M.S.Umashankar*1, K.S.Lakshmi, A.Bharath Kumar, A.Porselvi
SRM College of Pharmacy,
SRM University, Kattankulathur,
Tamil Nadu, India


It is a critical clinical condition in which more abnormalities in cardiac structure and its functions may impact the ineffectiveness of the heart to supply required oxygen to meet the cellular metabolic demands of the body. Heart is covered with protective layers and express the various functions in the body. Clinically cardiac disease prevalence rises with individual age. Cardiac dysfunction happens because of changes in blood volume, and neurohumoral transmission status. These desirable mechanisms to maintain adequate cardiac output and arterial blood pressure. The neurohumoral responses act as compensatory mechanisms and provokes heart failure by increasing ventricular after load and increasing preload,which further elevates the cardiac failure. Health care system with a clinical pharmacist is well allocated to impact the disease management through identification of risk factors, stage of severity, educating the patients and health care practioners and implementing the awareness programmes, modification of life style interventions with in health care system beneficial to the community may reduce the progression of disease severity.


PharmaTutor (Print-ISSN: 2394 - 6679; e-ISSN: 2347 - 7881)

Volume 5, Issue 9

Received On: 04/05/2017; Accepted On: 19/05/2017; Published On: 01/09/2017

How to cite this article: Umashankar MS, Lakshmi KS, Kumar AB, Porselvi A;Clinical Pharmacist specialized care in Management of Congestive Heart Failure - A Brief Review; PharmaTutor; 2017; 5(9); 16-22

Congestive heart failure is a clinical syndrome caused by abnormal functional defects in myocardium resulting in impairment of ventricular filling. The hypertension, diabetes mellitus and hyperlipidemia are the major causes of heart failure. The heart is inability to supply oxygen and nutrients to meet the required body needs1. The chambers of the heart contracts to hold more blood to pump through the body.During the heart failure condition heart pumping is weaker. The pressure rises the blood moves slowly from the body to heart. The chambers of the heart may responds to pump the blood to all parts of the body2.

Introduction to Clinical pharmacy
It is defined as area of the pharmacy concerned with science and practice of rational use of drugs. Clinical pharmacists interacts directly with physicians, health professionals and patients to ensure that the medications prescribed for patients contribute to the best possible health outcomes. Clinical pharmacists practice in health care settings where they have frequent and interactions with physicians and other health professionals,contributing to better care3.
The clinical pharmacist is educated and trained in direct patient care wards, including medical centers, clinics and a variety of other health care settings. These privileges are granted on the basis of the clinical pharmacist’s demonstrated knowledge of medication therapy and clinical experience4.

Physiology of  heart : The heart is located in the chest between the lungs behind the sternum and above the diaphragm5. It is surrounded by cardiac protective membranes. Its weight is about 250-300 g. It consist of  superior and inferior vena cava the pulmonary artery and vein as well as the aorta.

Anatomy of the Heart : The heart walls are composed of cardiac muscles is called myocardium. It consists of four compartments such as the right and left atria and ventricles6. The anterior aspect is the right ventricle and posterior aspect shows the left atrium. The left ventricular walls are much thicker than the right ventricular wall.

Fig 1 : Structure of  Heart

The heart has four valves, the right atrium and ventricle tricuspid valve is present and the left atrium and ventricle mitral valve is located. The pulmonary valve lies between the right ventricle and the pulmonary artery7.

The blood comes back from the systemic circulation to the right atrium and from there moves to tricuspid valve and  right ventricle. Oxygenated blood returns from the lungs to the left atrium, and from there moves mitral valve to left ventricle. Finally blood is pumped to the systemic circulation8.

The heart has four chambers.The upper two chambers are the atria and the lower two are the ventricles. The chambers are separated by a wall of tissue called the septum. Blood is pumped through the chambers with the help of four heart valves. The valves open and closed to manage the  blood  flow in single direction9.

Heart blood flow Patterns :
The normal blood flow is a cyclic process includes Heart moves to Lungs-moves to Heart-finally reaches the Body10.

Right side of the Heart
The right side of the heart receives deoxygenated blood from the body tissues into the right atrium. This deoxygenated blood passes through the tricuspid valve into the right ventricle.

Left side of the Heart
The left-hand side of the heart receives oxygenated blood from the lungs into the left atrium. This oxygenated blood then passes through the bicuspid valve into the left ventricle11.

Risk Factors
The main risk factors for congestive heart failure are :

High blood pressure

Coronary heart disease


Valve defects13

Heart attack

Viral or bacterial infection


Alcohol, Drugs, Tobacco

Decreased kidney function


High cholesterol12


The decrease in heart rate causes reduced cardiac out put which causes the myocardial injury. Improper regulation of  baro receptor stimulations causes the irregular heart pulses15. The reduced left ventricular function and activation of renin angiotensin aldosterone system causes more vasoconstriction and altered hemodynamic activity which causes the improper regulation of left ventricular function14.

The activation of renin angiotensin aldosterone system the angiotensin 1 is converted to angiotensin II causes the severe vasoconstriction16. The aldosterone secretion causes the salt and water retension increase the plasma volume and increase the preload, after load and cardiac work load consequences causes the heart failure.

Tests and diagnosis
Blood tests : Sample of  blood is collected from patient to check the any infections, inflammations,look of indicators for other diseases that affect the heart17.
Chest X-ray : The presence of heart failure, the heart may appear enlarged and more fluid deposition in the lungs.
Electrocardiogram : This test records the electrical activity of heart. The electrodes attached to skin. The Impulses are recorded as waves and displayed on a paper18.
Echocardiogram : An echocardiogram uses sound waves to produce a video image of heart. This test can help the physicians to verify the size and shape,pumping effectivenss of heart19.
Cardiac computerized tomography (CT) scan and magnetic resonance imaging (MRI): This test can be used to investigate the physiological process,anatomical positions of the working status of the heart to diagnose heart problems.
Coronary angiogram : In this test a thin, flexible catheter is inserted into a blood vessel at groin and guided through the aorta into coronary arteries20.
Myocardial biopsy : In this test inserting a small, flexible biopsy cord into a vein in neck or and a small pieces of the heart muscle is taken21.
Doppler Imaging : This test uses sound waves to measure the speed and direction of blood flow and valvular function.
Holter Monitor: A holter monitor is a small box and is attached to electrodes that are placed on chest which records the rhythm of  heart.
Cardiac Magnetic Resonance Imaging (MRI) : An MRI shows the structure and beating capability,contractions of  heart and signs of damage.
Positron Emission Tomography : It is used to see the blood is flow to the heart22.
Thyroid Function Tests : This test is performed to determine the causes of heart failure  due to thyroid dysfunction.



 Swelling of feet

feeling tired

Changes in the frequency of urination


Severe shortness of breath.

Weight gain

Profuse sweating,Chest pain23



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