Chronic heart failure

Congestive heart failure (CHF), also known as pump failure, usually refers to a significant reduction in myocardial contractile function, leading to decreased cardiac output, accompanied by elevated left ventricular end-diastolic pressure, clinically causing manifestations of pulmonary congestion and inadequate peripheral circulatory perfusion, as well as varying degrees of coexistence of both. Pump failure is commonly seen in acute myocardial infarction, especially in acute extensive anterior or lateral wall myocardial infarction, where pump failure is more likely to occur. In the early stage of pump failure, elevated blood pressure is often present, and elevated blood pressure and increased peripheral resistance can worsen pump failure. Therefore, if elevated blood pressure is detected in patients with pump failure, especially when pulmonary rales-acute pulmonary edema appear, active measures should be taken immediately to lower blood pressure as soon as possible, that is, to reduce afterload, maintain normal blood circulation, and ensure perfusion of tissues and organs. Congestive heart failure is a pathological state in which, despite adequate venous return, cardiac output is insufficient to meet the metabolic needs of tissues due to systolic and/or diastolic dysfunction of the heart. Clinically, it is characterized by insufficient cardiac output, reduced tissue blood perfusion, and congestion of the pulmonary or systemic venous systems. It is a clinical syndrome. From a hemodynamic perspective, due to myocardial systolic and diastolic dysfunction, cardiac pressures are higher than normal (left ventricular end-diastolic pressure or left ventricular filling pressure >18 mmHg; right ventricular end-diastolic pressure or right ventricular filling pressure >10 mmHg), which constitutes heart failure, also known as cardiac insufficiency. The concepts of congestive heart failure and cardiac insufficiency are basically consistent, but the latter has a broader meaning, including the stage where cardiac output is already reduced but clinical symptoms have not yet appeared.