CONGESTIVE CARDIAC FAILURE DEFINiTION- Congestive Cardiac Failure/Heart Failure(HF) is clinical syndrome caused by inability of the heart to pump sufficient blood to meet the metabolic needs of the body. HF can results from any disorders that reduces ventricular filling(diastolic dysfunction)myocardial contractility(systolic dysfunction) CLASSIFICATION- According to position Backward Failure Forward Failure According to location Left Ventricle Failure(aortic Failure) Right Ventricle Failure(pulmonale Failure) Biventricular Failure(total Failure)(4)(5) CLINICAL MANESFESTATION- Fatigue Weakness Shortness of Breath at rest and exertion Cough and Wheezing Fluid overload Nocturia Proxymal nocturnal dyspnea Pulmonary edema Mitral valve stenosis Hypertropic cardiomayopathy DIAGNOSIS- Patient History 12.Acute Renal Injury Physical Examination 13.Dilated cardiomayopathy ECG-stress/rest 14.Pulse Oximetry Doppler 2D 3D 15.ABG/VBG measurement Cardiac Catheterization 16.TEE measurement Chest Radiography 17.SPECT Angiography 18.MRI-CT scan(7) Blood Test Fasting Lipid Profile(FLP) Coronary Angiography Myocardial Biopsy(7) LAB FINDINGS- BUN(Blood Urea Nitrogen) Test Liver Function Test Kidney Function Test B-type Naturetic peptide Test(BNP) TREATMENT- 1)SURGICAL TREATMENT- Coronary Artery Bypass Graft surgery Valve Surgery Left Ventricular Reconstructions Passive Cardiac Support Artificial cardiac pacemakers Cardiac Transplantations Implantable Cardiovascular Defibrillator Ventricular Assist devicesvad.jpg(2)(3)(4)(6) PATIENT MEDICATION COUNSELLING- Maintain Patient in high Fowler`s Position Elevates extremities when patient is stress Frequently Monitor vital signs Monitor intake of salt and water Restrict intake of fluid below 1.5 liters in a day Teach patient and family about disease provide life style change therapy Explain side effects of medince Provide info for exertion of work so as not increase workload on heart (3)(6)(8)

