In CCF there Is-
Hea failure symptoms are traditionally and somewhat arbitrarily divided into "left" and "right" sided, recognizing that the left and right ventricles of the hea supply different poions of the circulation. However, hea failure is not exclusively backward failure (in the pa of the circulation which drains to the ventricle). There are several other exceptions to a simple left-right division of hea failure symptoms. Additionally, the most common cause of right-sided hea failure is left-sided hea failure. The result is that people commonly present with both sets of signs and symptoms. Left-sided failure The left side of the hea receives oxygen-rich blood from the lungs and pumps it forward to the systemic circulation (the rest of the body except for the pulmonary circulation). Failure of the left side of the hea causes blood to back up (be congested) into the lungs, causing respiratory symptoms as well as fatigue due to insufficient supply of oxygenated blood. Common respiratory signs are increased rate of breathing and increased work of breathing (non-specific signs of respiratory distress). Rales or crackles, heard initially in the lung bases, and when severe, throughout the lung fields suggest the development of pulmonary edema (fluid in the alveoli). Cyanosis which suggests severe low blood oxygen, is a late sign of extremely severe pulmonary edema. Additional signs indicating left ventricular failure include a laterally displaced apex beat (which occurs if the hea is enlarged) and a gallop rhythm (additional hea sounds) may be heard as a marker of increased blood flow or increased intra-cardiac pressure. Hea murmurs may indicate the presence of valvular hea disease, either as a cause (e.g. aoic stenosis) or as a result (e.g. mitral regurgitation) of the hea failure. Backward failure of the left ventricle causes congestion of the lungs' blood vessels, and so the symptoms are predominantly respiratory in nature. Backward failure can be subdivided into the failure of the left atrium, the left ventricle or both within the left circuit. The person will have dyspnea (shoness of breath) on exeion and in severe cases, dyspnea at rest. Increasing breathlessness on lying flat, called ohopnea, occurs. It is often measured in the number of pillows required to lie comfoably, and in ohopnea, the person may reso to sleeping while sitting up. Another symptom of hea failure is paroxysmal nocturnal dyspnea: a sudden nighttime attack of severe breathlessness, usually several hours after going to sleep. Easy fatigability and exercise intolerance are also common complaints related to respiratory compromise. "Cardiac asthma" or wheezing may occur. Compromise of left ventricular forward function may result in symptoms of poor systemic circulation such as dizziness, confusion and cool extremities at rest Right-sided hea failure is often caused by pulmonary hea disease (cor pulmonale), which is typically caused by difficulties of the pulmonary circulation, such as pulmonary hypeension or pulmonic stenosis. Physical examination may reveal pitting peripheral edema, ascites, liver enlargement, and spleen enlargement. Jugular venous pressure is frequently assessed as a marker of fluid status, which can be accentuated by eliciting hepatojugular reflux. If the right ventricular pressure is increased, a parasternal heave may be present, signifying the compensatory increase in contraction strength. Backward failure of the right ventricle leads to congestion of systemic capillaries. This generates excess fluid accumulation in the body. This causes swelling under the skin (termed peripheral edema or anasarca) and usually affects the dependent pas of the body first (causing foot and ankle swelling in people who are standing up, and sacral edema in people who are predominantly lying down). Nocturia (frequent nighttime urination) may occur when fluid from the legs is returned to the bloodstream while lying down at night. In progressively severe cases, ascites (fluid accumulation in the abdominal cavity causing swelling) and liver enlargement may develop. Significant liver congestion may result in impaired liver function (congestive hepatopathy), and jaundice and even coagulopathy (problems of decreased or increased blood clotting) may occur. Biventricular failure Dullness of the lung fields to finger percussion and reduced breath sounds at the bases of the lung may suggest the development of a pleural effusion (fluid collection between the lung and the chest wall). Though it can occur in isolated left- or right-sided hea failure, it is more common in biventricular failure because pleural veins drain into both the systemic and pulmonary venous systems. When unilateral, effusions are often right sided. If a person with a failure of one ventricle lives long enough, it will tend to progress to failure of both ventricles. For example, left ventricular failure allows pulmonary edema and pulmonary hypeension to occur, which increase stress on the right ventricle. Right ventricular failure is not as deleterious to the other side, but neither is it harmless. There is mounting evidence that chronic kidney disease itself is a major contributor to severe cardiac damage and, conversely, that congestive hea failure is a major cause of progressive chronic kidney disease(oligouria).. The anemia is associated with worsening cardiac and renal status and often with signs of malnutrition Ref Davidson 23rd edition pg 478
Oliguria
Polyuria
Olijuria during day and polyuria during night
Anuria
C.V.S