Congestive Heart Failure (CHF) is a chronic condition that affects the ability of the heart to pump blood adequately throughout the body. It’s a condition that has affected millions of people around the world.

We created this study guide to provide you with an overview of this topic. We provided practice questions for your benefit as well. So, if you’re ready, let’s get started.

What is Congestive Heart Failure?

As previously mentioned, Congestive Heart Failure (CHF) is a progressive, chronic condition that impacts the ability of the heart muscle to pump blood throughout the body.

It’s often caused by hypertension, coronary artery disease, or other valve conditions of the heart.

When the ventricles are unable to pump blood effectively, blood and other fluids begin to accumulate in the heart. Then, it eventually accumulates in the lungs, abdomen, and other parts of the body.

This explains why fluid overload is one of the primary signs of CHF.

When fluid begins to accumulate in the lungs, this is known as pulmonary edema and it leads to several different breathing and respiratory issues.

Signs and Symptoms of Congestive Heart Failure

A patient with CHF may show the following signs and symptoms:

  • Fluid overload
  • Hypoxemia
  • Dyspnea
  • Tachypnea
  • Orthopnea
  • Diaphoresis
  • Cyanosis
  • Peripheral edema
  • Jugular venous distention

Keep in mind that each patient is different, therefore, their signs and symptoms may vary.

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Congestive Heart Failure Diagnosis

The patient’s signs and symptoms play a role in the diagnosis of CHF, however, the following diagnostic tests would also be useful:

  • Chest x-ray
  • Electrocardiogram (EKG)
  • Echocardiogram
  • Arterial Blood Gas (ABG)
  • Complete Blood Count (CBC)
  • Hemodynamic monitoring
  • Cardiac enzyme analysis

As a Respiratory Therapist, you must know and understand what to look for when obtaining the results of each of these diagnostic tests.

Congestive Heart Failure Treatment

The treatment methods for CHF will vary from patient to patient depending on the severity of their signs and symptoms. As a Respiratory Therapist, one thing that you may notice is severe hypoxemia which can be treated with oxygen therapy.

For example, the patient may require 100% oxygen immediately which can be delivered via a nonrebreathing mask.

Diuretic agents would be recommended to treat fluid overload. Some other medications that may be considered include:

  • Preload reducers
  • Afterload reducers
  • Positive inotropic agents
  • Analgesic medications
  • ACE inhibitors
  • Beta-blockers

Noninvasive ventilation may be indicated to support the patient’s breathing and help with oxygenation and/or ventilation. If BiPAP is administered and the patient continues to deteriorate, intubation and mechanical ventilation would be indicated.

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Congestive Heart Failure Practice Questions:

1. What is Congestive Heart Failure?
Congestive heart failure is a condition where the heart cannot pump enough blood and oxygen to the body’s tissues. It is a chronic and progressive inability of the heart to pump sufficiently to meet the body’s metabolic needs.

2. What occurs with a normal heart?
The heart pumps enough blood to match the body’s need for oxygen.

3. In congestive heart failure, the heart is not able to what?
To move as much blood as it should with each beat.

4. In respiratory therapy school, congested heart failure is typically associated with what disease?
Pulmonary edema.

5. What common two causes of left-sided heart failure?
Myocardial Infraction and hypertension.

6. What are the forward effects of left-sided congestive heart failure?
The left ventricle is unable to pump which causes decreased cardiac output, tissue perfusion, and tissue hypoxia.

7. What are the backward effects of left-sided congestive heart failure?
Blood coming into the left ventricle cannot be pumped forward. Blood backs up into the lungs.

8. What is often the earliest sign of heart failure?
Dyspnea on exertion.

9. What are the three common causes of right-sided congestive heart failure?
Left ventricle failure, pulmonary hypertension (cor pulmonale) and right ventricle myocardial infarction.

10. What is the forward effect of right-sided congestive heart failure?
Left ventricle receives inadequate volume to pump so CO falls.

11. What is the backward effect of right-sided congestive heart failure?
Right ventricle unable to pump forward so blood backs up in venous system is the main effect.

12. What is the goal of treatment for congestive heart failure?
To decrease the heart’s workload and improve cardiac output.

13. Why are diuretics used for congestive heart failure?
To decrease cardiac workload by decreasing the fluid volume that the heart has to pump.

14. When does congestive heart failure occur?
It occurs when the heart is unable to pump sufficiently to maintain blood flow to meet the body’s needs.

15. What are the common causes of heart failure?
Coronary artery disease, previous myocardial infarction, hypertension, atrial fibrillation, valvular heart disease, excessive alcohol use, and sepsis.

16. What are diagnostics used for congestive heart failure?
BNP (B-type natriuretic peptide) measures the severity of heart failure, chest x-ray, and EKG.

17. What is left-sided heart failure?
A left-sided heart failure happens when the left ventricle fails. This failure causes blood to back up into the lungs causing respiratory symptoms as well as fatigue due to insufficient supply of oxygenated blood.

18. What are the signs and symptoms of left-sided heart failure?
Increase rate and work of breathing, rale/crackles heard in the lungs, dyspnea on exertion, and orthopnea.

19. What is right-sided heart failure?
A right-sided heart failure occurs when the right ventricle has difficulty pumping blood to the lungs. It is often caused by issues within the pulmonary circulation such as pulmonary hypertension or pulmonary stenosis and backward failure of the right ventricle leading to congestion of systemic capillaries.

20. What are the signs and symptoms of right-sided heart failure?
Peripheral edema, ascites, liver enlargement and jugular vein distention.

21. What management is available for heart failure?
Diuretics, anti-hypertensives, smoking cessation, fluid restriction, and low sodium diet.

