Congestive heart failure natural history

Congestive Heart Failure Microchapters
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Acute Pharmacotherapy
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Chronic Pharmacotherapy in HFrEF Diuretics ACE Inhibitors Angiotensin receptor blockers Aldosterone Antagonists Beta Blockers Ca Channel Blockers Nitrates Hydralazine Positive Inotropics Anticoagulants Angiotensin Receptor-Neprilysin Inhibitor Antiarrhythmic Drugs Nutritional Supplements Hormonal Therapies Drugs to Avoid Drug Interactions Treatment of underlying causes Associated conditions
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Surgical Therapy: Biventricular Pacing or Cardiac Resynchronization Therapy (CRT) Implantation of Intracardiac Defibrillator Ultrafiltration Cardiac Surgery Left Ventricular Assist Devices (LVADs) Cardiac Transplantation
ACC/AHA Guideline Recommendations Initial and Serial Evaluation of the HF Patient Hospitalized Patient Patients With a Prior MI Sudden Cardiac Death Prevention Surgical/Percutaneous/Transcather Interventional Treatments of HF Patients at high risk for developing heart failure (Stage A) Patients with cardiac structural abnormalities or remodeling who have not developed heart failure symptoms (Stage B) Patients with current or prior symptoms of heart failure (Stage C) Patients with refractory end-stage heart failure (Stage D) Coordinating Care for Patients With Chronic HF Quality Metrics/Performance Measures
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Congestive heart failure end-of-life considerations
Specific Groups: Special Populations Patients who have concomitant disorders Obstructive Sleep Apnea in the Patient with CHF NSTEMI with Heart Failure and Cardiogenic Shock
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-In-Chief: Cafer Zorkun, M.D., Ph.D. [2]; Saleh El Dassouki, M.D. [3], Atif Mohammad, M.D.

Overview

Congestive heart failure is associated with a poor prognosis. In the Framingham experience, 80% of men and 70% of women with heart failure who were under 65 years of age had died within 8 years of the diagnosis.

Complications

1. Cardiac Arrhythmias:

• Ventricular tachycardia and ventricular fibrillation can occur as serious complications of heart failure when its pump function is severely impaired. This further worsens the cardiac output and even possible death.
• Atrial fibrillation which is rapid beating of atrium without optimal forward pumping of blood is another complication of heart failure which occurs as a result of resistance to blood flow from atrium to ventricles. These patients are at increased risk of stroke.
• Left bundle branch block is an abnormality in electrical conduction in the heart.

2. Pulmonary Congestion:

• Pulmonary congestion which occur in left ventricular failure can cause pulmonary edema.
• Venous stasis and pedal edema can occur as a complication of right heart failure. These conditions predispose patients to venous ulcers, infections and cellulites.
• Cardiac cirrhosis occurs as a result of hepatic venous congestion. This can lead to coma and even death .

3. Angina and myocardial infarction: Cardiac ischemia and infarction can also occur when heart failure patients undergo exertion. With LV dilation, LV wall stress increases, and this increases the risk of angina. Autopsy studies demonstrate that plaque rupture and coronary thrombosis is a common mode of death in patients with congestive heart failure.

4. Renal failure: Renal impairment can occur secondary to decreased renal perfusion. This further worsens heart failure by fluid retention.

5. Cardiac cachexia: Unintentional rapid weight loss (a loss of at least 7.5% of normal weight within 6 months) can occur in chronic heart failure. This is a bad prognostic factor.

Prognosis

Mortality Associated with Heart Failure

Based on the 44-year follow-up of the NHLBI’s Framingham Heart Study:

• 80% of men and 70% of women under age 65 who have heart failure will die within following 8 years.
• In people diagnosed with heart failure, sudden cardiac death occurs at 6 to 9 times the rate of the general population.
• One in eight deaths has heart failure mentioned on the death certificate.