Congestive Cardiac Failure (CCF)
Description
Congestive Cardiac Failure (CCF) is a clinical syndrome in which the heart is unable to pump enough blood to meet the body’s metabolic needs, or to dispose of venous return adequately — or both.
Diagnosis of CCF relies mainly on clinical findings; no single test is specific.
It may result from congenital or acquired heart disease leading to volume or pressure overload, or from myocardial insufficiency.
Table 44: Causes of Congestive Cardiac Failure (CCF)
| Cause | Examples |
|---|---|
| 1. Cardiac Causes | |
| A. Congenital | • Ventricular Septal Defect (VSD) • Atrial Septal Defect (ASD) • Patent Ductus Arteriosus (PDA) • Arrhythmias |
| B. Acquired | • Endocardial/Valvular disease e.g. Rheumatic Heart Disease (RHD) • Myocardial diseases e.g. Viral myocarditis, Dilated or Hypertrophic cardiomyopathy • Pericardial diseases e.g. Tuberculous pericarditis |
| 2. Extracardiac Causes | • Anaemia • Pulmonary diseases (e.g. pulmonary hypertension, severe pneumonia especially in neonates) • Systemic hypertension • Metabolic disorders (e.g. electrolyte imbalances, hypoglycaemia) • Endocrine disorders (e.g. thyroid disease) • Drugs (e.g. antineoplastic agents) |
Signs and Symptoms
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Poor feeding
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Failure to thrive
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Difficulty in breathing
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Poor weight gain
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Easy fatigability (especially in older children)
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Tachypnoea
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Tachycardia
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Hepatomegaly
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Presence or absence of cardiac murmurs
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Oedema
Investigations
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Full Blood Count and Differential Count (FBC/DC)
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Urea and Serum Creatinine
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Serum Electrolytes
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Echocardiography (ECHO) and Electrocardiogram (ECG)
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Chest X-ray
Treatment
Supportive Care
| Measure | Purpose |
|---|---|
| Propped-up position | To ease breathing |
| Oxygen therapy | To correct hypoxia |
| Salt and fluid restriction | To prevent fluid overload |
| Daily weight monitoring (in hospitalised patients) | To assess fluid balance |
Pharmacological Management
| Drug Class | Example and Dose | Notes |
|---|---|---|
| Preload Reduction | Frusemide 1 mg/kg/dose, 2–3 times daily IV/PO | Loop diuretic; monitor electrolytes |
| Afterload Reduction | Captopril 0.1–0.5 mg/kg divided 8 hourly (max 0.6 mg/kg/day) OR Enalapril 0.1 mg/kg OD or BD (max 0.5 mg/kg/day) | ACE inhibitors improve cardiac output |
| Inotropes | Digoxin 0.02–0.05 mg/kg/day PO (for stable patients) Dobutamine or Dopamine infusion (for severe CCF) | Digoxin increases myocardial contractility; Dopamine/Dobutamine for acute decompensation |
| β-blockers (Chronic HF) | Carvedilol 0.08 mg/kg every 12h; increase by 0.08 mg/kg every 1–2 weeks to max 0.5 mg/kg every 12h if tolerated | Used in chronic heart failure, especially in dilated cardiomyopathy |
Key Points Summary
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CCF is not a single disease, but a clinical syndrome caused by multiple cardiac or extracardiac factors.
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Early detection and management improve prognosis.
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Supportive care and pharmacologic therapy must be titrated carefully to avoid worsening heart failure.
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Monitor electrolytes, renal function, and weight daily during inpatient care.