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Congestive Heart Failure,
An Overview
P A R T
BY DR. MIAN A. JAN MD, FACC, FSCAI
AND ZARSHAWN JAN

1
7. Heart rhythm disturbance
8. Thyroid disorder
9. Congenital conditions
10. Lung disease
11. Storage and collage diseases such as amyloid

Pathophysiology: The heart is a pump, which depending on
the body's needs, pumps certain outputs to cover those needs,
however, whether because of weakness or stiffness, the heart is not
able to meet those needs.

FIGURE 1
Definition: Congestive Heart Failure (CHF) is a condition
where the heart does not pump blood as well as it should. It can
occur when the heart muscle is too weak or too stiff, but also
when other defects prevent it from circulating blood properly.
There are 6.5 million people living with CHF in the US
and one in five Americans will develop CHF in their lifetime.
The total direct medical care cost of CHF was estimated to be,
in 2012, at 21 billion dollars, and projected to increase to 53
billion in 2030. Eighty-one percent of this cost was for patients
over the age of 65 years.
There are many causes, here are just a few of the most
important ones:
1. Coronary Artery Disease especially after Myocardial
infarction
2. Hypertension
3. Valvular Disease
4. Idiopathic - such as after myocarditis or takotsubo
syndrome
5. Long standing Alcohol Abuse
6. Infections

24 CHESTER COUNT Y Medicine | SPRING 2019

FIGURE 2
As a result of a damaged pump, cardiac output is thus
insufficient to meet the metabolic demand for oxygen in the body.
This results in congestion in the lungs and the venous system since
diminished forward flow results in stagnation and backflow into
these areas. Compensatory mechanisms such as the activation of
the sympathetic system and the renin angiotensin system become
active to compensate for low cardiac output. They will increase
output but they are short term solutions and ultimately place
further strain on the heart which will result in heart failure if this
becomes chronic and untreated. Drug therapy in chronic CHF
aims to inhibit these unhelpful compensatory mechanisms. The
kidney is a very important part of this equation and ultimately the



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