Congestive heart failure is the most common cause of hospital admission in the United States. It occurs when the heart is unable to pump sufficiently, leading to poor oxygen delivery and fluid accumulation in the lungs. There are two main types: systolic dysfunction with reduced ejection fraction and diastolic dysfunction with impaired relaxation. Common causes of systolic dysfunction include hypertension, myocardial infarction, and valvular heart disease. Treatment focuses on ACE inhibitors, beta blockers, diuretics, and devices like implantable defibrillators for severe cases. While treatments are available for systolic dysfunction, there are no proven therapies yet for diastolic dysfunction beyond diuretics and beta blockers.

1. jul /11 /16
Congestive Heart Failure
Manuel Fonseca Crescioni
Medical intern
Hospital San Lucas Guayama P.R

2. ✤ IN USA CHF is the MCC of being admitted to the
hospital

3. Heart Failure
✤Dysfunction of the heart as a pump
✤Results in insufficient 02 delivery to tissues
acompanied by the accumulation of fluid in the lungs

4. Pathophysiology
✤ Activation of renin-angiotensin system
✤ Angiotensin II( TPR, Aldosterone)

5. ✤Can be either from systolic dysfunction( decreased
EF and heart dilatation) or from diastolic dysfunction (
inability to relax and recieve blood, EF is preserved
sometimes even above normal)

6. Causes of Systolic Heart Failure
✤ HTN (MC)
✤ MI
✤ Valvular heart dz of all types
✤ All 3 account for the vast
majority of cases (over 95%)

7. Systolic Heart Failure
✤ Less common causes of systolic dysfunction are;
✤ Etoh
✤ Postviral (idiodpathic) myocarditis = Often due to coxsackie B virus
✤ Radiation
✤ Adriamycin(doxorubicin)
✤ Chagas
✤ Hemochromatosis
✤ Thyroid dz
✤ Peripartum cardiomyopathy
✤ Thiamine deficiency

8. Presentation
✤ Dyspnea (SOB)
✤ Orthopnea(worse when lying flat, relieved when sitting up
or standing)
✤ Rales , Wheezing on lung examination Bibasilar crakles,
decreased breath sounds at the bases due to pleura
effusion
✤ JVD
✤ S3, S4

9. Diagnostic Test
✤ Echocardiography (To distinguish systolic from
diastolic dusfunction) every pt must get echo to
evaluate EF
✤ Best initial test= Transthoracic echo
✤ Most accurate test= MUGA Scan , Nuclear
Ventriculogram,
✤ BNP

13. Systolic Dysfunction (low EF) Tx.
✤ ACE inhibitors , ARB*
✤ B-blockers*
✤ Spirinolactone/eplerenone*
✤ Hydralazine/ nitrates*
✤ Diuretics
✤ Digoxin (does not lower mortality in CHF, controls sx.)
✤ Implantable defibrillator*/ Biventricular pacemaker*( EF below 35%)
✤ Transplantation when all else fails

14. Distolic Dysfunction (CHF w/
Preserved EF ) Tx.
✤ Nothing we know lowers mortality in diastolic
dysfunction
✤ Clearly beneficial= B-Blockers and Diuretics
✤ Clearly not Beneficial Digoxin and Spirinolactone
✤ Uncertain = ACE inhib, ARB’s & hydralazine

15. References
✤ Harrisons Principles of Internal Medicine 15th
Eugene Braunwald
✤ Medscape
✤ New York Heart Association
✤ Fundamental of Pathology Husain A. Sattar
✤ Master The Boards Step 2 CK Conrad Fischer, MD