Congestive Cardiac Failure or Congestive Heart Failure (CHF)- B. Pharma 2nd Semester Pathophysiology notes pdf

Congestive Cardiac Failure or Congestive Heart Failure (CHF)

Congestive Cardiac Failure or Congestive Heart Failure (CHF)- B. Pharma 2nd Semester Pathophysiology notes pdf


At the end of this PDF Notes, student will be able to

       Define  congestive heart failure

       Discuss the types of congestive heart failure

       Explain the pathophysiology of congestive heart failure

       Discuss the signs and symptoms of it


•      Congestive Heart Failure (CHF), often simply referred to as heart failure, is a chronic and potentially life-threatening medical condition that affects the heart’s ability to pump blood effectively. Despite its name, CHF doesn’t mean that the heart has stopped working, but rather that it’s struggling to meet the body’s demands for oxygen and nutrients. In this article, we’ll explore CHF in detail, including its causes, symptoms, diagnosis, treatment, and ways to manage this condition effectively.

•     A clinical syndrome

•      Result from any disorder that impairs the ability of the ventricle to fill with or eject blood

•      Rendering the heart unable to pump blood at a rate sufficient to meet the metabolic demands of the body

       Heart failure can result from any disorder that reduces ventricular filling (diastolic dysfunction) and/or myocardial contractility (systolic dysfunction)

Causes of CHF: CHF is typically a result of underlying heart conditions, including coronary artery disease, high blood pressure, heart valve disease, cardiomyopathy, or congenital heart defects. Other factors like diabetes, obesity, and smoking can also contribute to its development.

Mechanism of CHF: CHF occurs when the heart’s chambers become weakened or stiff, making it difficult for the heart to fill with blood or pump blood effectively. This can lead to a buildup of fluid in the lungs and other parts of the body.

Common Symptoms of CHF:

Shortness of Breath: People with CHF often experience breathlessness, especially during physical activity or when lying down.

Fatigue: Feeling tired or fatigued, even after minimal exertion, is a common symptom.

Swelling: Swelling in the legs, ankles, or abdomen is frequently observed in CHF patients due to fluid retention.

Rapid or Irregular Heartbeat: Arrhythmias or irregular heartbeats may be present in individuals with CHF.

Reduced Exercise Tolerance: CHF can limit a person’s ability to engage in physical activities and exercise.


Etiology of Congestive Heart Failure

Systolic dysfunction (decreased contractility)

       Reduction in muscle mass (e.g. myocardial infarction)

       Dilated cardiomyopathies

       Ventricular hypertrophy

       Pressure overload (e.g. systemic or pulmonary HT, aortic or pulmonic valve stenosis)

       Volume overload (e.g., valvular regurgitation, shunts, high-output states)

Diastolic dysfunction (restriction in ventricular filling)

       Increased ventricular stiffness

       Ventricular hypertrophy (e.g. hypertrophic cardiomyopathy)

       Infiltrative myocardial diseases (e.g. amyloidosis, sarcoidosis, endomyocardial fibrosis)

       Myocardial ischemia and infarction

       Mitral or tricuspid valve stenosis

       Pericardial disease (e.g. pericarditis, pericardial tamponade)

Types of Heart Failure

       Acute and chronic heart failure

       High output and low output HF

       Left sided, right sided and biventricular HF

       Forward and backward HF

       Systolic and diastolic HF

Acute heart failure 

       Heart is not able to pump the blood effectively

       Also called as Decompensated heart failure

       Compensatory mechanisms  of human body cause increase in CO by stimulation of β1  receptors and also RAA-system

       Both mechanism leads to vasoconstriction

       Treatment with Inotropic drugs becomes necessary

Chronic heart failure

       Failure of compensatory mechanism

       Heart needs to undergo surgery for its repair

       Further controlled by administration of drugs

High output HF:

       There is high demands of the body, which are not met even with increased cardiac output

       e.g.: anemia, pregnancy

Low output HF:

       There is decreased contractility of heart leading to decreased cardiac output

       e.g.: cardiomyopathy, valvular disease

Left sided (left ventricular) HF

        Excess fluid accumulates upstream

        Reduction in left ventricular output

        Increase in left atrial pressure

        Increase in pulmonary venous pressure

Ø  Acute increase in left atrial pressure causes pulmonary congestion and pulmonary edema e.g.: MI

Ø   Gradual increase in left atrial pressure causes reflex pulmonary hypertension but no pulmonary edema

e.g. : aortic stenosis

Right sided (right ventricular) HF:

         Excess fluid accumulates upstream behind the failing right ventricle

         Reduction in right ventricular output

         Results in systemic venous congestion

Ex: pulmonary valvular stenosis, multiple pulmonary emboli

Systolic HF:

       Characterized by an abnormality of ventricular contraction

       As seen in ischemic heart failure and dilated cardiac myopathy

Diastolic HF:

       Characterized by an impaired ventricular relaxation

       Increased ventricular stiffness resulting in diastolic dysfunction

e.g.: ischemia, left ventricular hypertrophy

Pathophysiology of Congestive Heart Failure

Preload: Pressure that fills the left ventricle during diastole

     Main Determinant– left ventricular compliance and venous return

     Small increase in end-diastolic volume

     large increase in cardiac output

     Primary compensatory mechanism in normal heart

     Ability of heart to alter the force of contraction depends  on preload

Afterload: Pressure against which the left ventricular contracts and is measured as the mean aortic pressure

  • Main determinants – total peripheral resistance and left ventricle size
  • Left ventricular dysfunction – an inverse relationship exist between afterload and stroke volume
  • An increase in afterload causes a decrease in stroke volume

