Congestive heart failure (CHF) or congestive cardiac failure (CCF) refers to chronic, usually biventricular failure of the heart.
The patients of congestive cardiac failure present with features of left and right heart failure. The clinical manifestations are as below.
Features due to left heart failure:
Features due to right heart failure:
Framignham criteria is used for the diagnosis of congestive cardiac failure. The presence of one major and two minor criteria is the minimal requirement for establishing the diagnosis.
The major criteria include:
The minor criteria include:
The main investigations in the diagnosis of congestive cardiac failure include the following.
The treatment strategy for congestive cardiac failure has three components; namely correction of the underlying cause(s), removal of the precipitating cause(s) and control of congestive cardiac failure.
The general measures for controlling the congestive cardiac failure include the following.
Initially, angiotensin converting enzyme (ACE) inhibitors are given to the patient which reduce cardiac workload by causing vasodilation . Captopril and lisinopril are the commonly used agents .
If ACE inhibitors alone are not effective, a combination of other vasodilators (such as nitrates, hydralazine and neseritide) and diuretics (such as loop diuretics, thiazide diuretics and potassium sparing diuretics) may be used  .
Cardiac transplantation is indicated in end stage cardiac disease that is refractory to other kinds of therapy. Ideal candidates should have age less than 60 years, adequate renal function and pulmonary vascular resistance less than 3 RU  .
The prognosis depends upon the extent of cardiac failure and the type of treatment given. Prognosis is poor when the underlying heart disease is not treatable. Other poor prognostic factors include left ventricular dysfunction with ejection fraction less than 20%, secondary renal insufficiency, hyponatremia and hypokalemia (with potassium less than 3 mEq/l).
Ventricular arrhythmias and pump failure are the leading causes of death in these patients.
Congestive cardiac failure results from the following types of conditions related to the heart.
Congestive cardiac failure usually involves failure of both the left and right side of the heart. The features of left sided heart cardiac failure are mainly due to congestion of the lungs. Dyspnea occurs because of the damming of blood in the lungs resulting in pulmonary venous congestion. Initially dyspnea occurs only at exertion. Later on orthopnea and paroxysmal nocturnal dyspnea also develop. Later on dyspnea occurs even at rest. Orthopnea refers to breathlessness on lying flat. It occurs because of the following two circulating changes when the person lies flat.
Paroxysmal nocturnal dyspnea results from the same two mechanisms above along with the following:
Later on, pulmonary edema also develops and causes persistent breathlessness.
Right sided heart failure mainly causes tissue congestion because of the inability of the heart to empty properly. Many organs including the brain, liver and kidneys are affected. In addition, generalized congestion develops which manifests as peripheral edema.
The causes that predispose to the development of myocardial or valvular diseases should be avoided. In case of active disease, early diagnosis and prompt treatment is necessary to reduce mortality.
Cardiac failure refers to the inability of the heart to maintain adequate cardiac output to meet the demands of the body. Depending upon the cause, there may be a failure of the left side or the right side of the heart; known as left and right sided cardiac failure respectively. The salient features are also different.
Biventricular cardiac failure is the condition in there is chronic failure of both the left and right sides of the heart. In most of the cases, right sided cardiac failure is a result of preexisting left sided cardiac failure.
Congestive cardiac failure refers to the failure of both sides of the heart. The blood is not adequately pumped by the heart. As a result, the organs of the body do not get sufficient amount of blood and damming of blood in the vessels also takes place. A healthy lifestyle and proper treatment prevents mortality from congestive cardiac failure.