Heart failure is an imprecise term used to describe the state that developes when the heart cannot maintain an adequate cardiac output or can do so only at the expense of and elevated filling pressure. OR Heart failure is a complex clinical syndrome that can result from any structural or functional cardiac disorder that impairs the ability of the ventricle to fill with or eject blood. Congestive Heart Failure describes a condition where the heart muscle is weakened and cannot pump as strongly as before.

1. CONGESTIVE CARDIAC
FAILURE
Presented by: Anand
Vaghasiya
Guided By: Dr. Darshna Nariya

2. WHAT WILL BE COVERED INSIDE
 Definition
 Pathophysiology
 Types of cardiac Failure
 Clinical features
 Complications
 Medical Investigation
Medical Management/Treatment

3. DEFINITION
 Heart failure is an imprecise term used to describe the state that developes
when the heart cannot maintain an adequate cardiac output or can do so only
at the expense of and elevated filling pressure.
OR
 Heart failure is a complex clinical syndrome that can result from any structural
or functional cardiac disorder that impairs the ability of the ventricle to fill with
or eject blood. Congestive Heart Failure describes a condition where the heart
muscle is weakened and cannot pump as strongly as before.

4. PATHOPHYSIOLOGY
In order to maintain normal
cardiac output, several
compensatory mechanisms
play a role as under:
Compensatory enlargement
in the form of cardiac
hypertrophy, cardiac
dilatation, or both.
Tachycardia due to activation
of neurohumoral system. e.g.
release of norepinephrine
and atrial natrouretic
peptide, activation of renin-
angiotensin aldosterone
mechanism.
 It is associated with
Nuerohormonal changes
including renin angiotensin
aldosterone Axis.
 impaired renal perfusion
and diuretic therapy leade to
release of more renin in

6. TYPES OF HEART FAILURE
 Acute Or chronic
 Left, Right or Biventricular HF
 forward and backward HF
Diastolic Systolic HF
High OutputHF
Low Output HF

7. LOW-OUTPUT HEART FAILURE
 Systolic Heart Failure:
•decreased cardiac output
•Decreased Left ventricular ejection fraction
Diastolic Heart Failure:
• Elevated Left and Right ventricular end-diastolic pressures

8. HIGH-OUTPUT HEART FAILURE
• Seen with peripheral shunting, low-systemic vascular resistance,
hyperthryoidism, beri-beri, carcinoid, anemia
• Often have normal cardiac output
BIVENTRICULAR HEART FAILURE
•Dilated cardiomyopathy, ischemic heart disease

9. RIGHT-VENTRICULAR FAILURE
• Reduction in Right ventricular Output
• reason can be Chronic lung disease, multiple pulmonary emboli, and
pulmonary valvular stenosis
LEFT-VENTRICULAR FAILURE
• Reduction in left ventricular output and/or an increase in the left
atrial or pulmonary venous pressure.

10. CLINICAL FEATURE OF HEART
FAILURE

11. CLINICAL FEATURES LEFT SIDED
HEART FAILURE:
1) Pulmonary Edema
a) Dyspnea (SOB)
b)Orthopnea
c)Paroxysmal Nocturnal Dyspnea
2) Decreased forward Perfusion Activated Renin Angiotensin
Aldosterone System, which cause fluid retention and worsenen CHF.

13. CLINICAL FEATURES RIGHT SIDED
HEART FAILURE:
Most common cause of cause of Right Heart Failure is Left side Heart
Failure.
a) Dyspnea
b)Jugular Venous Distention
c)Pitting Edema
d)Ascitis
e)Nutmeg Liver “Hepatomegaly”

14. RISK FACTORS

15. INVESTIGATIONS
 BNP>100pg/mL
 Electrocardiogram may be normal or it could show numerous abnormalities including
acute ST-T–wave changes from myocardial ischemia, atrial fibrillation, bradycardia,
left ventricular hypertrophy
 Serum creatinine may be increased because of hypoperfusion. Pre existing renal
dysfunction can contribute to volume overload.
 Complete blood count useful to determine if heart failure is a result of reduced
oxygen-carrying capacity
 Chest radiography is useful for detection of cardiac enlargement, pulmonary edema,
and pleural effusions
 Echocardiogram assesses left ventricle size, valve function, pericardial effusion, and
ejection fraction
 Hyponatremia, serum sodium <130mEq/L, is associated with reduced survival and

16. COMPLICATION
 Uraemia
Hypokalaemia
Hyponatraemia: feature of Severe HF, due to extreme diuretic
therapy, inappropriate water retention, and failure of ion pump in cell
membrane
 impaired liver function: mild jaundice
Thrmboembolism
Arrhytmias: atrial and ventrical are common and may be related to
electrolyte changes

17. MANAGEMENT OF HF
 Non Pahrmacological therapy
•Palliative care and end-of-life care
•Modification of lifestyle
•Learning and reeducation to avoid factors such as smoking, obesity and
sedentary lifestyle
• learn to copup with sign and symptoms with right precautions and care

18. SURGERY
• Heart transplantation
• Coronary bypass surgery.
• Heart valve repair or replacement.
• Implantable cardioverter-defibrillators (ICDs).
• Cardiac resynchronization therapy (CRT), or biventricular pacing.
• Ventricular assist devices (VADs).

19. DRUG THERAPY/ MEDICATION:
•Angiotensin-converting enzyme (ACE) inhibitors.
•Angiotensin II receptor blockers.
•Beta blockers.
•Diuretics.
•Aldosterone antagonists.
•Inotropes.
•Digoxin (Lanoxin).

20. THANK
YOU !