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Congest heart failure (CHF)is a common clinical syndrome and conventionally implies right ventricular failure associated with left heart failure. However, the latter may be minimal or sometimes may be absent as in chronic cor-pulmonale. It is usually a chronic condition but may be occasionally be acute due to either rapid development or as happens more frequently, a gradual or abrupt increase in the pre-existing congestive heart failure. It may then became a medical emergency requiring prompt treatment. In a few cases acute left heart failure, with or without pulmonary oedema, dominates the clinical picture.
Majority of the cases of congestive heart failure have an obvious underlying disease involving the myocardium or the cardiac valves, the most frequent being rheumatic, ischemic or hypertensive heart disease, thyrotoxicosis, various forms of carditis and cardiomyopathy and chronic cor-pulmonale. An acute increase in the degree of heart failure in such cases may result from onset of paroxysmal or persistent atrial tachycardia or fibrillation, pulmonary embolism, acute rheumatic activity, concomitant infection., acute massive hemorrhage, after surgical operation or from discontinuation of digitalis and diuretics. It is important to recognize such precipitating causes from the point of view of immediate management as well as to prevent recurrence of acute episodes of congestive heart failure
The patient should be assured complete bed rest in the most comfortable position which is usually semi-sitting. If dyspnoea is overwhelming some relief may be obtained by lowering the legs or applying rotating tourniquets or blood pressure cuffs inflated to about 10mm Hg below diastolic pressure, on three limbs with a plan to release each tourniquet every 15 minutes. The later may be as good as phlebotomy in such cases. Actual venesection is outmoded.


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