Originally Posted by jaish  Failure is anything implies expectation unfilled, and ones definition of heart failure depends upon what one expects of the heart. The clinician regards his patient as having heart failure when there are symptoms and physical signs attributable to inadequate cardiac performance. The physiologist regards that heart as failing when the contractility of the ventricles or the cardiac output falls outside the statistically defined normal range. There is no clear distinction between normality and abnormality; valves in the ‘abnormal’ range may be found in normal hearts in the gace of extreme demand and ‘normal’ valves may be encountered in diseased hearts when the demands are slight. The term heart failure refers to clinical syndrome rather than a specific diagnosis.
Almost all forms of heart disease can lead to heart failure e.g. Hypertension, valvular heart disease, coronary artery disease, cardiomyopathy etc.
The heart failure can be mainly divided into left heart failure and right heart failure. The feature of LHS develops when there is a major obstruction to outflow from the left atrium (e.g. .mitral stenosis) or when the left ventricle cannot cope with the demands upon it. Myocardial infarction hypertension, aortic valvular disease, mitral regurgitation and cardiomyopathy are the commonest cause of LHF. Dyspnea on exertion, orthopnea, paroxysmal nocturnal dyspnea and pulmonary edema are the commonest symptoms. Pulmonary crepitations, 3rd heart sound, pleural effusion and pulsus alternous are the commonest physical signs of LHF. Likewise right heart failure develops when the failure of the right ventricle can no longer cope with the demands upon it or when there is tricuspid stenosis. Consequence effect of left ventricle failure, right ventricular infarction, pulmonary disease, pulmonary valve disease, tricuspid regurgitation and pulmonary hypertension are the common cause of right ventricular failure. The characteristic hypertensions are the common cause of right ventricular failure. The characteristic features of the right heart failure are evaluated jugular venous pressure, hepatomegaly, dependent oedema and the ascites. The other common but less specify features of cardiac failures are fatigue, cachexia, confusion, insomnia, anxiety and mild jaundice.
Simple test like urea, electrolytes, hemoglobin, thyroid function, ECG, chest radiology may help to establish the nature and severity of underlying heart disease and detect any complications. Echocardiography is very useful investigation to confirm the diagnosis and detect underlying heart disease.
Ideally, the treatment of cardiac failure is the correction of the underlying cause but for a variety of reasons this may not be possible, at least initially. In some conditions, such as ischemic heart disease and cardiomyopathies, the ventricular muscle is irreversible and no currently available methods of treatment can correct underlying muscle weakness.
In other disorders, the radical treatment necessary for cure such as major surgery cannot be safely undertaken until cardiac failure has been corrected. The main objective of therapy is to alleviate the symptoms caused by heart failure and to improve the prognosis.
General measures like avoiding high salt intake, good general nutrition weight reduction, for obese patient, avoidance of alcohol, total abstinence from smoking, regular moderate exercise with in the limit of symptoms may be encouraged.
Two categories of drugs are commonly used in the management in patients with heart failure, diuretics and vasodilators. The other drugs that may have particular role in particular patient include beta-blockers, digoxin and anti-arrhythmic agents. ACE inhibitors are the commonly used vasodilators in patients with heart failure, useless contraindicated. Coronary artery bypass surgery or percutaneous coronary intervention can be used to treat very carefully selected patients. Cardiac transplantation is an established and very successful form of treatment for patient with intractable heart failure. |