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HEART FAILURE

HEART FAILURE. Objectives:-. Definition Epidemiology Aetiology Pathophysiology Staging Symptoms & Signs Investigations Treatments Complications. Definition :-. Inability to maintain a cardiac output adequate for the body ’ s need.

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HEART FAILURE

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  1. HEART FAILURE

  2. Objectives:- • Definition • Epidemiology • Aetiology • Pathophysiology • Staging • Symptoms & Signs • Investigations • Treatments • Complications

  3. Definition :- • Inability to maintain a cardiac output adequate for the body’s need. • It is considered to be a clinical syndrome , because despite different causes , it is associated with cardiac dilation and impaired cardiac contractility .

  4. Epidemiology : • It is Primarily a disease of old age , affecting 30% of people over 80 years. • Improvements in the managements of acute MI & chronic heart disease has led to more heart failure rates , because more patients survive to develop it later in life .

  5. Aetiology:- - Causes of Left heart failure : • Inadequate LV filling : -Mitral stenosis . -LV diastolic dysfunction (LVH) • Pressure overload : -Aortic stenosis . -Hypertension . • Volume overload : -Aortic or mitral regurgitation . -High output failure , e.g. anemia • LV muscle disease : -Myocardial infarction . -Cardiomyopathy. -Myocarditis .

  6. - Causes of Right heart failure : • Any Cause of LHF . • Pulmonary hypertension (lung disease) . • Atrial septal defect .

  7. Pathophysiology :- 1 Cardiac Damage Cardiac output Neuroendocrine activation Fluid retention Peripheral resistance 2 Ventricular dilatation

  8. Symptoms & Signs : - Left Heart Failure : • Symptoms : - Shortness of breath . - Orthopnea. - PND. • Signs : - Tachypnoea . - Tachycardia . - 3rd heart sound on aus . - Bibasilar pulmonary crepitations .

  9. - Right Heart Failure : • Symptoms : Non specific such as : - Fatigue . - Anorexia . - Nausea . • Signs : - JVP . - Hepatomegly . - Pitting edema (an kles and pedal) . - Ascites . - Functional tricuspid incompetence .

  10. Investigations : • ECG . • Echocardiography . • Chest x ray. • Nuclear isotope scanning . • 24 hr ECG to investigate arrhythmias .

  11. Treatment General Measures Surgical Medical

  12. General Measures :. :. • Treat the underlying cause . • Reduce salt and water intake . • Daily weight . • Treat HTN and CAD aggressively.

  13. .: Medical Treatment :. • Diuretics. • ACE inhibitors . • Angiotensin II receptor antagonist. • B- blockers. • Digoxin .

  14. Diuretics : 1 - Classified into : (A) Loop diuretics e.g. furosomide , bumetanide. - MOA : Inhibit Na reabsorption in the ascending limb of the loop of Henle. - They are potent . - S/E : - Marked renal k loss. - Promote hyperuricemia.

  15. (B) Thiazides e.g. bendroflumethiazide. -MOA : Inhibit Na reabsorption in the distal renal tubule. -Mild diuretics except metolazone which causes excess diuresis. -S/E : -Hypokalemia. - Hyperglycemia & hyperuricemia. (C) K- sparing diuretics e.g. spironolactone. -MOA :Increase Na secretion on the distal nephron and inhibit K secretion. -S/E :Gynaecomastia, nausea and abdominal pain.

  16. ACE Inhibitors : 2 • E.g. captopril , enalapril , lisinopril . • MOA : - Inhibit angiotensin II. - Increase cardiac output by decreasing preload and afterload . - Decrease vascular resistance and PCWP . • Common S/E : - First dose hypotension . - the dose of diuretics 24 hr before first dose . - Start with low dose followed by gradual increase every 1-2 weeks . - Other S/E angioedema and persistant cough.

  17. Studies of LVD (SOLVD) .Enalapril. - Decrease all cause mortality 16% - Decrease mortality from HF 22%

  18. 3 Angiotensin 2 receptor antagonist : e.g. losartan ,valsartan. - They block binding of angiotensin 2 with type 1 receptors. - Do not produce cough. B – blockers : 4 e.g. metoprolol, bisoprolol, carvedilol. - Restricted to patients with chronic stable HF. - ACC guidelines recommend that b-blockers should be routinely prescribed to patients with asymptomatic LV dysfunction unless they have contraindication. 5 Digoxin : - Has +ve inotropic effect . - No mortality benefit.

  19. .: Surgery :. Cardiac transplantation . • Has 90% 1-year survival after surgery . • 75% a live after 5 years. • Death usually due to : 1- operative mortality. 2- organ rejection.

  20. Complications : • Thromboembolism • AF • Ventricular arrythmia

  21. Thank You

  22. Questions • What is New York HF classification ? • What are the C/I of ACE inhibitors ?

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