This document discusses heart failure (CHF) and summarizes key points about clinical syndromes, diagnostic syndromes, and treatment options for CHF. There are three main clinical syndromes - pure right ventricular failure causing leg swelling, left ventricular failure causing pulmonary edema and shortness of breath, and low output failure causing weakness. Diagnostically, CHF can be systolic or diastolic dysfunction. Treatment for systolic dysfunction focuses on ACE inhibitors while diastolic dysfunction is best treated with ACE inhibitors, beta blockers, and calcium channel blockers.
This document provides an overview of hypertrophic cardiomyopathy (HCM). It begins with definitions of cardiomyopathy and HCM. It then discusses the historical perspective, genetic basis, morphology, pathophysiology, clinical features, diagnosis, and management of HCM. Some key points include:
- HCM is a genetic heart condition characterized by unexplained thickening of the heart muscle. It is the most common cause of sudden cardiac death in young people.
- The genetic basis involves mutations in genes encoding sarcomere proteins. This leads to impaired relaxation and increased calcium sensitivity of the heart muscle.
- Morphologically, HCM involves asymmetric left ventricular hypertrophy and abnormalities of the mitral valve apparatus. Hist
Restrictive cardiomyopathy is characterized by stiff ventricles that do not fill properly, though systolic function is usually preserved initially. It can be caused by infiltrative diseases, fibrosis, or other processes that restrict ventricular filling. On echocardiogram, restrictive cardiomyopathy shows impaired ventricular filling and enlarged atria, while cardiac catheterization reveals elevated diastolic pressures and a distinctive "square root sign" pressure tracing. Treatment focuses on managing symptoms and underlying causes if identifiable, though prognosis is often poor without transplantation.
This document discusses hypertrophic cardiomyopathy (HCM), including its definition, causes, variants, pathophysiology, clinical presentation, diagnostic workup, and management. Key points include:
- HCM is defined by left and/or right ventricular hypertrophy, usually involving the septum with a thickness over 15mm. It is commonly caused by genetic mutations affecting cardiac proteins.
- Presentation can range from being asymptomatic to symptoms of heart failure, angina, or syncope. Exams may reveal murmurs and EKGs often show abnormal patterns. Echocardiograms and cardiac catheterization are used for diagnosis and assessment.
- Management involves medications like beta-blockers to reduce
Basics on heart murmurs, differentiate physiologic murmur from pathologic. Learn when to investigate further and when to monitor. Know the effect of different maneuvers on murmurs and physiology behind them. Listen to the heart sounds on the slides to appreciate the distinctive nature of each murmur.
This document discusses the assessment of severity in valvular heart disease. It addresses three main issues in managing patients with valvular heart disease: assessing disease severity, determining the effect on the cardiovascular system, and deciding the timing and type of intervention. Disease severity is classified as mild, moderate, or severe based on physical exam findings, echocardiography, and other tests. Only severe disease generally causes symptoms and requires intervention. Assessment of severity integrates data from multiple tests and should guide decisions about treatment.
- Constrictive pericarditis results from scarring and loss of elasticity of the pericardial sac, typically due to chronic inflammation and sometimes calcification. This causes the pericardium to thicken and lose its ability to expand and contract normally.
- The inelastic pericardium prevents normal filling of the heart chambers, especially in mid to late diastole. Inspiration does not decrease pressure in the left ventricle as it normally would due to the thickened pericardium isolating the heart.
- Diagnosis involves physical exam findings like elevated JVP, hepatomegaly, and Kussmaul's sign combined with echocardiography findings like sept
This document discusses aortic stenosis, including its causes, symptoms, diagnosis, and treatment. It notes that aortic stenosis can be valvular, subvalvular, or supravalvular and can be caused by rheumatic fever, congenital defects, or age-related calcification. Common symptoms include chest pain, shortness of breath, fatigue, and murmurs. Diagnosis involves echocardiogram, EKG, chest X-ray and cardiac catheterization. Treatment options range from medication to manage symptoms, balloon valvuloplasty, or aortic valve replacement surgery.
This document contains information about hypertrophic obstructive cardiomyopathy (HOCM). It begins with an overview of HOCM, defining it as a genetic heart condition characterized by asymmetric left ventricular hypertrophy. It then discusses the pathophysiology of HOCM, focusing on left ventricular outflow tract obstruction, diastolic dysfunction, myocardial ischemia, and mitral regurgitation due to systolic anterior motion of the mitral valve. The document outlines clinical manifestations such as symptoms, physical exam findings, ECG and echocardiographic features, and complications. It concludes by covering treatment options for HOCM including medications, surgical septal myectomy via transaortic or transapical approaches, and other procedures like alcohol septal
This document provides an overview of hypertrophic cardiomyopathy (HCM). It begins with definitions of cardiomyopathy and HCM. It then discusses the historical perspective, genetic basis, morphology, pathophysiology, clinical features, diagnosis, and management of HCM. Some key points include:
- HCM is a genetic heart condition characterized by unexplained thickening of the heart muscle. It is the most common cause of sudden cardiac death in young people.
