Congestive heart failure is the inability of the cardiac muscle to propel sufficient blood to meet the body's needs.
The cardiac output is too low.
It is a clinical syndrome with various causes.
Heart failure can be acute or chronic.
Congestive heart failure may involve the left or the right side of the heart or all chambers of the heart.
zu sehr guten Konditionen
The body reacts to the reduced cardiac output with different mechanisms to compensate for the reduced output.
One of the earliest neurohumoral responses is an increased release of catecholamines resulting in an increased heart rate.
Another response to increased demand is to increase the available contractile elements of the cardiac muscle (hypertrophy).
If the organism fails to compensate for the deficit via different response mechanisms or medicinal treatment, this status is referred to as decompensation.
The left ventricle has a diminished output.
- The systemic circulation is undersupplied with blood.
- Reduced performance
- Weakness, fatigue
- Blood flows back into the pulmonary vessels.
- Dyspnea (shortness of breath due to elevated pressure in the pulmonary circulation)
- Orthopnea (apart from the blood that flows back into the pulmonary vessels, an additional volume of blood is orthostatically displaced into the pulmonary circulation when the patient lies flat, resulting in severe respiratory distress.)
Sitting up allows the accessory respiratory muscles to work, which provides relief.
- Cardiac asthma
Pulmonary congestion leads to nocturnal fits of coughing and respiratory distress
- Pulmonary oedema
In severe disease, pulmonary edema may occur, in which case fluids accumulate in the pulmonary alveoli and the exchange of gases is severely obstructed.
The pressure in the blood vessels consequently becomes greater than both the colloidal osmotic pressure in the blood and the pressure in tissues.
|The guiding symptom of left-sided heart failure is dyspnoea
Isolated right-sided heart failure is rare.
Right-sided heart failure (congestive heart failure) usually occurs secondary to primary left-sided heart failure.
As the pressure in the pulmonary circulation rises, the right ventricle becomes unable to pump the blood efficiently.
This leads to congestion of blood in front of the right ventricle and thus to reflux into the systemic circulation.
- Distended veins (neck veins, veins at the tongue base)
- Weight gain and oedema, especially at the ankles
- Impaired liver function
- Impaired renal funtion (excessive urination at night (nycturia)
- Congestive gastritis
|The guiding symptom of right-sided heart failure is oedema formation
Danger of decompensation with secondary:
- Pulmonary oedema
- Cardiac shock
Physical and psychical relief:
- Good medication prior to dental treatment
- Supine positioning
- Sedation, if necessary
- Administration of oxygen, if necessary
- Gentle treatment
- Minimal excitement