Heart failure

Heart failure

definition Cardiac output is inadequate for the body

function

Prognosis-82% die within 6 years after diagnosis .

clasification LVF

RVFboth-congestive cardiac faliure

CO=SV* HR

Stroke volume Preload Afterload Ventricular contractility

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

Causes of cardiac failure

Abnormalities of heart rate Excessive preload Increased after load Reduced contractility

Altered cardiac contractility Heart muscle disease –

cardiomyopathy ,ischemic heart disease Restricted filling –constrictive pericarditis Drugs that reduce cardiac contractility-B

blockers

Excessive preload Fluid overload-ex-NSAIDs causing fluid retention/renal

faliure/excess IVF

Mitral regurgitation

Excess afterload Hypertension Aortic stenosis

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

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

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

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 renin angiotensin aldesterone axis

This results in edema,orthopnoea,PND Vasoconstriction and tachycardia evolves as a

compensatory mechanism which further leads to weakening of the heart

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

Complications Cardiac arrythmias Renal faliure altered liver function Electrolyte imbalances

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

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

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

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

Drugs used –pathophysiological basis Reduce preload Diuretics –reduce oedema ACE inhibitiors –to counterract activated renin angiotensin

aldesterone axis spironolactonereduce 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

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

Thank you….