Congestive cardiac failure

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Classification, signs and sypmtoms of congestive heart failure

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Congestive cardiac failure

  1. 1. Congestive Heart Failure
  2. 2. Classification
  3. 3. Generally classified as the following : <ul><li>Left vs right failure </li></ul><ul><li>Systolic vs diastolic dysfunction </li></ul><ul><li>Backward vs forward failure </li></ul><ul><li>Low output vs high output cardiac failure </li></ul><ul><li>The degree of functional impairment conferred by the abnormality (as in the NYHA functional classification) </li></ul>
  4. 4. New York Heart Association Functional Classification <ul><li>Class I: No limitation experienced in any activity and no symptoms from ordinary activities. </li></ul><ul><li>Class II : Mild limitation of activity and comfortable at rest or mild exertion </li></ul><ul><li>Class III : Marked limitation of any activity and comfortable only at rest </li></ul><ul><li>Class IV : Any physical activity brings discomfort and symptoms appear at rest </li></ul>
  5. 6. Signs and symptoms
  6. 7. Left Sided Failure- Symptoms <ul><li>Backward Failure : Respiratory compromise </li></ul><ul><li>Dyspnea on exertion </li></ul><ul><li>Dyspnea at rest (severe) </li></ul><ul><li>Orthopnea (on lying flat) </li></ul><ul><li>Paroxysmal nocturnal dyspnea (cardiac asthma) </li></ul><ul><li>Nocturnal cough </li></ul>
  7. 8. Left Sided Failure- Symptoms <ul><li>Forward Failure: Poor systemic circulation </li></ul><ul><li>Dizziness </li></ul><ul><li>Confusion </li></ul><ul><li>Cool extremities at rest </li></ul><ul><li>Easy fatigueability </li></ul><ul><li>Exercise intolerance </li></ul>
  8. 9. Right Sided Failure- Symptoms <ul><li>Backward Failure : Congestion of systemic capillaries </li></ul><ul><li>Excess fluid accumulation in the body </li></ul><ul><li>Peripheral edema/ anasarca </li></ul><ul><li>Dependent edema (foot, ankle, sacral) </li></ul><ul><li>Nocturia </li></ul><ul><li>Ascites </li></ul><ul><li>Liver congestion (hepatomegaly, jaundice and coagulopathy) </li></ul><ul><li>Forward Failure : Hypotension </li></ul>
  9. 11. Left Sided Failure- Signs <ul><li>Non specific signs of respiratory distress: </li></ul><ul><li>Tachypnea </li></ul><ul><li>Increased work of breathing </li></ul><ul><li>Decreased vital capacity </li></ul><ul><li>Development of pulmonary edema: </li></ul><ul><li>Rales/Crackles – initially at base, throughout the lung when severe </li></ul><ul><li>Extremely severe pulmonary edema: </li></ul><ul><li>Cyanosis (severe hypoxemia) </li></ul>
  10. 12. Left Sided Failure- Signs <ul><li>Laterally displaced apex beat (heart enlargement) </li></ul><ul><li>S3 gallop rhythm (increased blood flow/ increased intra cardiac pressure) </li></ul><ul><li>Heart murmurs- indicative of valvular diseases (Cause or result of heart failure) </li></ul>
  11. 13. Right Sided Failure- Signs <ul><li>Peripheral pitting edema </li></ul><ul><li>Hepatomegaly </li></ul><ul><li>Jugular venous pulse accentuated by hepatojugular reflux (marker of fluid status) </li></ul><ul><li>Positive abdominojugular test </li></ul><ul><li>Parasternal heave (increased RV pressure) </li></ul><ul><li>Ascites (late onset) </li></ul>
  12. 14. Ascites Pitting Edema of Ankle
  13. 15. Cardiomegaly Pulmonary Edema
  14. 16. Biventricular Failure <ul><li>Pleural effusions- more common in biventricular failures. </li></ul><ul><li>Unilateral failures cause right sided effusions (large area of right lung) </li></ul><ul><li>Signs: </li></ul><ul><li>Dullness of lung fields </li></ul><ul><li>Reduced breath sounds at lung bases </li></ul>
  15. 17. Other signs <ul><li>Cardiomegaly </li></ul><ul><li>Weight loss </li></ul><ul><li>Tachycardia (>120 bpm) </li></ul><ul><li>Pink frothy sputum (severe) </li></ul>
  16. 18. Measuring elevated JVP Common symptoms of CCF (overview)
  17. 19. References <ul><li>Internet </li></ul><ul><li>www.wikipedia.org </li></ul><ul><li>www.wrongdiagnosis.com </li></ul><ul><li>www.medicinenet.com </li></ul><ul><li>Davidson’s Principles and Practice of Medicine, 20 th Ed. </li></ul><ul><li>Harrison’s Manual of Internal Medicine, 17 th Ed. </li></ul>
  18. 20. Thank You

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