1. CONGESTIVE CARDIAC
FAILURE
M.PHARM FY-
CLINICAL PHARMACY
1
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2. CONTENTS
• Definition
• Introduction
• Classification
• Pathophysiology
• Etiology
• Clinical manifestation
• Diagnosis
• Lab Findings
• Pharmacothearupetics Treatment
• Recent Approaches to HF
• Patient Medication Councelling
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3. DEFINiTION
Congestive Cardiac Failure/Heart Failure(HF) is
clinical syndrome caused by inability of the heart
to pump sufficient blood to meet the metabolic
needs of the body. HF can results from any
disorders that reduces ventricular filling(diastolic
dysfunction)myocardial contractility(systolic
dysfunction)(1)(5)
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4. INTRODUCTION
• HF occurs when heart fails to supply adequate blood so
body deficieny for oxygen and nutrients supply to body.
• Not all conditions that lead to heart failure can be reversed,
but treatments can improve the signs and symptoms of heart
failure and help you live longer. Lifestyle changes such as
exercising, reducing sodium in your diet, managing stress
and losing weight can improve your quality of life.
• One way to prevent heart failure is to prevent and control
conditions that cause heart failure, such as coronary artery
disease, high blood pressure, diabetes or obesity.(2)(4) (6) (7)
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5. CLASSIFICATION
• According to position
1. Backward Failure
2. Forward Failure
• According to location
1. Left Ventricle
Failure(aortic Failure)
2. Right Ventricle
Failure(pulmonale Failure)
3. Biventricular Failure(total
Failure)(4)(5)
• According to output
1. High output Failure
2. Low output Failure
• According to Function
1. Systolic Failure(afterload
Failure)
2. Diastolic Failure(preload
Failure) (4)(5)
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6. Normal
ABNORMAL
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7. CLASSIFICATION
• NYHA( New York heart
Association)
1. Class I: no limitation is
experienced in any activities;
there are no symptoms from
ordinary activities.
2. Class II: slight, mild limitation
of activity; the patient is
comfortable at rest or with
mild exertion.
3. Class III: marked limitation of
any activity; the patient is
comfortable only at rest.
4. Class IV: any physical activity
brings on discomfort and
symptoms occur at
rest.(1)(2)(3)(6)
• American College of
Cardiology classification
A. Stage 1-Patient at high risk
of HF
B. Stage 2-Patient with
structural disease but no
HF symptoms
C. Stage 3-Patient with
disease and symptoms
D. Stage 4-Refractory HF with
specialized
interventions(1)(2)(3)(6)
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8. PATHOPHYSIOLOGY
Cornary artery
disese
Heart attack
Cardiomayopathy
Heart Inflamation
Congenital heart
defect
Sever lungs disease
Diabates
Sever Anemia
Abnormal Rhytms
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9. ETIOLOGY
Arrthymias
Myocardial
Infraction
Atherosclerosis
AnemiaHypertensionInfection
Obesity
Alcohol and
Tobaco
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10. CLINICAL MANESFESTATION
• Fatigue
• Weakness
• Shortness of Breath at rest
and exertion
• Cough and Wheezing
• Fluid overload
• Nocturia
• Proxymal nocturnal
dyspnea
• Pulmonary edema
• Mitral valve stenosis
• Hypertropic
cardiomayopathy
• Pleural Enfusion
• Narrow Pulse Pressure
• Pulmonary Congestion
• Chenye-Stokes
Respirationchyen stokes.jpg
• Cardiomegaly
• Hypertrophy
• Jugular venous distension
• Gallop rhythm
• Peripheral Pitting edema
• Orthopnea
• Kerly b lines
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11. DIAGNOSIS
1. Patient History 12.Acute Renal Injury
2. Physical Examination 13.Dilated cardiomayopathy
3. ECG-stress/rest 14.Pulse Oximetry
4. Doppler 2D 3D 15.ABG/VBG measurement
5. Cardiac Catheterization 16.TEE measurement
6. Chest Radiography 17.SPECT
7. Angiography 18.MRI-CT scan(7)
8. Blood Test
9. Fasting Lipid Profile(FLP)
10.Coronary Angiography
11.Myocardial Biopsy(7)
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12. LAB FINDINGS
1. BUN(Blood Urea Nitrogen) Test
2. Liver Function Test
3. Kidney Function Test
4. B-type Naturetic peptide Test(BNP)
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16. SURGICAL TREATMENT
1. Coronary Artery Bypass Graft surgery
2. Valve Surgery
3. Left Ventricular Reconstructions
4. Passive Cardiac Support
5. Artificial cardiac pacemakers
6. Cardiac Transplantations
7. Implantable Cardiovascular Defibrillator
8. Ventricular Assist devicesvad.jpg(2)(3)(4)(6)
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17. PATIENT MEDICATION
COUNCELLING
1. Maintain Patient in high Fowler`s Position
2. Elevates extremities when patient is stress
3. Frequently Monitor vital signs
4. Monitor intake of salt and water
5. Restrict intake of fluid below 1.5 liters in a day
6. Teach patient and family about disease provide life
style change therapy
7. Explain side effects of medince
8. Provide info for exertion of work so as not increase
workload on heart (3)(6)(8) 173/25/2019
16

18. REFERENCE
• Dipiro T. Joseph, Robert L.Talbert, Gary C.Yee,
L.Michael Posey textbook of Pharmacothearphy a
Pathophysiology approach 7th edition
• Roger Walker Cate Whittlesea textbook of Clinical
Pharmacy and Thearupetics 4th edition
• Kamlesh Kohli Clinical Pharmacothearupetics 4th
edition
• Richard A. Harvey Lippincott’s illustrated view
textbook of pharmacology 5th edition
• Harsh Mohan textbook of Pathophysiology 6th
edition 183/25/2019

19. • Bennett and Brown textbook of Clinical
Pharmacology 6th edition
• Medscape .scholar
• Langes charts of Pharmacology
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20. THANK YOU
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