Chronic Heart Failure: Etiology, Diagnosis, and Treatment

This report provides a comprehensive overview of chronic heart failure (CHF), also known as congestive heart failure, a condition where the heart cannot pump enough blood. It explores the etiology, including risk factors like diabetes and hypertension, and the pathophysiology involving compensatory mechanisms and cardiac remodeling. The report details clinical manifestations such as congested lungs, fluid retention, fatigue, and irregular heartbeats. It then examines diagnostic processes, including echocardiograms, ECGs, chest X-rays, and blood tests. Treatment options, both pharmaceutical (ACE inhibitors, beta-blockers, diuretics) and non-pharmaceutical (physical activity, nutrition, fluid management, smoking cessation, and health promotion programs), are discussed. The report concludes by emphasizing the global health issue CHF represents and the effectiveness of integrated treatment approaches.

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Table of Contents
Introduction.................................................................................................................................................2
Body............................................................................................................................................................2
Etiology & Pathophysiology....................................................................................................................2
Clinical manifestations............................................................................................................................4
Diagnosis process....................................................................................................................................5
Treatments...............................................................................................................................................6
Pharmaceutical treatment.....................................................................................................................6
Non-pharmaceutical treatment.............................................................................................................7
Conclusion...................................................................................................................................................9
References.................................................................................................................................................11

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Chronic heart failure
Introduction
Chronic heart failure is also known as the congestive heart failure is the ongoing
incapability of the heart to push or pump sufficient blood throughout the body to make sure
enough oxygen is supplied to each part of the body. This condition can be caused by different
risk factors like old age, increased blood pressure, diabetes, and being obese (Stout et al., 2016).
The symptoms associated with this condition include chest pain, cough, swelling of the ankles
and legs, tiredness, constipation, weakness, loss of appetite, nausea, and shortness of breathing.
This Adverse health condition impacts the inferior chambers of the heart called the left and right
ventricles. CHF occurs when the heart is unable to cope with the changing oxygen demands of
oxygen of the body (Klip et al., 2013).
Congestive heart failure assessed at least 300,000 population of Australia currently
undergo Congestive heart failure (CHF) and about 30,000 fresh cases are identified each year.
Between, 1996-1997, nearly 41,000 hospitalizations were reported for congestive heart failure as
a principal diagnosis (Sahle, Owen, Mutowo, Krum, & Reid, 2016). There are presently 26
million heart failure patients globally. Particularly in the US, the prevalence of these health
conditions is more than 5.2 million. In this particular assessment report the etiology, clinical
manifestations, diagnosis, and treatment for CHF will be discussed (Zarrinkoub, et al., 2013).
It can be concluded that this particular health conditions is a global health issue.
Body
Etiology & Pathophysiology

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Causes
In this particular section, the pathophysiology and etiology will be discussed. Chronic
heart failures are caused by the combination of different health condition including coronary
heart disease, heart attack, and cardiomyopathy, conditions that overwork the heart such as valve
disorder, diabetes, kidney disorder, and hypertension.
Risk factors
The risk factors associated with this health condition include diabetes type two, obesity,
excessive smoking, anemia, hypo and hyperthyroidism, myocarditis, heart arrhythmias, atrial
fibrillation, lupus, amyloidosis, emphysema, excessive alcohol consumption, and viral
contamination of the heart muscles (Borlaug, 2014).
Chronic Heart failure is the final outcome of dissimilar pathophysiological courses in
which there is damage to the heart that include loss or diminishing of working myocardial cells.
Mechanisms of Compensatory neuro-hormone are triggered in order to uphold satisfactory
cardiac function and the tissue perfusion. Instigation of the sympathetic nervous system upsurges
heart rate and contractility of the cardiac system, while triggering of the system called renin-
angiotensin-aldosterone raises reabsorption of sodium and water withholding. Although these
reactions are primarily beneficial, continued overstimulation of both sympathetic nervous
scheme and renin-angiotensin-aldosterone structure outcomes in maladaptive circulatory
remodelling. The discharge of natriuretic peptides counters the vasoconstriction impacts of the
sympathetic nervous organization and renin-angiotensin-aldosterone scheme (Piepoli, &
Crisafulli, 2014).
In the diastolic type of congestive heart failure, the ventricle turns into less compliant or
harder, this damages ventricular filling. This damage results in abridged ventricular

