Abstract
ABSTRACT
Objective
To determine the frequency of various etiological factors responsible for causing congestive heart failure (CHF) in a tertiary care hospital in Peshawar, Pakistan.
Subjects and Methods
This retrospective, observational, single center study was conducted in Department of Medicine, Khyber Teaching Hospital, Peshawar from October 2009 to May 2010 and included 100 patients of CHF. After history and clinical examination, a diagnosis of CHF was established according to Framingham criteria. All patients had a 12-leads electrocardiogram (ECG), echocardiogram and serial blood tests.
Results
Out of 100 patients, 60% were male and 40% female with mean age of 54 years. Ischemic heart disease (IHD) was present in 35% of patients, hypertension in 27%, rheumatic heart disease (RHD) in 13%, cardiomyopathies in 11% and congenital heart disease in 6%.
Conclusion
IHD, hypertension, valvular heart disease and cardiomyopathy were the major causes of CHF in our patients. (Rawal Med J 2010;35: ).
Key words: Electrocardiogram, echocardiogram, congestive cardiac failure.
INTRODUCTION
Congestive heart failure (CHF) is a condition that impairs the ability of the heart to fill with or pump a sufficient amount of blood through the body.1 More than 550,000 patients are diagnosed with CHF for the first time each year in US.2 The prevalence of CHF is known to rise with increasing age and affects about 10% of the population older than 75 years of age.3,4 According to Framingham study, major criteria are paroxysmal nocturnal dyspnea, orthopnea, raised jugular venous pulse, lung crepitations, cardiomegaly and gallop sounds. Minor criteria were ankle edema, night cough, dyspnea on exertion, hepatomegaly, pleural effusion and tachycardia.5 The diagnosis of predominantly systolic CHF required a minimum of two major or one major plus two minor criteria and LVEF<50%. The diagnosis of predominantly diastolic CHF required above mentioned clinical criteria, LVEF ≥ 50% and evidence of abnormal LV diastolic function by Doppler examination.
Limitations in activity can be quantified using the New York Heart Association (NYHA) functional classification or the more recent American Heart Association–American College of Cardiology classification.6 AHA has reported IHD, hypertension, valvular heart disease, cardiomyopathies, cor pulmonale, anemia, hyper and hypothyroidism, chronic arrhythmias, anemia and cardiac fibrosis as common causes of HF.7 Transthoracic two-dimensional echocardiography with Doppler flow studies8 and transthoracic Doppler echocardiography allow confirmation of diagnosis.9 ECG is valuable and a normal ECG virtually rules out systolic dysfunction with sensitivity of 94% and specificity 61%.10 There is no nation wide data available about the epidemiology of CHF in Pakistan. The present study was designed to know the frequency of etiological factors causing CHF in our institution.
SUBJECTS AND METHODS
This retrospective, observ

Key words: Electrocardiogram, echocardiogram, congestive cardiac failure.