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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