5.

Risk Factors of CHF

- Dietary indiscretion
- Myocardial ischemia/infarction
- Arrhythmias (tachycardia or bradycardia)
- Discontinuation of HF therapy
- Infection
- Anemia
- Alcohol consumption
- Pregnancy
- Worsening hypertension
- Acute valvular insufficiency
- Initiation of medication that worsen HF
Calcium antagonist
Beta blocker
NSAID
Antiarrhythmic agents (all class I agents, sotalol Class III)
Anti TNF antibodies

6. Complications
Abnormal Heart Rhythm
In a normal heart, the upper chambers (called the atria) and lower chambers (the
ventricles) squeeze and relax in turn to move blood through body. If ticker is weak,
these chambers might not squeeze at the right time. heart might beat too slowly,
too quickly, or in an irregular pattern. When the rhythm is off, heart can't pump
enough blood out to body.
Atrial fibrillation (AFib) is one type of abnormal heart rhythm that heart failure
can cause. It causes heart to quiver and skip instead of beating.
An irregular heartbeat can cause blood to pool, which might lead to clots. A clot
that forms in a vein is called venous thromboembolism. The clot can break free and
travel to lungs. Then it's called pulmonary embolism. Or a clot can travel to brain.
If it blocks a blood vessel there, could have a stroke.

Heart Valve Problems

Heart has four valves that open and close to keep blood flowing in and out of
heart. As the damage gets worse and heart has to work harder to pump out blood, it
gets bigger. The change in size can damage the valves.

Kidney Damage or Failure

Kidneys filter wastes and extra fluid out of blood. Just like other organs, they
need a steady supply of blood to work like they should.
Without the amount of blood they need, they won’t be able to remove enough
wastes from blood. This is called kidney failure. It's treated with dialysis or a
kidney transplant.
Kidney disease can also make heart failure worse. Damaged kidneys they can't
remove as much water from blood as healthy ones. 'll start to hold onto fluid, which
boosts blood pressure. High blood pressure makes heart work even harder.

Anemia
This is a lack of the red blood cells that move oxygen to ody's tissues. If patient
have anemia, the body may not get enough oxygen. Kidneys make a protein called
erythropoietin (EPO), which helps body make new red blood cells. Kidney damage
from heart failure prevents the body from making enough EPO.

Liver Damage
Liver breaks down toxins so the body can remove them. It also stores bile, a
fluid used to digest food. Heart failure can rob the liver of the blood it needs to
work. The fluid buildup that comes with it puts extra pressure on the portal vein,
which brings blood to liver. This can scar the organ to the point where it doesn't
work as well as it should.
Lung Problems
A damaged heart can't pump blood as effectively from lungs out to body. Blood
backs up, raising pressure in the veins inside the lungs. This pushes fluid into the
air sacs. As liquid builds up, it gets harder to breathe. This is called pulmonary
edema.

Extreme Weight Loss and Muscle Loss

Heart failure can affect muscle and fat metabolism. In the late stages, might lose
a lot of weight and muscle mass. The muscles can get smaller and weaker

7. Treatment
Non Pharmacology
-Education about heart failure, causes and how to recognize and efforts when
complaints arise, and the basis of treatment
- Diet and control of salt intake can only be given 1g, and 1 liter / day fluid intake.
- Weight monitoring, in cases with sudden weight gain can be considered for an
increase in diuretic doses.
- Patients must be hospitalized because they tend to not be able to maintain the need
for fast-acting drugs, namely bypassing intravenously.

Pharmacology
Get patients requested to be hospitalized for parenteral therapy. Angiotensin
Converting Enzym Inhibitors or Angiotensin Receptor Blockers (ARBs) are first-
line drugs. Must be given as soon as possible. The mechanism of action of the
angiotensin receptor works by reducing blood pressure through the renin-
angiotensin-aldosterone system. Angiotensin receptor blockers inhibit angiotension
II binding with its receptors in blood vessels resulting in vasodilation, decreased
vasopressin production, and reduced aldosterone secretion. These three decreases.
Hydralazine and isosorbide dinitrate (h-isdn) can be used as alternatives.
Candesartan is given an initial dose of 4 mg or 8 mg given x / day and with a target
dose of 32 mg given as much as 1 x / day.
Combinations with essential drugs for treatment are found to contain excessive fluid
in the lungs where there are full complaints of pulmonary edema. The
administration of diuretics can be given from a minimum dose of furosemide 20-40
mg but must be careful with side effects which can occur hypokalemia,
hypomagnosis, and hyponatraemia.