22. How much of the thoracic cavity should the heart cover?
1/3.

23. What is traditional congestive heart failure?
The syndrome in which carbon monoxide does not keep pace with peripheral demands for blood flow and oxygen cannot get to the organs for the body.

24. What early signs can be observed in patients with congestive heart failure?
Reduced exercise tolerance (early fatigue).

25. What can be expected in patients with congestive heart failure?
Shortened life expectancy.

26. What may be the principal manifestation of nearly every form of cardiac disease?
Heart failure.

27. How many deaths occur each year due to congestive heart failure?
>200,000 deaths.

28. How many hospitalizations occur each year due to congestive heart failure?
1 million hospitalizations.

29. What percent of patients diagnosed with systolic congestive heart failure will still be alive within five years?
50%.

30. How is congestive heart failure characterized?
Intravascular and interstitial volume overload and manifestations of inadequate tissue perfusion.

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31. What are signs of intravascular and interstitial volume overload?
Shortness of breath, rales and edema.

32. What are symptoms of inadequate tissue perfusion?
Impaired exercise tolerance, fatigue and renal dysfunction.

33. Approximately how many people have congestive heart failure in US?
5 million people.

34. What age comprises 75% of the patients with congestive heart failure?
65 years old.

35. What are five possible causes of left-sided failure?
Ischemia, hypertension, myocardial infarction, dilated cardiomyopathy and restrictive cardiomyopathy.

36. How does ischemia cause left-sided failure?
Low blood flow causes damage to the heart myocardium, causing it to lose function as a pump.

37. How does hypertension cause left-sided failure?
Hypertension causes left ventricle hypertrophy. A thicker wall is harder to oxygenate properly. Ischemic damage causes loss of pump functionality.

38. What is dilated cardiomyopathy (DCM)?
Dilated cardiomyopathy is a disorder of four-chambered dilatation where all chambers are stretched too wide.

39. How can DCM cause left-sided failure?
DCM causes the chambers of the muscles stretched to wide. This stretching of the muscles impedes the ability to contract, causing congestive heart failure. It is important to note that studies have shown that DCM patients may also have impaired Frank-Starling mechanism due to troponin mutation, which would be why you would not see the normal increase in contraction force due to increased stretch.

40. How can myocardial infarction cause left-sided failure?
Dead cardiac myocytes cannot pump.

41. What is restrictive cardiomyopathy and how can it cause left-sided failure?
Restrictive cardiomyopathy is a disorder in which the heart cannot fill properly. Thus the heart cannot pump sufficiently.

42. What is the primary consequence of left-sided heart failure?
Pulmonary congestion is the direct consequence of left-sided heart failure. It is when the left side cannot keep up with the right where blood becomes backed up in the blood vessels of the lungs.

43. What intravascular pressure increases during pulmonary congestion?
Hydrostatic pressure.

44. What are four symptoms of pulmonary congestion?
Pulmonary edema with dyspnea, PND (Paroxysmal nocturnal dyspnea), orthopnea and crackles.

45. What is orthopnea?
It is difficulty breathing lying flat. It is one of the signs of congestive heart failure.

46. What causes crackles?
Edema/fluid in lung interstitium.

47. What is heart failure a problem of?
Back flow and forward flow.

48. What are the jobs of the heart and how does this relate to heart failure?
The heart has to supply every organ and keep the lungs free of fluid. As soon as this is interrupted, we become symptomatic.

49. What is heart failure?
Heart failure is a complex syndrome due to a structural or functional disorder resulting in an inability of the ventricle to fill with or eject blood leading to a mismatch in the metabolic supply and demands of the body.

50. What can chronic heart failure result from?
Chronic heart failure may result from a wide variety of cardiac insults. The etiologies can be grouped into those that impair ventricular contractility, increase afterload and impair ventricular relaxation and filling.

51. How prevalent is CHF?
In the United States, 6 million cases with 500,000-700,000 new cases per year.

52. What is the mortality rate for CHF?
There is 50% mortality within 5 years of diagnosis which is a higher mortality than the combined average for all types of cancer. While 10% mortality within 1 year of diagnosis. This disease is very debilitating, no quality of life at the end, and essentially bedridden.

53. Which respiratory conditions is CHF most related to?
Pulmonary edema

54. What is the primary sign or symptom of CHF?
Fluid overload

55. What are three diagnostic tests that can help with the diagnosis of CHF?
ABG, EKG, and CBC.

Final Thoughts

Providing care for patients with Congestive Heart Failure (CHF) is common for Respiratory Therapists. This is why it’s a requirement to learn about this condition.

Hopefully, the information in this study guide can help you do just that.

We have a similar guide that focuses on Pulmonary Edema that I think you would find useful. Thank you so much for reading and, as always, breathe easy my friend.

References

The following are the sources that were used while doing research for this article:

  • Rrt, Des Terry Jardins MEd, and Burton George Md Facp Fccp Faarc. Clinical Manifestations and Assessment of Respiratory Disease. 8th ed., Mosby, 2019. [Link]
  • Faarc, Kacmarek Robert PhD Rrt, et al. Egan’s Fundamentals of Respiratory Care. 12th ed., Mosby, 2020. [Link]
  • “Congestive Heart Failure And Pulmonary Edema.” National Center for Biotechnology Information, U.S. National Library of Medicine, 10 Aug. 2020, www.ncbi.nlm.nih.gov/books/NBK554557.
  • “Heart Failure: Diagnosis, Management and Utilization.” PubMed Central (PMC), 1 July 2016, www.ncbi.nlm.nih.gov/pmc/articles/PMC4961993.
  • “Chronic Heart Failure: Contemporary Diagnosis and Management.” National Center for Biotechnology Information, U.S. National Library of Medicine, Feb. 2010, www.ncbi.nlm.nih.gov/pmc/articles/PMC2813829.

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