4. Congestive Heart Failure
Impaired cardiac pumping
– Ventricular dysfunction
Heart remodeling
– Reduced exercise tolerance
Diminished quality of life
Shortened life expectancy
Associated with CAD and HTN
5. Congestive Heart Failure
Demographics
5 million people in US
Most rapidly increasing form of CV
disease
– AHA estimates 450,000 new cases/year
– Increases with age 1 in every 100 adults
– Most common DX in hospitalized adults > 65
– Incidence equal in men and women
6. Congestive Heart Failure
Risk Factors
Diabetes Mellitus, cigarette smoking,
obesity, high serum cholesterol
Major contributing factor
HYPERTENSION
7. Congestive Heart Failure
Pathophysiology
Systolic Failure
– Defect in ventricular contraction
Left Ventricle loses ability to generate enough pressure to
eject blood forward through the high pressure aorta –
Decreased ejection fraction
Afterload – hypertension, cardiomyopathy, and
valvular heart disease
Diastolic Failure
– Impaired ability of ventricles to fill
– Decreased filling = decreased stroke volume
– Pulmonary congestion, pulmonary hypertension,
with normal ejection fraction
9. Congestive Heart Failure
Pathophysiology
Mixed Systolic & Diastolic Failure
– Poor ejection fraction
– High pulmonary pressures
Both ventricles have poor filling and emptying
capacity
– Acute MI; cardiomyopathy, poorly
controlled Hypertension
10. Congestive Heart Failure
Common Causes
Chronic Acute
CAD
Hypertensive HD
Rheumatic Heart Dis
Congenital Heart Dis
Cor pulmonale
Cardiomyopathy
Anemia
Bacterial endocarditis
Valvular disorders
Acute MI
Dysrhythmias
Pulmonary emboli
Thyrotixicosis
Hypertensive crisis
Rupture of papillary
muscle
VSD
Myocarditis
11. Congestive Heart Failure
Pathophysiology
Left Venticular Failure – Most Common
– Left ventricular function
– Blood backup – left atrium & pulmonary
veins
– Increased pulmonary pressure
– Fluid extravasation from pulmonary capillary
bed to interstitium & alveoli
– Results: Pulmonary Congestion
Pulmonary Edema
15. Congestive Heart Failure
Pathophysiology
Right Ventricular Failure
Backward flow of blood to right atrium and venous
circulation
Systemic venous congestion in systemic
circulation
Results: peripheral edema, hepatomegaly,
splenomegaly, vascular congestion of the GI tract,
jugular vein distention
Primary Cause: left ventricular failure
Chronic pulmonary congestion & hypertension result in right
ventricular failure
Cor pulmonale – ventricular dilation & hypertrophy
16. Congestive Heart Failure
Clinical Picture
Right Sided Heart Failure
Jugular vein distention
Enlarged liver & spleen
Anorexia & nausea
Dependent edema (legs & sacrum)
Distended abdomen
Edematous hands and fingers
Polyuria at night
Weight gain
Increased BP (excess volume) OR
Decreased BP (from failure)
18. Congestive Heart Failure
Diagnostic Studies
Goal: Assess the cause & degree of failure
History and Physical Exam
Brain Natriuretic Peptide level (BNP).
– elevated in acute and chronic heart failure
– useful in following the response to treatment of
congestive heart failure.
ABGs, Serum chemistries, LFTs
Chest x-ray
EKG
Echocardiogram
Nuclear imaging studies
Cardiac catheterization
Hemodynamic monitoring
21. Congestive Heart Failure
Classification
Class 1 – No limitation of physical activity
Class 2 – Slight limitation – fatigue, dyspnea,
palpitations
Class 3 – marked limitation. Comfortable at
rest; ordinary activities cause symptoms
Class 4 – Inability to carry out any physical
activity without symptoms –
Pain/discomfort at rest
22. CHF – Outcome Measures
Use of ß-blockers at discharge and during admission.
Use of aspirin at discharge and during admission.
Timely and appropriate acute reperfusion (thrombolysis or primary
angioplasty).
The use of angiotensin-converting enzyme (ACE) inhibitors for
patients with depressed left ventricular systolic function. Similarly,
a minority of patients with AMI are potential candidates for this
care process,
The proportion of patients eligible for smoking-cessation
counseling is relatively small, and ascertainment can be difficult,
given the variability in documentation as well as practice.
Diet and exercise counseling
Cholesterol status assessment and management.
