Definition
It is characterized by a reduction in effective left ventricular output for given pulmonary venous or left atrial pressure...
Pathology
Ischemia heart disease (commonest)
Systemic hypertension
Mitral and aortic valve disease
Cardiomyopathies
Symptoms
Weakness, fatigue, weight loss and anorexia
Dyspnea on exertion or even orthopnea
Precordial discomfort
Paroxysmal nocturnal dyspnea
Gradual swelling of the abdomen and feet
Fainting on bending
Nocturia
Signs
Neck veins: markedly engorged, venous pressure fails to decline during inspiration (Kussmaul's sign)
Pulse: Low in volume, pulsus peradoxus may be present, may be irregular.
Blood pressure: low
Limbs cold: due to low cardiac output
Edema may be present.
Heart
Apex beat: absent or feeble
Triple rhythm may be heard.
Abdomen
Ascites and enlarged congested liver
Spleen may be palpable
Chest
May show pleural effusion findings
Respiration: Hurried, Cheyne strokes breathing
Face: Shows anxious look with sweating
Pulse: Tachycardia, Regular but tension and volume high, Pulsus alternans may be present (Pulse pressure low)
BP: High with scleroses arterial walls in some cases.
On examination of heart
Apex beat down, forceful and having.
Gallop rhythm may be present in mitral area
Pulmonary second sound is accentuated due to high pulmonary pressure.
Aortic II sound is accentuated in hypertensive cases.
Murmur may be present over the mitral or aortic area in cases where the valvular defect is the cause of heart failure.
On examination of lungs
Basal crepitations initially, turning into bilateral coarse crepitation all over the lungs due to pulmonary edema.
Tracheal rattling may be present
Hydrothorax on one or both sides may occur
Investigations
X-ray chest(PA view)
- Bilateral peripheral butterfly shadow due to pulmonary edema
- Enlargement of heart
- Congestion in lungs
ECG: Left ventricular enlargement, Ischemic changes or infarction in some cases
Echo: Depressed left ventricular ejection fraction
Differential diagnosis
Bronchial asthma: H/O eczema, urticaria etc., and H/O such similar attacks. Family history may be present. Usually acute in onset, especially in morning or late hours, of night. Expiratory dyspnea with scanty expectoration at the end of attack. No palpitation. Expiratory wheeze on examination, with prolonged expiration. No changes in heart and plenty of wheezing rhonchi over the lungs often differentiate the condition from LVF.
Homeopathic medicines / Treatment
Adonis V, Apis Mel, Adrenalin, Cactus, Arsenicum album, Iberis, Strophenthus, Caffeine.
Adonis Vernalis: Heart failure secondary to mitral or aortic regurgitation. Rheumatic endocarditis. Palpitation and dyspnea. Cardiac dropsy. Used i Q 10 drops, 3 times daily.
Caffeine: A direct heart stimulant and diuretic, cardiac dropsy depending upon valvular incompetence(Mitral and Aortic). It increases the contraction power of heart muscles, increases the pulse rate and raises the blood pressure and increased the diuresis.
Strophanthus: It acts on heart muscles, increasing the systole and removing the dropsical accumulations. In mitral regurgitation when dropsy has supervened. Tobacco smoker's heart. Arteriosclerosis, Dyspnea ascending. Pulse fast, weak, irregular due to muscular debility of heart.
Iberis: Cardiac dilation with dyspnea. Wakes with palpitation about 2pm, Cough causing redness of face. Dropsy with enlarged heart.
Aspidosperma: Pulmonary stenosis causing left ventricular failure. Cardiac dyspnea.
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