Heart Failure

Heart FailureIt is the pethophysiological process in which the heart as a pump is unable to meet the metabolic requirement of tissues for oxygen

End result is fluid retention

C.O.

Activation of SNS

HR

Renal blood flow

Renin angiotensin system activation

V.C.

Salt & water retention

V.C.

CAUSES1. Vascular 2. Valvular3. Cardiomyopathy4. Congenital heart disease 5. Hypertension 6. Cardiac arrhythmia7. Infective8. Infiltrative disease of heart

Precipitating factors1. Increase demand

Anaemia Fever Infection Salt intake Thyrotoxicosis Pregnancy

2. Arrhythmia 3. Alcohol Ingestion4. Thiamine Deficiency5. Uncontrolled HTN6. Drugs

Beta adrenergic blockers Salt retaining drugs e.g. steroids, NSAIDS

Classifying Heart Failure1. RHF v/s LHF 2. Low output v/s High

output 3. Acute v/s Chronic 4. Systolic v/s Diastolic 5. Forward v/s Backward

Pathophysiology Left heart failure

failure of forward flow from LV into the aorta leads to LV pressure . This pressure is transmitted to LA/ P. vein.

pressure in pulmonary capillaries Exudation of fluid in alveolar

air sac

dyspnoea In sufficient blood pumped into aorta leads to hypotension & poor perfusion & oxygenation

PathophysiologyRight heart failure

Pressure in RV

Pressure in RA

SVC & IVC

JVP & Congestive symptoms

1. Dyspnoea2. PND3. Swelling over dependent part4. Fatigue & Weakness5. Anorexia & Nausea6. Cerebral symptoms 7. Chyne stokes respiration

CLINICAL FEATURES

SIGNS

Tachycardia

JVP Increased

SIGNS

SIGNSEdema

Crepitation in chest

SIGNS

SIGNSCardiac

3rd heart sound may be audible

Abdomen Liver is enlarged & tender

Laboratory Investigation

Normal Pulmonary edema

Chest X-ray

Laboratory Investigation

ECG

Echocardiography

Laboratory Investigation

Treatment1. Removal of precipitating causes2. Correction of underlying cause

Surgical correction CABG

3. Control of congestive heart failure states

Restriction of Physical Activity Diet Pharmaco therapy

Treatment Pharmaco therapy

Diuretics ACE inhibitors Beta blockers Inotropic drugs vasodilators

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