Heart Failure: What Is It And How Does It Form?

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Heart failure (HF) is the inability or the heart, to pump adequate blood to sufficiently meet the needs of the cells, tissues and organ systems for life sustaining oxygen and nutrients for it to function normally. In the past, HF was often referred to as congestive heart failure, because many patients experiencing pulmonary or peripheral congestion.

Presently, heart failure is recognized as a clinical syndrome best defined and characterized by definitive  signs and symptoms of fluid overload or the insufficient ability of the circulatory system to deliver oxygen rich blood and nutrients to the entire body.  Fluid overload and decreased tissue perfusion result when the heart can no longer generate an oxygen and carbon dioxide balance in meeting the body’s demands. The term HF primarily indicates a myocardial disease in which there is an underlying problem with the heart’s pumping ability.

Pathophysiology of Chronic Heart Failure

Some cases of heart failure are reversible depending on the underlying cause. However, the majority of the cases of HF is almost always progressive in nature with lifelong diagnosis that is managed with lifestyle changes and medications to prevent acute congestive episodes. HF results from a variety of cardiovascular conditions, including chronic hypertension, coronary artery disease and valvular disease.

These aforementioned conditions can result in the decreased contractility of the heart, decreased filling or both. Significant myocardial dysfunction most often results before the individual experiences signs and symptoms of heart failure such as shortness of breath, edema and extreme fatigue. As the heart’s workload increases, the contractility of the myocardial muscle fibers decreases as well. Decreased contractility results in an increased in the size of the right ventricle, stretching the muscle fibers adding to the workload of the heart which if left uncared for can eventually wear out and eventually cease to function.

Clinical manifestations of chronic heart failure

The clinical manifestations produced by the different types of heart failure is highly dependent on the cause of the HF whether its systolic in nature, diastolic or both. The following are the presenting signs and symptoms of heart failure:

1. General:

• Pale, cyanotic skin (due to decreased perfusion to extremities)
• Dependent edema
• Decreased activity tolerance
• Unexplained confusion or altered mental status

2. Cardiovascular

• Heart murmurs
• Increased heart rate (more than 100 beats per minute)
• Jugular vein distension

3. Cerebrovascular

• Confusion
• Dizziness
• Lightheadedness

4. Renal

• Decreased urinary frequency during the day
• Urinary urgency at night

5. Respiratory

• Dyspnea
• Bilateral crackles
• Cough on exertion or when lying down

Overall medical management of heart failure

The overall goals of management of HF are to relieve the symptoms, to improve functional status and overall quality of life of the individual and extend survivability. Medical management is primarily based on the type, severity and the cause of HF. Managing patients with HF includes basic lifestyle and diet changes, oral and

intravenous cardiac medications, implantation of assistive devices to the heart  and surgical procedures including cardiac transplantations can significantly assist in the managing and correcting dysfunctions of the heart’s contractility. Moreover, the best approach against heart failure is prevention and  by recognizing the signs and symptoms that need to be reported and managed by health care professionals.

Where to Learn More?

To learn more about recognizing and managing casualties of heart failure enrol in standard or emergency first aid courses with one of our training partners located throughout Canada and the U.S.A.  Participants will learn to provide aid using the latest techniques and training methods.