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Congestive heart failure

Congestive heart failure. Ivan Cerovečki Mentor: A. Žmegač Horvat. Elementary notions. Cardiac output Peripheral circulation Preload Afterload. Definition of CHF. Complex syndrome Impaired function of the heart Compromised peripheral perfusion. Epidemiology. Prevalence in Europe: 2 %

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Congestive heart failure

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  1. Congestive heart failure IvanCerovečki Mentor: A. Žmegač Horvat

  2. Elementary notions • Cardiac output • Peripheral circulation • Preload • Afterload

  3. Definition of CHF • Complex syndrome • Impaired function of the heart • Compromised peripheral perfusion

  4. Epidemiology • Prevalence in Europe: 2 % • Prevalence > 65 yrs: 10 % • 1st year mortality: 30 – 40 % • 5 year mortality: 60 – 70 %

  5. Clinical characteristics • Acute heart failure • Chronic heart failure

  6. Clinical characteristics • Left heart failure • Right heart failure • Biventricular (congestive) heart failure

  7. Aetiology • Cardiac pathology • Ischaemic heart disease • Hypertensive heart disease • Cardiomyopathy • Valvular heart disease • Congenital heart disease • Pericardial disease

  8. Aetiology • Extracardiac pathology • Pulmonary disease: pulmonary embolism • Endocrine and metabolic disease • Infective disease • Toxic substances: alcohol

  9. Pathophysiology • Sympathetic activation • Increased heart rate • Increased myocardial contractility • Venous vasoconstriction • Arteriolar vasoconstriction

  10. Pathophysiology • RAAS system • Arteriolar vasoconstriction • Fluid retention

  11. Pathophysiology • Natriuretic peptides • Diuretic effect • Natriuretic effect • Hypotensive effect

  12. Pathophysiology • Ventricular dilatation • Increase in metabolic requirements

  13. Clinical features • Common symptoms • Fatigue • Dyspnoea • Palpitations • Weight gain

  14. Clinical features • Left heart failure • Paroxysmal nocturnal dyspnoea • Orthopnoea • Basal lung crackles • Presence of the third heart sound

  15. Clinical features • Right heart failure • Jugular venous distension • Hepatomegaly • Peripheral oedema

  16. Diagnostics • Chest X-ray • ECG • Blood tests • Echocardiography • Natriuretic peptide

  17. Treatment • Vasodilator therapy • ACE inhibitors • Angiotensin II receptor antagonists • Nitrates • Hydralazine

  18. Treatment • β – blockers • Metoprolol • Bisoprolol • Carvedilol

  19. Treatment • Diuretics • Loop diuretics • Thiazide diuretics • Potassium–sparing diuretics

  20. Treatment • Digoxin • Dopamine • Dobutamine • Antiarrhythmic drugs

  21. Treatment • Revascularization • Biventricular pacemaker • Cardiac transplantation

  22. References • Vrhovac B et al: Interna medicina, Naklada Ljevak, 2008 • Ballinger A, Patchett S: Pocket Essentials of Clinical Medicine, Elsevier Saunders, 2007 • United States National Library of Medicine (nlm.nih.gov) • Wikipedia (wikipedia.org)

  23. The end

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