CONGESTIVE HEART FAILURE

(CHF)
OBJECTIVES
At the end of the session, the students will be able to:
1. State the condition of CHF in Saudi Arabia with 95% accuracy
2. Define CHF with 95% accuracy
3. Enumerate and discuss 3 out of 6 causes/risk factors of CHF
4. Discuss the types, signs & symptoms of CHF with 95% accuracy
5. Enumerate the management for CHF
BACKGROUND
One of the mostly affected human organs in terms of rapid industrialization
and urbanization is the heart. (Sanderson, 2003)
In Saudi Arabia, the recent epidemiologic study done by Al-Daghri, et al.
(2011) highlighted the worsening prevalence of diabetes mellitus
hypertension and coronary artery disease (CAD) where CHF is under this
group in the capital Riyadh as compared only to the previous decade
According to the latest WHO statistics, the vast majority of killer diseases
in the Kingdom of Saudi Arabia (KSA) are non-communicable, chronic
diseases.
Of the 413 deaths per 100,000 in 2002, 144 (35 percent) were due to
cardiovascular disease (WHO report, 2008)
Coronary artery disease (CAD) constitutes one of the main health
problems in Saudi Arabia, representing the third most common cause of
hospital-based mortality second to accident and senility (Kumosani et al.,
2011)
In a different study done in the Eastern region of KSA revealed that 26%
of total deaths were attributed to CADs (27% of deaths of males and
23.5% of females) (Gaziano, et al., 2010)
DEFINITION:
Heart failure is a complex syndrome characterised by reduced heart
efficiency and resultant haemodynamic and neurohormonal responses
(Poole-Wilson 1985).
CHF, or heart failure, in general, is the weakening of the hearts ability to
effectively pump blood (Alqahtani, et al., 2012)
The terms congestive heart failure (CHF) or congestive cardiac failure
(CCF) are often used interchangeably with chronic heart failure
(heartfoundation.org.au)

CAUSES/RISK FACTORS:
In Saudi Arabia, hypertension is present in more than 80% of patients
with heart failure, making it the single strongest predictor of CHF
(Elshaer, et al., 2009)
This was later confirmed from a recent study by Assiri (2011),
indicating that both hypertension and ischemic heart disease are the
major causes of heart failure among elderly Saudis
Abundant evidence shows that patients with type 1 diabetes or type 2
diabetes are at high risk for several cardiovascular disorders including
coronary heart disease, stroke, peripheral arterial disease,
cardiomyopathy and congestive heart failure.
Cardiovascular complications are now the leading causes of diabetesrelated morbidity and mortality (Grundy et al.,1999)
Atherosclerosis of the coronary arteries is the primary cause of CHF,
and coronary artery disease is found in more than 60% of the patients
with HF (Zipes, et al., 2005)
MI causes focal heart muscle necrosis, the death of myocardial cells,
and a loss of contractility; the extent of the infarction correlates with the
severity of HF (Brunner & Suddarths Medical-Surgical Nursing, 12th
ed. page 827)
As for obesity/overweight, a study by Malki et al. in 2003, showed that
overweight and obesity are frequently encountered in Saudi females of
childbearing age. The prevalence of overweight and obesity was
higher amongst a group of married than among a group of single
women.
Cigarette and tobacco smoke, high blood cholesterol, high blood
pressure, physical inactivity, obesity and diabetes are the six major
independent risk factors for coronary heart disease that you can modify
or control. (Kumosani et al., 2011)
Several systemic conditions, including progressive renal failure and
uncontrolled hypertension, contribute to the development and severity
of HF (Varughese, 2007)
TYPES OF CHF
LEFT-SIDED HEART FAILURE
Occurs when the left ventricle fails and cardiac output falls.
Blood backs up into the left atrium and lungs
S/S Left-sided HF (moh.gov.sa)
o blood tinged, frothy sputum
o nonproductive cough
o crackles
o dyspnea
o restlessness
o tachycardia
o s3 (ventricular gallop) & s4 (atrial gallop) sound
o orthopnea

o cool, pale skin

o paroxysmal nocturnal dyspnea
RIGHT-SIDED HEART FAILURE
Occurs when the right ventricle doesnt contract effectively.
Blood backs up into the right atrium and peripheral circulation
S/S Right-sided HF (moh.gov.sa)
o jugular vein distention
o splenomegaly
o hepatomegaly
o edema
o ascites
o nocturia
o weight gain
o anorexia, fullness, nausea
DIAGNOSTIC PROCEDURES:
Heart failure should be diagnosed using the pathway in the European
Society of Cardiology (ESC) guidelines (McMurray et al 2012)
Once diagnosis is confirmed the severity of symptoms can be
expressed using the New York Heart Association (NYHA) classification
MANAGEMENT
Education and self-management:
o Patients and carers require education about heart failure to
develop the staff-patient relationship and improve treatment
concordance, especially in older patients (Anderson et al 2005)
Lifestyle modification:
o For smokers, avoid smoking, the immediate release of nicotine
contracts arteries, increasing the risk of ischemia (Lanza et al
2011).
o Obesity and being sedentary adversely affect resting heart rate
and increase cardiac demands. Anemia increases cardiac
workload (Levick 2009)
o Conversely, exercise has significantly positive effects on
symptoms and left ventricular function (Piepoli et al., 2004)
Good control of comorbid conditions such as diabetes,
hypercholesterolemia and kidney disease improves cardiac outcomes.
Patients with heart failure who are hospitalized for another condition
have longer stays and worse outcomes than matched populations
without heart failure (Ahluwalia et al., 2012)
The mainstay of heart failure treatment medication can relieve
symptoms, reduce hospitalizations, shorten length of stay and improve

