 Welcome to the congestive heart failure part 1. In this section we'll discuss the pathophysiology and signs of symptoms of patients with CHF. What is congestive heart failure? A broad definition is that the heart is unable to meet the metabolic demands of the body. There are different types of congestive heart failure. It can be divided into left versus right-sided, or systolic versus diastolic. Left-sided versus right-sided CHF presents differently. Cystolic versus diastolic congestive heart failure is pointing to the cause. Cystolic heart failure occurs when the pump is unable to pump forward. Diastolic heart failure happens when the myocardium is unable to relax, or the muscles are stiff, and therefore it is slow to fill. Left-sided congestive heart failure presents as cardiogenic pulmonary edema. The most common reason is from systolic dysfunction. It mostly stems from decreased ejection fraction from previous ischemic heart disease. It can also happen from dilated cardiomyopathy. Left-sided diastolic dysfunction is less common. It can be caused by tachycardia, valvular disease, in which the myocardium is unable to relax, and therefore the ventricle is slow to fill. Right-sided heart failure presents as peripheral edema from venous congestion. The most common reason for right-sided systolic dysfunction is left-sided systolic dysfunction. It can also come from pulmonary disease such as pulmonary hypertension. Right-sided diastolic dysfunction is rare. It can happen, however, in cardiac tamponade. Why is congestive heart failure bad for patients who emerge in the department? 1. Pulmonary edema affects ventilation and oxygenation. Patients can also have sudden cardiac death. 3. Due to inadequate systemic organ perfusion, patients can have end organ failure. How do patients with CHF present? In general, patients have low cardiac output leading to fatigue and poor exercise tolerance. Then whether it is mostly right-sided or left-sided heart failure, their presentation is different. For left-sided heart failure, patients are mostly complaining of respiratory symptoms. They can complain of shortness of breath. Orthopnea, which means that their shortness of breath is better when they sit up. PND, which is proxysmal nocturnal dyspnea. And decreasing exercise tolerance due to shortness of breath. For example, let's say the patient was able to walk up one or two flights of stairs normally. If they have suddenly decreased that capacity and become dysnick on walking on say level ground or even at rest, knowing that is a good objective measure of their symptoms. Remembering how the patient with right-sided failure will be presenting with peripheral edema, you want to ask about weight gain in any presence of pitting edema. As a risk factors, they include previous myocardial infarction, hypertension, diabetes, or any history of cardiomyopathy. It is also important to ask about the triggers. Then they include a new cardiac event, changing their medications, or increasing salt intake. Patients with pulmonary edema from left-sided CHF can have respiratory distress. They may prefer to sit upright. They may present with pink frothy sputum. On vital signs, they can be tachycardic, tachypnec, and hypoxic. On the lung exam, for left-sided heart failure, we'll be looking for crackles, brails, and decreased breath sounds. On the cardiac examination, we might hear extra heart sounds like an S3, S4, or murmurs. The JVP will be high. For right-sided heart failure, we will see hipadrogecular reflex, hipadal splenomegaly, ascites, and peripheral edema. Since most patients who have right-sided heart failure stems from left-sided heart failure, often we will see physical findings of both in the same patient. In summary, we discuss the pathophysiology of congestive heart failure. We know that left-sided heart failure usually presents with respiratory findings, while right-sided failure presents mostly with peripheral edema. We discuss the risk factors and causes for these. In the next video, we'll talk about how to investigate and treat patients in the emergency department. We hope you find this helpful. Thank you for watching.