Chronic heart failure occurs when the heart unable to deliver an adequate amount of blood to the tissues and organs which result in inadequacy of oxygen and nutrients. Chronic heart failure is a complex condition associated with a number of symptoms arising from defects in left ventricular filling and/or emptying, of which shortness of breath, fatigue, and ankle swelling are the most common.
Chronic Heart Failure
Chronic heart failure is a common condition with a prevalence ranging from 0.3% to 2% in the population at large, 3–5% of the population over 65 years old, and between 8% and 16% of those aged over 75 years. Heart failure accounts for 5% of adult medical admissions to hospital. There is a loss of cardiac reserve with age, and heart failure may often complicate the presence of other conditions in the elderly. More than 10% of patients with heart failure also have atrial fibrillation as a contributory factor. This combination presents a risk of thrombo-embolic complications, notably stroke; the risk is 2% in patients in sinus rhythm but may exceed 10% a year in patients with atrial fibrillation who are not anticoagulated and have attendant risk factors.
The common underlying aetiologies in patients with heart failure are coronary artery disease and hypertension. The appropriate management of these predisposing conditions is also an important consideration in controlling heart failure in the community. Identifiable causes of heart failure include aortic stenosis, cardiomyopathy, mechanical defects such as cardiac valvular dysfunction, hyperthyroidism and severe anaemia. Conditions that place increased demands on the heart can create a shortfall in cardiac output and lead to intermittent exacerbation of symptoms. Symptoms of heart failure may occur as a consequence of hyperthyroidism, where the tissues place a greater metabolic demand, or severe anaemia, where there is an increased circulatory demand on the heart. Cardiac output may also be compromised by bradycardia or tachycardia, or by a sustained arrhythmia such as that experienced by patients in atrial fibrillation.
Chronic Heart Failure
Four Diagnostic tests are performed to confirm a diagnosis of heart failure.
Pharmacotherapy aim is to control symptoms, where diuretics and digoxin are the mainstays of treatment. While relieving the symptoms of heart failure remains decisive in improving a patient’s quality of life, a better understanding of the underlying pathophysiology has led to major advances in the pharmacological treatment of heart failure. With the introduction of angiotensin-converting enzyme (ACE) inhibitors, b-blockers, angiotensin II receptor blockers (ARBs) and aldosterone antagonists, delaying disease progression and ultimately improving survival have become realistic goals of therapy.