CHAPTER I INTRODUCTION

Heart failure is a clinical syndrome signed by shortness of breath, especially when lying down and fatigue when working or resting that caused by abnormality of cardiac structure or function.1 In this condition, heart is unable to pump sufficient blood for metabolizing tissues or can do so only from an abnormally elevated filling pressure.2 In US, more than 3 million people have CHF and more than 400,000 new patients present yearly. The prevalence rate of CHF is 1-2%. Approximately 30-40% patients with CHF are hospitalized every year. The 5-year mortality rate after diagnosis reported in 1971 was 60% in men and 45% in women. This may be secondary to an aging US population with declining mortality due to other diseases.3 The most common cause of death is progressive heart failure but sudden death may account for up to 45% of all deaths. After auditing data on 4606 hospitalized patients with CHF from 1992-1993, the total in-hospital mortality rate was 19%, with 30% of deaths occurring from non-cardiac causes. Patients with coexisting insulindependent diabetes mellitus have a significantly increased mortality rate.3 Prevalence is greater in males than in females in patients aged 40-75 years. No predilection is noted among patients older 75 years. Prevalence of CHF increases with increasing age and affects about 10% of the population older than 75 years.3 Left heart failure caused by ventricle weakness, increases the pulmonary vein and lung pressure cause shortness of breath and orthopnea. Right heart failure occurs if the abnormality weakened the right ventricle, such as in primary or secondary pulmonary hypertension, chronic thromboembolism, so elevated systemic vein congestion, peripheral edema, hepatomegaly, and jugular vein distention.1 But, because biochemical changes in heart failure occur to both of ventricle myocardium, fluid retention that happened monthly or yearly shows no difference.

The New York Heart Associations functional classification of CHF is one of the most useful guideline. Class I describes a patient who is not limited with normal physical activity by symptoms. Class II occurs when ordinary physical activity results in fatigue, dyspnea, or other symptoms. Class III is characterized by a marked limitation in normal physical activity. Class IV is defined by symptoms at rest or with any physical activity.3 Framingham criteria can be used for diagnosing CHF. The major criteria include paroxysmal nocturnal dyspnea, jugular vein distention, pulmonary rales, cardiomegaly, acute pulmonary edema, S3 gallop, increased jugular vein pressure, and hepatojugular reflux. The minor criteria include extremity edema, nocturnal cough, dispnea deffort, hepatomegaly, pleural effusion, decreased of vital capacity 1/3 than normal, and tachycardia (> 120/minute).1 The common causes of CHF are coronary artery disease, hypertension heart disease, valvular heart disease, congenital heart disease, cardiomyopathy, myocarditis, and infectious endocarditis caused by rheumatic heart disease.3 Treatments are aimed at symptomatic relief, removal of precipitating factors, and control of underlying cardiac disease. Drugs used in the treatments are diuretics, ACE inhibitors, beta blockers, digitalis, positive inotropic agents, and aldosterone antagonist.2,3 Because CHF is the common cardiac disease, especially in Indonesia that caused by rheumatic heart disease, we took one case to be reported. We hope that this case report will be useful for us.