quality of life and prognosis which includes diuretics, beta andrenergic

blockers, angiotensin converting enzyme (ACE) inhibitors,
mineralocorticoid-receptor antagonists and other second-line drugs,
such as nitrates, hydralazine, ivabradine and digoxin (McMurray et al
2012)
CONCLUSION
Understanding and being able to manage heart failure is important for patients
quantity and quality of life, regardless of age. It is also important for health
service costs. Heart failure is most common in older adults and it is expected that
the average age of patients will rise. Nurses have a crucial role in the care of
patients but a multidisciplinary approach is mandatory, including partnership with
older adult services

REFERENCES
JOURNALS/ARTICLES
Al-Malki JS, Al-Jaser MH, Warsy AS (2003). Overweight and obesity in
Saudi females of childbearing age. Inter. J. Obesity. 27: 134-139.

Alqahtani M, Alanazi T, Binsalih S, Aljohani N, Alshammari M, Ashagag A,

Abdullah M, Buabbas S, Abdulbaqia M. Characteristics of Saudi patients
with congestive heart failure and adherence to management guidelines in
a tertiary hospital in Riyadh. 2012. Ann Saudi Med 2012; 32(6): 583-587

Anderson C, Deepak B, Amoateng-Adjepong Y et al (2005) Benefits of

comprehensive inpatient education and discharge planning combined with
outpatient support in elderly patients with congestive heart failure.
Congestive Heart Failure. 11, 6, 315-321.

Assiri S. Clinical and therapeutic profiles of heart failure patients admitted

to a tertiary hospital, Aseer region, Saudi Arabia. Sultan Qaboos Univ Med
J 2011; 11: 230-5.

Elshaer F, Hassan W, Fawzy ME, Lockyer M, Kharabsheh S, AKhras N, et

al. The prevalence, clinical characteristics, and prognosis of diastolic heart
failure: a clinical study in elderly Saudi patients with up to 5 years followup. Congest Heart Fail 2009; 15:117-122

Gaziano TA, Bitton A, Anand S, Abrahams-Gessel S, Murphy A: Growing

epidemic of coronary heart disease in low- and middle-income countries.
Curr Probl Cardiol 2010, 35:72115.

Grundy SM, Benjamin IJ, Burke GL, Chait A, Eckel RH, Howard BV, Mitch
W, Smith SC, Sowers JR (1999). Diabetes and cardiovascular disease: a
statement for health professionals from the American Heart Association.
Circulation. 100: 1134-1146

Kumosani T, Alama M, Iyer A. Cardiovascular diseases in Saudi Arabia.

2011. Prime Research on Medicine (PROM) Vol. 1(x), pp. 01-06, April
24th 2011

Lanza G, Careri G, Crea F (2011) Mechanisms of coronary artery spasm.

Circulation. 124, 16, 1774-1782

Levick J (2009) An Introduction to Cardiovascular Physiology. Fifth edition.

Butterworth Heinemann, Oxford

McMurray J, Adamopoulos S, Anker S et al. (2012) ESC Guidelines for

the diagnosis and treatment of acute and chronic heart failure 2012.
European Heart Journal. 33, 14, 1787-1847

Piepoli M, Davos C, Francis D et al. (2004) Exercise training metaanalysis of trials in patients with chronic heart failure. BMJ. 328, 7433,
189-196

Sanderson JE, Tse TF. Heart failure: a global disease requiring global
response. Heart 2003; 89:585-6.

Varughese, S. (2007). Management of acute decompensated heart failure.

Critical Care Nursing Quarterly, 30(2), 94103.

Zipes, D. P., Libby, P. & Bonow, R. D. (Eds.). (2005). Braunwalds heart

disease (7th ed.). Philadelphia: Saunders

ONLINE
Heart Foundation Organization Australia
"Living Well With Chronic Heart Failure". Heart Foundation. p. 18.
Retrieved 25 May 2014
heartfoundation.org.au
Ministry of Health, Kingdom of Saudi Arabia
http://www.moh.gov.sa/en/HealthAwareness/EducationalContent/Disease
s/Heartcirculatory/Pages/HealthDay-2011-9-25-001.aspx