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acquiescence, which further causes insufficient left ventricular filling. Due to this, left atrial
stress increases and the augmented pressure are frequently communicated to the pulmonary
scheme, results in pulmonary jamming and dyspnoea. During Systolic congestive heart failure
loss of inherent contractility occurs inside the ventricle. Indications are linked to a reduction in
cardiac output and the consequence of a changed load on a deteriorating ventricle. In this
situation, the ventricle becomes incapable to contract and eject the blood supply. The outcome is
an abridged ejection fraction, a distended left ventricle and the remodelling of the heart chamber.
The procedure of remodelling encourages a transformed ventricular figure which further
misrepresents the bicuspid valve instigating regurgitation and augmented volume burden in the
deteriorating ventricle. This overfilling subsidizes promote to the remodelling course and illness
progression (Borlaug, 2014).
Chronic Heart failure is the main health issues in developed nations with increased
occurrence and prevalence in the aged populace. Hospitalizations due to heart failure augmented
159% in last decade notwithstanding the improvements in the management of the illness. Two-
thirds of individuals with chronic heart failure are favoured for completely by their primary care
doctor rather than being involved in the heart failure clinics and reintegration or rehabilitation
programs focused in handling the disease (Liu, & Eisen, 2014).
It can be concluded that CHF occurs due to damage to myocardial cells, increase in
reabsorption of sodium and water withholding, insufficient ventricular filling, and deterioration
of ventricles. This particular health issues increases hospitalizations in last few years.
Clinical manifestations
In this particular pat clinical manifestations of CHF will be discussed.
The following are possible symptoms of heart failure:

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Congested lungs: Build-up of fluid in the lungs area and result in breathing issues even when
relaxing and chiefly when lying down.
Retention of Fluid: as a smaller amount of blood is being driven to the renal part; it can result
in water retention. This may cause swelling in the ankles, legs, and stomach. It can likewise
increase weight and urination (Ponikowski, Voors, Anker, Bueno, Cleland, Coats, & Jessup,
2016).
Fatigue and dizziness: as less blood is getting the body organs, it may result in a sense of
weakness.
Irregular and rapid heartbeats: heart may pump more rapidly in order to overcome the
deficiency of blood being driven to the body (Better health, 2018).
Manifestations of CHF include congested lungs, retention of fluid, dizziness, and
irregular heartbeat,
Diagnosis process
In this part the diagnosis process of CHF will be discussed
Echocardiogram
This test is considered as the most useful test to diagnose CHF. It basically provides the
objective examination of the cardiac structure and the working and assures the diagnosis of
systolic LV malfunctioning
ECG

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It can particularly add or assures the information related to the causes of CHF. The
alternations detected on ECG are not precise to heart failure; therefore an abnormal ECG cannot
replace the echocardiography (Ramírez, Orini, Mincholé, Monasterio, Cygankiewicz, e Luna, &
Pueyo, 2017).
Chest X-ray
This test helps the physician to examine the exact conditions of the lungs and heart. The
specific malfunctioning can rule out the CHF as the explanation for the individual’s symptoms
and signs. Cardiomegaly, the pulmonary venous alterations and the intestinal oedema of the lung
areas help the examinations of the chronic heart failure
Blood tests
As mild anaemia is common in the CHF, therefore, this test is important to diagnose any
indications of Anaemia. It can also diagnose abnormal blood cells and contaminations. It can
also detect the BNP levels, which is a hormone that elevates heart failure.
Thyroid functions test; these tests are conducted to diagnose hypo and hyperthyroidism. These
tests indicate the thyroid dysfunction is recognised as the likely cause of CHD.
Stress tests
This test measures the wellbeing of the heart by identifying how it reacts to the exertion.
The physician may ask the patient to walk on the treadmill with the attached ECG machine or the
drug can also be administered intravenously that triggers the heart similar to work out or
exercise. Sometimes this test might be performed while the patient wearing the mask that

