ulmonary vascular congestion. The reduction in cardiac output is as a result of two mechanisms, that is, diastolic dysfunction and the systolic dysfunction (Butler, 2014). Systolic dysfunction results from ischemic heart disease, high-blood pressure, diseases that lead to valvular heart disorders and idiopathic dilation of cardiomyopathy. Diastolic dysfunction as well can occur due to these issues but more prevalent in women. More often heart failure affects the elderly who have other ailments which include diabetes, chronic lung diseases, high blood pressure and angina, generally, we can group them as comorbid conditions.

CHF does not necessarily occur because of the heart lacking ability to ensure maintenance of enough oxygen, in this case, it responds in a manner to ensure that enough supply is achieved. To determine the cardiac output, stroke volume and the rate of the heart needs to be taken into consideration. This syndrome generally is as a result of contractility and failure of ventricles (Butler, 2014). The performance of these ventricles are attributed to muscle contraction, the pressure of atrial, increase in systemic resistance and higher heart rate. Furthermore, the stroke volume is contributed pre-load, contractility, and after-load. Frank-Starling describes the law of the heart as the ability of the ventricular to increase and overstretch the muscle fibers of the myocardium as the stroke volume on the hand rises to the maximum level.

The result of this is the increase in pulmonary congestion however the stroke volume remains low or the cardiac output leading to length-force relationship muscle contractions. (Rahko, 2013) Congestive heart failure follows four stages, that is, class I up to class IV. At first, class one does not show any signs and in this case, the treatment is still manageable through a change of lifestyle and medications. Class II is where one now starts to feel fatigue but can is still controllable through behavioral change and monitoring. At class III, the patient now faces limitations of physical activities and short breathing, here, the treatment requires more attention. Finally, the last stage limits one from any amount of activity and there no way this can receive treatment.

Cardiomyopathy is one of the causes of heart failure. It affects the heart muscles where the ventricular chamber enlarges and results in contractile dysfunction. It may also result in the dilation and dysfunction of the right ventricle (Rowin & Maron, 2016). The disorder exhibits itself in the form of fatigue, dyspnea on exertion, orthopnea, and increase in abdominal girth. The main symptoms that cardiomyopathy exhibits include the congestive heart failure, arrhythmias, and sudden death. The heart failure, in this case, is due to declining in the heart’s ability to pump blood or damage of cardiac chambers, therefore, leading to the patient retaining excess fluid and therefore causing congestion in the lungs and abnormal heartbeat rhythm. Most of the cardiomyopathies have an unknown cause but the known causes link to dilation, hypertrophy or restrictions (Rowin & Maron, 2016).

In restrictive, the heart becomes stiff impairing ventricles. The hypertrophic cardiomyopathy, the ventricles appear to be small due to growth and abnormal cardiac muscles arrangements. The heart then receives interference from the sympathetic nervous system affecting the myocardium. (Rowin & Maron, 2016) These leads to release of vasorelaxant and natriuretic hormones with an aim of offsetting excessive pressor-sodium retentive mechanisms. After that, the reaction leads to vasoconstriction and deterioration of the patient. To analyze them as separate, cardiomyopathy falls into two categories: extrinsic and intrinsic. Extrinsic is the most common of the two and its cause is ischemia. Also, intrinsic as well as rare and mixes with other disease and those diseases have their own causes.

Conclusion
Generally, congestive heart failure is the weakening of the heart making it impossible to pump blood which leads to muscle weakness. This disorder has many causes but cardiomyopathy is one of them which entirely changes the way the heart functions. Therefore, cardiomyopathy can then be classified as primary or either secondary which causes disorders in the heart.