1. Heart failure

2. definition • Cardiac output is inadequate for the body function • Prognosis-82% die within 6 years after diagnosis .

3. clasification • LVFRVFboth-congestive cardiac faliure

4. CO=SV* HR

5. Stroke volume • Preload • Afterload • Ventricular contractility

6. Cardiac failure can be caused by • Factors that interfere with • SV • HR

7. Causes of cardiac failure

8. Abnormalities of heart rate • Excessive preload • Increased after load • Reduced contractility

9. Altered cardiac contractility • Heart muscle disease –cardiomyopathy ,ischemic heart disease • Restricted filling –constrictive pericarditis • Drugs that reduce cardiac contractility-B blockers

10. Excessive preload • Fluid overload -ex-NSAIDs causing fluid retention/renal faliure/excess IVF Mitral regurgitation

11. Excess afterload • Hypertension • Aortic stenosis

12. Alterations of heart rate • Heart rate being too high-Tacycardia • Heart rate being too low -Bradycardia • Abnormal heart rate -Arrythmia

13. High out put heart failure • Rare • This results when the body demand is more so the cardiac out put has to be maintained higher than normal. With time the heart becomes unable to maintain the cardiac output to meet the requirement • Causes include-anemia ,pregnancy ,beri beri ,hyperthyroidism

14. Clinical features • Oedema • Dyspnoea • Poor exercise tolerance • Fatigue • Orthopnoea • Paroxysmal nocturnal dyspnoea • Cough with pink frothy sputum • ANORREXIA

15. PATHOPHYSIOLOGY OF CARIDAC FAILURE • Cardiac failure results in reduced body perfusion giving rise to tiredness,reduced work capacity and loss of apatite • Fluid retention results form activation of reninangiotensinaldesterone axis • This results in edema,orthopnoea,PND • Vasoconstriction and tachycardia evolves as a compensatory mechanism which further leads to weakening of the heart

16. examination • Looks ill • Swollen lower limbs,abdomen • Abnormal cardiac auscultation • Weak pulse • Crakles in lungs • Pleural effussions

17. Complications • Cardiac arrythmias • Renal faliure • altered liver function • Electrolyte imbalances

18. Patients you would see • Patients with chronic heart failure • Patients with acute worsening of HF

19. Investigations • ECG • ECHO-to diagnose cardiac failure and cause • Chest X ray • Blood investigations –FBC,TFT,SE

20. Management • Acute heart failure is managed as a medical emergency • Chronic heart failure is managed over long term • Patient education • Diagnose and treat exacerbating factors –anemia ,hyperthyroidism

21. Management • Avoid exercerbating factors • Stop smoking • Optimal nutrition and weight • Less salt • Drugs • Final resort-heart transplant

22. Drugs used –pathophysiological basis Reduce preload • Diuretics –reduce oedema • ACE inhibitiors –to counterract activated reninangiotensinaldesterone axis • spironolactone reduce afterload • Vasodilators Improve contractility • Digoxin-if EF < 30% B blockers –reduce contractility/but usage shown to improve long term out come in patients with cardiac failure

23. Acute heart faliure • Medical emergency-breathless,weak pulse,cyanosed,lumg crackles • prop up • Oxygen • IV morphine and IV frusmide • Find and treat the cause • Inotropes

24. Thank you….