Congestive Heart Failure: Part 1

Unfortunately, many people living with a chronic form of congenital heart disease develop a complication referred to as congestive heart failure (CHF). This occurs primarily due to the fact that the heart is unable to pump blood sufficiently throughout the body, because its efficiency is compromised by the presence of lesions and/or the presence of structural anomalies.

Before discussing this problem at length, it is pertinent to differentiate between cyanotic and acyanotic forms of congenital heart disease. The anomalous circulation involved in cyanotic defects is such that not enough oxygenated blood reaches the body. This results in cyanosis, a bluish discoloration of the skin that occurs when the individual is not sustained by an adequate amount of oxygen-rich blood. Medical professionals frequently refer to this as "right-to-left" shunting: blood that has not had the chance to reach the lungs mixes in with the oxygenated blood destined to be pumped throughout the body.

Acyanotic CHDs, though more common and frequntly less complex, often bring about the problem of congestive heart failure, because the anomalous cirulation is such that too much blood is imposed upon the lungs. Cardiologists refer to this as "left-to-right" shunting: blood that has already been oxygenated by the lungs returns there on account of a "leak" (ex: a hole) or underlying structural abnormality. This can in turn prevent blood that is not yet oxygen-rich from reaching the lungs as it should. To learn more about the nature of the circulatory system, please refer to http://www.pediheart.org/parents/anatomy...

At first glance, this does not appear to be overly problematic, because the body is not deprived of the vital oxygen it requires to function normally. However, TOO much of a good thing is not desirable, for various reasons. The first and most important consideration is the long-term effect that a steady stream of too much blood can have upon the lungs. Overburdened, the cells that line the lungs become thicker and tougher, which can result in the serious condition of pulmonary hypertension. Depending upon the gradient of the shunt (the extent to which normal circulation is altered, the difference between right and left heart "pressures"), this may or may not be of clinical significance. The second problem that can arise is that of congestive heart failure. This occurs when the heart is overburdened and therefore unable to pump blood at maximum efficiency. Tissue in the body begins to accumulate and retain fluid, resulting in edema, which is particularly noticeable in the legs, feet, eyelids and face of the afflicted individual. Fluid also tends to accumulate very rapidly in the lungs, which can lead to complications that range from frequent chest colds to the development of pneumonia (hence the term "congestive"). Other symptoms of CHF are tachycardia (when the overworked heart beats too rapidly), tachypnea (quick, shallow breathing), and mild to severe indrawing (in which the ribcage becomes noticeable when the affected individual takes a breath). In addition, infants who are suffering from CHF are frequently unable to feed properly, becoming tired and sleepy before they are able to consume a sufficient amount of milk to meet their nutritional requirements. This often leads to a "failure to thrive", in which the baby does not gain adequate weight or hence develop at the proper pace. If left untreated for an extended period of time, CHF can be life-threatening, and adversely affect the outcome indicators for the successful surgical management of many congenital heart disorders.

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