Q. Explain about Congestive Cardiac Failure?

It is an end stage heart disease and a significant contributor to morbidity and mortality particularly in the elderly population. Congestive cardiac failure is a form of chronic decompensated disease as the condition may develop over a period of time. It results from an injury to the heart muscle due to atherosclerosis, hypertension or rheumatic fever resulting in progressive weakening of the heart muscle. This leads to inadequate blood circulation and hence insufficient supply of nutrients and oxygen to the tissues. This leads to malnutrition and underweight. If oedema is present, it masks the state of malnutrition. Mostly haemodynamic derangements are present. Congestive cardiac failure causes left ventricular systolic dysfunction over a period of time. The heart muscle -myocardium gets weakened progressively and is not able to maintain normal cardiac blood output or blood circulation. Firstly, it can cause pulmonary oedema causing breathing problems of pumping out blood fast enough resulting in blood accumulation on the right side of the heart, affecting normal circulation. This affects the normal flow of fluid between tissue space and blood vessel which thus starts accumulating in the tissue causing oedema. The two hormones in the body that control water balance also fail. (Antidiuretic hormone and the aldosterone). The aldosterone Conserves sodium and water and worsens the oedema. Reduced blood circulation affects the metabolism of tissues resulting in increased cells breakdown and potassium is released. Increased potassium in the cell increases the osmotic pressure and sodium tries to replace potassium causing more water retention.