Congestive Cardiac Failure Types | Etiology | Pathogenesis

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Congestive Cardiac Failure | What Is Congestive Cardiac failure | CCF Full Form

Congestive Cardiac failure is a condition associated with heart disorders leading to
impairment of the heart to supply sufficient blood to meet the body requirements. Cardiac
Failure may be associated with the failure of the right or left ventricle or both. Cardiac failure causes the blood to move through the heart and body at a slower rate, leading to increased pressure in the heart.

As a result, the heart is unable to pump enough oxygen and nutrients to meet the body’s requirements. The heart chambers thus respond by stretching in order to hold more blood to pump through the body or by becoming more stiff and thickened. Such mechanism helps to keep the blood moving for a short while, but the heart muscle walls tend to weaken with time and then are unable to pump with enough strength. The direct result of the reduced contractility of the cardiac muscles especially those of the ventricles, cause a decrease in the cardiac output and increase in the blood volume of the heart.

This causes the kidneys to often respond by causing the body to retain fluid (water) and sodium, as the systemic blood pressure and the renal blood flow both are reduced. This results into building up of fluid in the arms, legs, ankles, feet, lungs or other organs causing oedema which makes the body congested, hence the name Congestive cardiac failure. The term congestive heart failure is used for the chronic form of heart failure in which the patient has evidence of congestion of peripheral circulation and of lungs; CHF is the end result of various forms of serious heart diseases.


Etiology of congestive heart failure | CHF Etiology


There are many causes of congestive heart failure including:

1. Coronary artery disease leading to heart attacks and heart muscle weakness.

2. Primary heart muscle weakness from viral infections or toxins such as prolonged alcohol exposure.

Etiology There are many causes of congestive heart failure including:

  1.  Coronary artery disease leading to heart attacks and heart muscle weakness.
  2.  Primary heart muscle weakness from viral infections or toxins such as prolonged alcohol exposure.
  • HIV cardiomyopathy (caused by Human Immunodeficiency Virus).
  • Connective tissue diseases such as Systemic lupus erythematosus.
  •  Abuse of drugs such as alcohol.
  •  Pharmaceutical drugs such as chemotherapeutic agents.
  • Arrhythmias.

Major causes include Ischemic heart, Hypertension, Cardiomyopathy

Sign and symptoms of Cardiac Heart Failure (CHF)


Symptoms may
notice first
Symptoms that indicate
condition has worsened
Symptoms that indicate a
severe heart condition
Fatigue Irregular heartbeatChest pain that radiates through
the upper body
Swelling in ankles,
feet and legs
A cough that develops from
congested lungs
Rapid breathing
Weight gain Wheezing Skin that appears blue, which is
due to lack of oxygen in lungs
Increased need to
urinate, especially at
Shortness of breath, which
may indicate pulmonary



Pathogenesis of Congestive Heart Failure | CHF Pathogenesis

Heart failure may be caused by one of the following factors either singly or in combination.

1. Intrinsic Pump Failure: The most common and most important cause of heart failure is weakening of the ventricular muscle due to disease so that the heart fails to act as an efficient pump. The various diseases which may culminate in pump failure by these mechanisms are as under:

  • (i) Ischemic heart disease,
  • (ii) Myocarditis,
  • (iii) Cardiomyopathies,
  • (iv) Metabolic disorders like beriberi,
  • (v) Disorders of the rhythm e.g. atrial fibrillation and flutter.

2. Increased workload on the heart: Increased mechanical load on the heart results in increased myocardial demand resulting in myocardial failure. Increased load on the heart may be in the form of pressure load or volume load.

(a) Increased pressure load may occur in the following states:

  • (i) Systemic and pulmonary arterial hypertension.
  • (ii) Valvular disease e.g. mitral stenosis, aortic stenosis, pulmonary stenosis.
  • (iii) Chronic lung diseases.— Increased volume load occurs when a ventricle is required to eject more than normal volume of the blood resulting in cardiac failure. This is seen in
    the following conditions:


  • (i) Valvular insufficiency
  • (ii) Severe anaemia
  • (iii) Thyrotoxicosis
  • (iv) Arteriovenous shunts
  • (v) Hypoxia due to lung diseases.


3. Impaired filling of cardiac chambers: Decreased cardiac output and cardiac failure may result from extra cardiac causes or defect in filling of the heart in pericarditis.


Types of Heart Failure | Different Types of Cardiac Heart Failure  [CHF]


Congestive heart failure (CHF) is generally classified as systolic or diastolic heart failure and becomes progressively more common with increasing age. In addition, patients with risk factors for heart disease are more likely to develop congestive heart failure.

  1.  Systolic heart failure: This condition occurs when the pumping action of the heart is reduced or weakened. A common clinical measurement is ejection fraction (EF). The ejection fraction is a calculation of how much blood is ejected out of the left ventricle (stroke volume) divided by the maximum volume remaining in the left ventricle at the end of diastole, or when the heart is relaxed after filling with blood. A normal ejection fraction is greater than 55%. Systolic heart failure is diagnosed when the ejection fraction has significantly decreased below the threshold of 55%.
  2. Diastolic heart failure: This condition occurs when the heart can contract normally but is stiff, or less compliant, when it is relaxing and filling with blood. The heart is unable to fill with blood properly, which produces backup into the lungs and heart failure symptoms. Diastolic heart failure is more common in patients older than 75 years of age, especially in patients with high blood pressure, and it is also more common in women. In diastolic heart failure, the ejection fraction is normal or increased.
  3.  Acute heart failure: It is sudden and rapid development of failure following massive myocardial infarction, valve rupture, myocarditis etc. The sudden reduction in cardiac output, hypotension without edema is prominent features.
  4. Chronic heart failure: It develops slowly with gradual reduction in cardiac output. It is commonly seen in slowly progressive valvular heart disease, systemic arterial hypertension, chronic obstructive pulmonary diseases etc. Blood pressure is well maintained but is associated with peripheral edema.


Related: Cardiovascular System | Anatomy of the Heart

Cardiac Output Measurement Calculate | Functions of Cardiovascular System

Conduction System of the Heart | Anatomy of the heart

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