspnea On exertion
Nocturnal cough
Tachycardia
Pleural effusion
Vital capacity 1/3rd
Tender hepatomegaly
Pitting pedal edema
Oliguria

Major Criteria = Rest all are major criteria.

Important Information

For Diagnosis

2 major criteria should be present or
1 major + 2 minor

Also Read: Myocardial Infarction - Neet PG Medicine

Framingham heart risk calculator

To determine chances of coronary events in next 10 yrs (risks)

Congestive Heart Failure Stages

Now that you have learned about the criteria for diagnosis of CHF, let’s take a look at the stages of CHF:

(ACCORDING TO ACC)

Stage A → No structural damage, high risk of developing symptoms (risk factors present)

Stage B→ Structural heart disease + No symptoms of CHF

Stage C → Structural heart disease + Symptoms of CHF

Stage D → Refractory heart failure

Before reading further, refer to this video and boost your knowledge related to The Abnormal Heart Sounds Auscultated In Various Heart Pathologies

The Abnormal Heart Sounds Auscultated In Various Heart Pathologies

WORKUP

1. BNP levels / N - terminal Pro BN

Released from ventricles of heart
If >100 pg/ml - It differentiate from non-cardiogenic pulmonary edema

2. Chest X-ray

Chest X-ray for congestive heart failure — Chest X-ray

a. Earliest radiological finding: Prominent upper lobe veins/ Antler sign or Reverse moustache sign

b. CT ratio increased > 0.5

c. Bat wing pulmonary edema

d. Costophrenic angle blunting

e. B/L pleural effusion

f. Kerley B lines → Perpendicular to pleural surface. Due to thickened interlobular septa

Also seen in lymphangitis carcinomatosis (Kerley A lines: Present in the periphery of hila
Due to distension of anastomotic channels between central and peripheral lymphatics Kerley C lines: Reticular opacities at lung base.)

Important Information

Reverse Bat Wing Edema- Chronic Eosinophilic Pneumonia
Moustache sign - Pneumoperitoneum (gas under diaphragm)

3. Echocardiography

Ejection fraction = Stroke volume/End diastolic volume
In systolic malfunction = EF↓
In diastolic malfunction = EF can be normal
In HTN patient → Left ventricular end diastolic pressure increase
Pooling of blood in lungs

4. Cardiac MRI

Preferred imaging
Type of malfunction: Systolic Vs Diastolic
Etiology: Fibrosis/ischemic/Hypokinesia/DCM
Prognosis

5. BORG scale - Tells functional assessment of the patients

Refer the table below:

RPE Scale	Rate of perceived Exertion
10	Max effort Activity It Feels almost impossible to keep going. Completely out of breath, unable to talk. Cannot maintain for more than a very short time.
9	Very hard Activity Very difficult to maintain exercise intensity. Can barely breathe and speak only a few words
7-8	Vigorous Activity Borderline uncomfortable. Short of breath, can speak a sentence.
4-6	Moderate Activity Breathing heavily, can hold short conversation, still somewhat comfortable, but becoming noticeably more challenging
2-3	Light Activity Feel like you can maintain it for hours. Easy to breathe and carry a conversation
1	Very Light Activity Hardly any exertion, but more than sleeping, watching TC, etc.

Also Read: Infective Endocarditis- NEET PG Medicine

EPILEPSY AND Electroencephalography (EEG) : NEET PG Medicine

TREATMENT

Learn about the Congestive Heart Failure Treatment below:

Heart failure with preserved EF (HFpEF)

Preserved EF 50%

Seen in:

HTN, RCM, Radiation
CTD, aging
Endocardial fibroelastosis
Hemochromatosis

Aldosterone antagonist
ARNI → Valsartan (ARB) + sacubitril (neprilysin → inhibitors degradation of BNP)

Digoxin

Ineffective
↑O₂ demand of heart
Can be detrimental

Heart failure with reduced EF (HFrEF) Seen in:

CAD: Ischemic cardiomyopathy
HTN: recent onset
Valvular Lesion
L → R shunt
Cor Pulmonale
Chagas diseases/Ch.Arrhythmias

Management

Congestive heart failure Treatment of acute pulmonary edema

L → Lasix (Furosemide)

M → Morphine (↓Pulmonary edema)

N → Nitroglycerine

O → Oxygen (NIV)

P → Positioning

How to remember

LMNOP

Vasodilators

Nitroglycerine
Nesiritide
Nitroprusside

Diuretics

Furosemide

Nesiritide

BNP Analogue

Treatment of Acute decompensation with cardiogenic shock

1. Vasopressors

Nor-epinephrine → DBP ↑→ CBF ↑
Dopamine: improves GFR also
Dobutamine: β₁ →↑ HR→↑O₂ consumption

2. Inodilators: Milrinone \& Amrinone

3. Levosimendan

Omecamtiv → ↑ production of stronger actin-myosin complex

Acute CHF/HFrEF: <40% of EF
Cardiogenic Shock	Volume Overload
Vasopressors	L → Lasix (Furosemide)M → Morphine (↓Pulmonary edema )N → NitroglycerineO → Oxygen (NIV)P → Positioning

CHRONIC CHF

↓Post discharge

Initiate with ARNI: Valsartan. Sacubitril
ACE + Blockers
Spironolactone

Heart Failure
HF with preserved ejection fraction EF ≥ 50%	HF with reduced ejection fraction EF < 40%
Causes	Causes
Long standing HTNARNIAldosterone antagonist ACE inhibitors	Acute pulmonary edema S. anemia with CHF T3 pregnancy→ LMNOP→ ARNI→ ACEI + βblockers IVABRADINE Cardiogenic Shock → vasopressors

Medically Refractory Cardiogenic Shock

1. LVAD:LV assist device: heart-mate

2. CRT: Cardiac resynchronization therapy

3. Cardiac transplantation

Digoxin toxicity

V. Bigeminy (MC arrhythmia)
Non paroxysmal atrial tachycardia with AV block

Lignocaine

We hope that now you’ve a better understanding of what Congestive Heart Failure is along with its stages, symptoms and treatment. To study more about such important topics, download the PrepLadder App and enhance your knowledge with NEET PG Medicine Notes.

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