{"id":8325,"date":"2013-03-20T16:28:10","date_gmt":"2013-03-20T20:28:10","guid":{"rendered":"http:\/\/insidesurgery.com\/?p=8325"},"modified":"2013-03-30T19:39:34","modified_gmt":"2013-03-30T23:39:34","slug":"congestive-heart-failure","status":"publish","type":"post","link":"https:\/\/insidesurgery.com\/2013\/03\/congestive-heart-failure\/","title":{"rendered":"Congestive Heart Failure"},"content":{"rendered":"

Pathophysiology of Congestive Heart Failure<\/h4>\n

Congestive heart failure is:<\/p>\n

<\/p>\n

1)<\/strong> inability of heart to deliver sufficient cardiac output to meet physiologic needs
\n2)<\/strong> both diastolic and systolic phases are abnormal
\n3)<\/strong> initially, compensatory mechanisms occur(increased catecholamines, increased atrial natriuretic factor<\/a>, myocardial hypertrophy), but eventual failure of these ensues causing congestive heart failure
\n4)<\/strong> result is increase in venous pressure with congestion of liver, spleen, and kidney (“backward failure”) and sodium retention, peripheral edema, and pulmonary sequelae (“forward” failure”)
\n5)<\/strong> a “final common pathway” occurs with coronary artery disease (most common), valve dysfunction, and hypertension<\/p>\n

Signs and Symptoms<\/h4>\n

1)<\/strong> dypsnea
\n2)<\/strong> orthopnea
\n3)<\/strong> distended neck veins
\n4)<\/strong> pitting edema in dependent body parts
\n5)<\/strong> rales on lung auscultation
\n6)<\/strong> ascites
\n7)<\/strong> pleural effusions
\n8)<\/strong> cough
\n9)<\/strong> pulmonary edema
\n10)<\/strong> pulmonary hypertension
\n11)<\/strong> cyanosis of lips and nail beds
\n12)<\/strong> weakness and fatigue
\n13)<\/strong> confusion
\n14)<\/strong> memory loss
\n15)<\/strong> nocturia
\n16)<\/strong> failure of right ventricle
\n17)<\/strong> abnormally increased atrial filling pressure relative to stroke volume<\/p>\n

Characteristic Test Findings<\/h4>\n

Laboratory<\/em><\/p>\n

1)<\/strong> increased renin (owing to decreased glomerular filtration rate)
\n2)<\/strong> increased angiotensin
\n3)<\/strong> increased aldosterone
\n4)<\/strong> increased sodium resorption (which causes increased fluid retention)
\n5)<\/strong> increased catecholamines (to stimulate cardiac contractility)
\n6)<\/strong> increased atrial natriuretic factor (in an attempt to excrete the excess sodium
\n7)<\/strong> moderate increase in transaminases (owing to liver congestion)
\n8)<\/strong> increased bilirubin (owing to liver congestion)<\/p>\n

Histology\/Gross Pathology<\/h4>\n

1)<\/strong> “nutmeg” liver
\n2)<\/strong> “brown” induration of lungs
\n3)<\/strong> fluid-filled alveoli
\n4)<\/strong> alveoli with hemodsiderin-filled macrophages
\n5)<\/strong> interstitial pulmonary fibrosis
\n6)<\/strong> dilated heart chambers
\n7)<\/strong> enlarged heart<\/p>\n

Associated Conditions<\/h4>\n

1)<\/strong> precipitating factors in congestive heart failure are coronary artery disease, hypertension, bacterial endocarditis, valve failure from any cause, hemochomomatosis
\n2)<\/strong> increased incidence in congestive heart failure of pulmonary embolism, arrhythmias, myocardial infarction<\/p>\n

Inheritance\/Epidemiology<\/h4>\n

affects 2-3 million people in USA<\/p>\n

Treatment<\/h4>\n

1)<\/strong> ACE inhibitors (lisinopril, enalapril)
\n2)<\/strong> beta-adrenergic blockers (metoprolol)
\n3)<\/strong> thiazide diuretics (furosemide)
\n4)<\/strong> restriction of sodium intake
\n5)<\/strong> digitalis<\/p>\n

Tips for USMLE<\/h4>\n

1)<\/strong> if question mentions nutmeg liver, think congestive heart failure
\n2)<\/strong> if the patient is an 85 year old man who needs to sleep on three pillows to avoid waking up gasping for breath, who has a history of two myocardial infarctions, and who has edema around the ankles, think congestive heart failure<\/p>\n","protected":false},"excerpt":{"rendered":"

Pathophysiology of Congestive Heart Failure Congestive heart failure is:<\/p>\n","protected":false},"author":1,"featured_media":0,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"_exactmetrics_skip_tracking":false,"_exactmetrics_sitenote_active":false,"_exactmetrics_sitenote_note":"","_exactmetrics_sitenote_category":0,"_genesis_hide_title":false,"_genesis_hide_breadcrumbs":false,"_genesis_hide_singular_image":false,"_genesis_hide_footer_widgets":false,"_genesis_custom_body_class":"","_genesis_custom_post_class":"","_genesis_layout":"","footnotes":""},"categories":[5080],"tags":[5534,5538,5533,5535,5536,5537],"yoast_head":"\nCongestive Heart Failure - InsideSurgery Medical Information Blog<\/title>\n<meta name=\"robots\" content=\"index, follow, max-snippet:-1, max-image-preview:large, max-video-preview:-1\" \/>\n<link rel=\"canonical\" href=\"https:\/\/insidesurgery.com\/2013\/03\/congestive-heart-failure\/\" \/>\n<meta property=\"og:locale\" content=\"en_US\" \/>\n<meta property=\"og:type\" content=\"article\" \/>\n<meta property=\"og:title\" content=\"Congestive Heart Failure - 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