Congestive Cardiac Failure

​Congestive  Cardiac  Failure  (CCF) A complex  syndrome  caused  by  a  structural  or  functional  abnormality  in  the  cardiac  muscle  that impairs  its  ability  to  function  as  a  pump  and  meet  the  metabolic  needs  of  the  body.  Characterized  by shortness  of  breath,  fatigue  and  signs  of  fluid  retention. Decreased  cardiac  output  triggers  the  baroreceptors  in  the  the  LV,  carotid  sinus  and  the  aortic  arch  . This  leads  to  stimulation  of  the  cardio-respiratory  centre  in  the  brains,  increased  ADH  release (causing  peripheral  vasoconstriction  and  increases  renal  salt  and  water  absorption)  and  increased sympathetic  stimulation  (activating  renin  –  angiotension  system,  promoting  more  water  retention and  peripheral  vasoconstriction).  These  lead  to  LV  dilatation  and  hypertrophy  (poor  ejection fraction),  increased  peripheral  vascular  resistance  (high  afterload)  and  retention  of  fluid(  high preload). Most patients  present  with  left  heart  failure  which  can  progresses  to  right  heart  failure.  The  most common cause  of  right  heart  failure  is  left  heart  failure  but  it  can  also  be  caused  by  pulmonary hypertension  (cor  pulmonale)  or  disease  that  effect  the  RV>LF  (like  EMF).  Heart  failure  can  be  either compensated  (when  the  patient  is  stable)  or  decompensated  (when  the  patient  suddenly  gets worse) Etiology  of  CHF Systolic  Dysfunction  (inability  to  expel  blood)   Hypertension*   Ischemic heart disease   Idiopathic  cardiomyopathy  (like  HIV)*   Valvular  disease*   Alcoholic cardiomyopathy   Drug-associated  cardiomyopathy   Myocarditis *  The  most  common  causes  in  our  setting Diastolic  Dysfunction  (abnormal  filling)   Hypertension   Fibrosis   Ischemia   Aging process   Constrictive  pericarditis  (like  TB)*   Restrictive  pericarditis  (like  EMF)*   Hypertrophic cardiomyopathy 

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