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calculates the ability of the heart and lungs to intake O2 and exhalation of CO2 (Ahmad, et al.,
2014).
The diagnosis process or CHF includes using ECG, chest X ray, blood tests, and stress
tests.
Treatments
In this section some of the treatment options will be discussed.
Pharmaceutical treatment
ACE inhibitors: ACE or angiotensin-converting enzyme inhibitors widen the narrowed blood
vessels to enhance the blood flow. Some of the ACE inhibitors include benazepril, captopril,
enalapril fosinopril, lisinopril, quinapril, ramipril, and perindopril. Some of the side effects can
be caused by these drugs such as low blood pressure, a build-up of potassium in the loped,
abnormal heart rhythms, and water and sodium retention (Abete, Testa, Della-Morte, Gargiulo,
Galizia, De Santis, & Cacciatore, 2013).
Beta blockers: these drugs are helpful in reducing the blood pressure and decrease the rapid heart
rhythm. Some of the beta blockers include acebutolol, atenolol, bisoprolol, carteolol, esmolol,
metoprolol, nadolol, nebicolol, and propranolol. The side effect includes increased
cardiovascular impacts like low blood pressure and reduced heart rate (Abete et al., 2013).
Diuretics: diuretics are the drugs that decrease the body’s fluid intake as CHF can stimulate the
body to retain extra liquid than it should. The doctor may prescribe medications like thiazide
diuretics (helps in widening to the blood vessels and remove the extra fluid), loop diuretics
(triggers kidneys to generate more urine to remove additional fluid), and potassium-sparing
diuretics (helps in get rid of sodium and liquid). The side effects of these drugs include

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headaches, dizziness, thirst, very low levels of potassium in the blood, an increase of blood sugar
(Ramírez, et al., 2017).
Non-pharmaceutical treatment
Non-pharmaceutical management of CHF might be as essential as the drug therapies a
patient might develop physical deconditioning. Some of the non-pharmaceutical interventions
include;
Physical activity
Most of the physician now recommends regular exercises for the individual having CHF.
The physical activities have been proven to enhance the functional ability, sign and symptoms,
and neuro-hormonal malfunctioning. Some of the exercises that must be included in patient's
interventions programs are normal walking, bicycling, light weight lifting, and stretching
workouts. The patient should be educated about the type of physical exercise they are
recommended to perform every day (Hetland, et al., 2013).
Nutrition
Nutritional approaches might also be beneficial for the patient with CHF. The intake of
saturated fat should be restricted for the patient with CH. Among the CHD patient constipation id
common due to gastrointestinal hypoperfusion, therefore high fibre food should be included in
their routine diet. Fluid overload is caused due to the excessive dietary sodium is the main cause
of preventable hospitalizations (Ponikowski et al., 2016), therefore reducing the dietary sodium
in the diet might be beneficial clinical and haemodynamic impacts specifically when mixed with
the diuretics (Slawson, Fitzgerald, & Morgan, 2013).

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Fluid management
Fluid management is the key approach in order to achieve the health goals already set for
a particular patient. The patient must be advised that a steady gain of weight with time may
indicate that they are retaining a high amount of fluid. If the patient gained more than 2 kg of
weight in two days, they must talk to their physician or expert. Little to moderate intake of
alcohol might improve the prognosis in the individual with left ventricle dysfunction is actually
controversial. Intake of high caffeine might exacerbate issues related to arrhythmia, upsurge the
BP and heart rate (Philipson, Ekman, Forslund, Swedberg, & Schaufelberger, 2013).
Smoking
Smoking or chewing tobacco should be stopped as it can reduce the oxygen availability
in the blood, provokes the vasoconstriction, and impacts the respiratory and endothelial
performance or functioning (Bos-Touwen et al., 2015).
Health promotion
There is a number of health programs are conducted by the Australian government to
increase the awareness of this health condition among the people. Different services providers
like heart foundation, Australian indigenous Healthinfonet, World Heart Foundation, RHD
action, Reach, her heart, and Ministry of health are working continuously to reduce the
prevalence of this health issues by funding research companies, making people conscious about
the risk factors of the chronic heart failure and other heart condition. The health promotion
programs conducted are working in different societies and states of Australia to enhance the
lifestyle and reducing the causing factor of CHD (Chen et al., 2016).

