CONGESTIVE CARDIAC FAILURE

Presented by;

Aiswarya.A.T,

First year M.Pharm.,

Dept. of Pharmacy

Practice,

Grace college of pharmacy.

Heart failure is a clinical

syndrome in which an

abnormality of cardiac

structure or function is

responsible for the

inability of heart to

eject or fill with blood at

a rate commensurate

with the requirements

of the metabolizing

tissues.

CLASSIFICATION

Left ventricular dysfunction

Right ventricular dysfunction

Biventricular HF

Left ventricular systolic dysfunction

Left ventricular diastolic dysfunction

Ischaemic HF

Non-ischaemic HF

Acute HF

Chronic HF

Low output HF

High output HF

Forward HF

Backward HF

Compensated HF

Cardiac failure is a common condition with a prevalence

ranging from 3-5% in the population over 65 years old &

between 8-16% of those aged over 75years.

It is the leading cause for hospitalization in people older than

65. In developed countries, the mean age of patients with heart

failure is 75years old.

Heart failure is more common in men than in women until age

65 years, reflecting the greater incidence of coronary artery

disease in men.

Improved survival of patients after myocardial infarction is a

likely contributor to the increased incidence and prevalence of

heart failure.

EPIDEMIOLOGY

Infection

Arrhythmias

Physical, Dietary, Fluid, Environmental &

Emotional Excesses

Myocardial Infarction

Pulmonary Embolism

Anemia

Thyrotoxicosis & Pregnancy

Aggravation of Hypertension

Rheumatic, Viral & Other Forms of Myocarditis

Infective Endocarditis

AETIOLOGY

ETIOPATHOGENESIs

ADAPTIVE AND MALADAPTIVE MECHANISMS

1. The Frank-Starling mechanism

2. Compensatory hypertrophy

3. In ventricular remodeling

4.Redistribution of a subnormal cardiac

REDUCTION IN CARDIAC EFFICIENCY

ALTERATIONS IN ENERGY METABOLISM

ALTERATIONS IN SARCOMERIC PROTEINS

MYOCARDIAL CELL DEATH

ABNORMALITIES OF EXCITATION-CONTRACTION

COUPLING

Loss of contractile function due to;

•Pressure overload of the heart

•Work overload of the heart

•Loss of myocardium

•Generalized decrease in contractility

Impaired cardiac function(congestive signs & symptoms)

Compensatory mechanisms:

Cardiac compensatory mechanism

•Ventricular dilation

•Ventricular hypertrophy

Peripheral compensatory mechanism

•Increased sympathetic activity

•Activation of RAAS

•Increased afterload

•Increased blood volume

•Receptor changes

PATHOPHYSIOLOGY

CLINICAL MANIFESTATIONS

Signs

■ Pulmonary rales

■ Pulmonary edema

■ Cool extremities

■ Pleural effusion

■ Tachycardia

■ Narrow pulse pressure

■ Cardiomegaly

■ Peripheral edema

■ Jugular venous distension

■ Hepatojugular reflux

■ Hepatomegaly

Symptoms

■ Dyspnea, particularly on exertion

■ Orthopnea

■ Paroxysmal nocturnal dyspnea

■ Exercise intolerance

■ Tachypnea

■ Cough

■ Fatigue

■ Nocturia

■ Hemoptysis

■Abdominal pain

■Anorexia

■ Nausea

■ Bloating

■ Poor appetite, early satiety

■Ascites

■ Mental status changes

DIAGNOSIS

IMAGING

•Echocardiography

•Chest X-rays/ Chest Radiograph

ELECTROPHYSIOLOGY

Electrocardiogram (ECG/ EKG)

BLOOD TESTS

ANGIOGRAPHY

MONITORING

MANAGEMENT

NON PHARMACOLOGICAL MANAGEMENT

•Bed rest

•Consuming small but frequent meals (4 to 6 daily)

•Moderate sodium restriction (2 to 4g / day)

•Smoking cessation

•Avoid alcohol intake

PHARMACOLOGICAL MANAGEMENT•ACE’sCaptopril, Enalapril, Lisinopril, Perindopril, Ramipril, Trandolapril•ARB’sCandesartencilexetil, Eprosartan, Irbesartan, Losartan, Olmesartan, Telmisartan,Valsartan•Beta adrenergic blocking agentsBisoprolol, Metoprolol, Carvedilol•DiureticsThiazide- Chlorothiazide, Hydrochlorothiazide, Indapamide, ChlorthalidoneLoop diuretics- Furosemide, Ethacrynic acid, Bumetanide, TorsemidePotassium sparing diuretics- Amiloride, Spironolactone, Triamterene•Aldosterone antagonistsSpironolactone, Eplerenone•VasodilatorsNitroprusside, Hydralazine, Prazosin, Nitrates•Digitalis glycosidesDigitalis (Digoxin)•Calcium channel blockers•Inotropic agentsDopamine i.v, Dobutamine, Inamrinone, Milrinone, Nesiritide