Key components of the pathophysiology of cardiac remodelling

pathophysiology of cardiac remodeling

Compensatory Mechanisms

Cardiac compensatory mechanism:

Ø  Ventricular dilation

Ø  Ventricular hypertrophy

Peripheral compensatory mechanisms:

Ø  Increased sympathetic activity

Ø  Activation of renin angiotensin aldosterone system

Ø   Increased release of arginine vasopressin

Renin Angiotensin Aldosterone system

Renin Angiotensin Aldosterone system

Clinical Presentation – Signs of Congestive Heart Failure

       Pulmonary edema

        Pleural effusion



       Peripheral edema

        Jugular venous distension

        Hepatojugular reflux


Symptoms of Congestive Heart Failure



       Paroxysmal nocturnal dyspnea

        Exercise intolerance


       Ascites, Mental status changes





        Abdominal pain, Anorexia, Nausea, Bloating

Diagnosis and Evaluation:

Medical History: A doctor will start by taking a thorough medical history to understand symptoms, risk factors, and potential causes.

Physical Examination: A physical examination will assess vital signs, signs of fluid retention, and abnormal heart sounds.

Imaging Tests: Diagnostic tests like echocardiography, X-rays, or cardiac MRI can provide images of the heart’s structure and function.

Blood Tests: Blood tests are used to assess kidney and liver function, as well as check for specific markers related to heart failure.

Treatment Options:

Lifestyle Changes: Managing CHF often involves adopting a heart-healthy lifestyle, which includes dietary changes, regular exercise, smoking cessation, and stress management.

Medications: Medications like diuretics, ACE inhibitors, beta-blockers, and others may be prescribed to alleviate symptoms and improve heart function.

Medical Devices: In some cases, medical devices such as pacemakers, implantable cardioverter-defibrillators (ICDs), or ventricular assist devices (VADs) may be recommended.

Surgery: Surgical interventions like coronary artery bypass grafting (CABG) or heart valve repair or replacement may be necessary in certain cases.


Prognosis Varies: The prognosis for CHF can vary widely based on factors like the cause of heart failure, its severity, and how well it’s managed. With appropriate care, many people with CHF can lead fulfilling lives.

Progression Management: Although CHF is a chronic condition, its progression can often be slowed or stabilized with treatment and lifestyle changes.


Managing Risk Factors: Preventing CHF involves managing risk factors such as high blood pressure, diabetes, obesity, and coronary artery disease through lifestyle changes and regular medical check-ups.


       CHF is a clinical syndrome that impairs the ability of the ventricle to fill with or eject blood

       Heart is unable to pump blood at a rate sufficient to meet the metabolic demands of the body

       It can be classified as:  Acute and chronic heart failure,

       High output and low output heart failure,

       Left sided, right sided and biventricular heart failure,

       Systolic and diastolic heart failure

Congestive Heart Failure (CHF) PDF Notes Download


Certainly! Here are some frequently asked questions (FAQ) about Congestive Heart Failure (CHF):

Q1: What is Congestive Heart Failure (CHF)? Congestive Heart Failure (CHF) is a medical condition in which the heart is unable to pump blood effectively, leading to a buildup of fluid in the lungs and other body tissues. It is also known as congestive cardiac failure.

Q2: What causes CHF? CHF can be caused by various underlying conditions, including coronary artery disease, high blood pressure, heart valve disease, cardiomyopathy, and other heart-related or systemic diseases.

Q3: What are the common signs and symptoms of CHF? Symptoms of CHF can include shortness of breath, fatigue, swelling of the legs and ankles, rapid or irregular heartbeat, and reduced exercise tolerance.

Q4: How is CHF diagnosed? CHF is diagnosed through a combination of medical history, physical examination, imaging tests like echocardiography, blood tests, and sometimes a heart catheterization.

Q5: What are the treatment options for CHF? Treatment for CHF may include lifestyle changes, medications, such as diuretics and ACE inhibitors, and in some cases, medical devices like pacemakers or implantable cardioverter-defibrillators (ICDs).

Q6: Can CHF be cured, or is it a lifelong condition? CHF is typically a chronic condition, but its progression can be managed effectively with treatment, allowing individuals to lead a quality life.

Q7: Are there different types of CHF? Yes, CHF can be categorized into two main types: systolic heart failure (where the heart’s pumping ability is reduced) and diastolic heart failure (where the heart’s relaxation and filling abilities are impaired).

Q8: Can lifestyle changes help manage CHF? Yes, lifestyle modifications like a heart-healthy diet, exercise, smoking cessation, and managing stress can significantly improve the management of CHF.

Q9: Is CHF preventable? Prevention involves managing risk factors such as hypertension, diabetes, and coronary artery disease through a healthy lifestyle and regular medical check-ups.

Q10: What is the prognosis for individuals with CHF? The prognosis for CHF varies depending on the severity of the condition and the effectiveness of treatment. With proper management, many people can live fulfilling lives with CHF.

Q11: Can CHF worsen over time? CHF can progress over time, but with appropriate medical care and lifestyle changes, the progression can often be slowed or stabilized.

Q12: Is CHF the same as a heart attack? No, a heart attack (myocardial infarction) is a sudden event caused by a blockage in the coronary arteries, while CHF is a chronic condition related to the heart’s inability to pump effectively.

Q13: Are there support groups or resources for individuals with CHF? Yes, there are support groups, educational resources, and healthcare professionals who specialize in managing CHF to help individuals and their families cope with the condition.

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