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It can be concluded that by using some of the treatment options including
pharmacological treatment, non-pharmacological treatment, nutrition, fluid management, and
stop smoking can be beneficial in CHF. A different health promotions programme has been
implemented by different organisations like AIH, WHF, and ministry of health.
Conclusion
Chronic or congestive heart failure is basically the current incapability of the human
blood to drive or pump enough blood to different parts of the body. Risk factors associated with
this health condition include being obese, old age, increased BP, diabetes, and other heart
condition. Nearly 300000 people of Australian presently suffering from this health issue, and 26
million people are affected worldwide. It occurs due to the dysfunctioning of myocardial cells.
The diastolic CHF caused when ventricles become stiffed and due to the pulmonary blocking and
dyspnoea. In systolic CHF occurs due to the reduced cardiac output and deteriorating ventricles.
CHF is the worldwide issue which increases the hospitalization cases by 159 per cent. The
symptoms associated with CHF include congested lungs, dizziness, and retention of fluid,
fatigue, quick and irregular heartbeats. The diagnosis methods can be prescribed by a physician
for this health includes ECG, echocardiogram, chest X-Ray, blood tests (complete CBC and
infection), thyroid function test, and Stress tests. The treatment methods applied for this problem
is two types; pharmaceutical and non-pharmaceuticals. The pharmaceutical management o CHF
includes ACE inhibitor, beta blockers, and diuretics. The non-pharmaceutical treatment includes
applying recommended physical activities, diet rich in fibre, less dietary sodium, management of
fluid intake, and stopping smoking. Health promotion also plays a major role in the elimination
of this health. There is the number if health promotions have been implemented by the Australian

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government to enhance the knowledge and awareness about the preventive measures, treatment
option and risk factors that can cause this health. Some of the health promotion services
providers available in Australia are Reach, Heart Foundation, and the Ministry of health.

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References
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(2013). Treatment for chronic heart failure in the elderly: current practice and
problems. Heart failure reviews, 18(4), 529-551.
Better health (2018). Congestive heart failure (CHF). Retrieved from:
https://www.betterhealth.vic.gov.au/health/conditionsandtreatments/congestive-heart-
failure-chf
Philipson, H., Ekman, I., Forslund, H. B., Swedberg, K., & Schaufelberger, M. (2013). Salt and fluid
restriction is effective in patients with chronic heart failure. European journal of heart
failure, 15(11), 1304-1310.
Ahmad, T., Fiuzat, M., Neely, B., Neely, M. L., Pencina, M. J., Kraus, W. E., & Adams, K. F. (2014).
Biomarkers of myocardial stress and fibrosis as predictors of mode of death in patients with
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Stout, K. K., Broberg, C. S., Book, W. M., Cecchin, F., Chen, J. M., Dimopoulos, K., & Kuvin, J. T. (2016).
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Borlaug, B. A. (2014). The pathophysiology of heart failure with preserved ejection fraction. Nature
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Borlaug, B. A. (2014). The pathophysiology of heart failure with preserved ejection fraction. Nature
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Chen, A. M., Yehle, K. S., Albert, N. M., Ferraro, K. F., Mason, H. L., Murawski, M. M., & Plake, K. S.
(2014). Relationships between health literacy and heart failure knowledge, self-efficacy, and self-
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Klip, I. T., Comin-Colet, J., Voors, A. A., Ponikowski, P., Enjuanes, C., Banasiak, W., & van Veldhuisen,
D. J. (2013). Iron deficiency in chronic heart failure: an international pooled analysis. American
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Liu, L., & Eisen, H. J. (2014). Epidemiology of heart failure and scope of the
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