- The genetic basis involves mutations in genes encoding sarcomere proteins. This leads to impaired relaxation and increased calcium sensitivity of the heart muscle.
- Morphologically, HCM involves asymmetric left ventricular hypertrophy and abnormalities of the mitral valve apparatus. Hist
Restrictive cardiomyopathy is characterized by stiff ventricles that do not fill properly, though systolic function is usually preserved initially. It can be caused by infiltrative diseases, fibrosis, or other processes that restrict ventricular filling. On echocardiogram, restrictive cardiomyopathy shows impaired ventricular filling and enlarged atria, while cardiac catheterization reveals elevated diastolic pressures and a distinctive "square root sign" pressure tracing. Treatment focuses on managing symptoms and underlying causes if identifiable, though prognosis is often poor without transplantation.
This document discusses hypertrophic cardiomyopathy (HCM), including its definition, causes, variants, pathophysiology, clinical presentation, diagnostic workup, and management. Key points include:
- HCM is defined by left and/or right ventricular hypertrophy, usually involving the septum with a thickness over 15mm. It is commonly caused by genetic mutations affecting cardiac proteins.
- Presentation can range from being asymptomatic to symptoms of heart failure, angina, or syncope. Exams may reveal murmurs and EKGs often show abnormal patterns. Echocardiograms and cardiac catheterization are used for diagnosis and assessment.
- Management involves medications like beta-blockers to reduce
Basics on heart murmurs, differentiate physiologic murmur from pathologic. Learn when to investigate further and when to monitor. Know the effect of different maneuvers on murmurs and physiology behind them. Listen to the heart sounds on the slides to appreciate the distinctive nature of each murmur.
This document discusses the assessment of severity in valvular heart disease. It addresses three main issues in managing patients with valvular heart disease: assessing disease severity, determining the effect on the cardiovascular system, and deciding the timing and type of intervention. Disease severity is classified as mild, moderate, or severe based on physical exam findings, echocardiography, and other tests. Only severe disease generally causes symptoms and requires intervention. Assessment of severity integrates data from multiple tests and should guide decisions about treatment.
- Constrictive pericarditis results from scarring and loss of elasticity of the pericardial sac, typically due to chronic inflammation and sometimes calcification. This causes the pericardium to thicken and lose its ability to expand and contract normally.
- The inelastic pericardium prevents normal filling of the heart chambers, especially in mid to late diastole. Inspiration does not decrease pressure in the left ventricle as it normally would due to the thickened pericardium isolating the heart.
- Diagnosis involves physical exam findings like elevated JVP, hepatomegaly, and Kussmaul's sign combined with echocardiography findings like sept
This document discusses aortic stenosis, including its causes, symptoms, diagnosis, and treatment. It notes that aortic stenosis can be valvular, subvalvular, or supravalvular and can be caused by rheumatic fever, congenital defects, or age-related calcification. Common symptoms include chest pain, shortness of breath, fatigue, and murmurs. Diagnosis involves echocardiogram, EKG, chest X-ray and cardiac catheterization. Treatment options range from medication to manage symptoms, balloon valvuloplasty, or aortic valve replacement surgery.
This document contains information about hypertrophic obstructive cardiomyopathy (HOCM). It begins with an overview of HOCM, defining it as a genetic heart condition characterized by asymmetric left ventricular hypertrophy. It then discusses the pathophysiology of HOCM, focusing on left ventricular outflow tract obstruction, diastolic dysfunction, myocardial ischemia, and mitral regurgitation due to systolic anterior motion of the mitral valve. The document outlines clinical manifestations such as symptoms, physical exam findings, ECG and echocardiographic features, and complications. It concludes by covering treatment options for HOCM including medications, surgical septal myectomy via transaortic or transapical approaches, and other procedures like alcohol septal
Aortic regurgitation occurs when the aortic valve does not close properly, allowing blood to flow back into the left ventricle. It can be caused by conditions that damage the aortic valve such as rheumatic fever or a congenital heart defect. Symptoms may include breathlessness, fatigue, and chest pain. Diagnosis is made through echocardiogram which can assess the severity. Treatment depends on severity but may involve lifestyle changes, medications, or aortic valve replacement surgery if symptoms worsen or damage to the heart progresses. Prognosis depends on severity and treatment, with severe untreated cases having a high risk of heart failure or sudden cardiac death.
Heart failure is a complex clinical syndrome that results from any structural or functional impairment of the heart that limits its ability to fill with or eject blood. The pathophysiology involves neurohormonal activation of the sympathetic nervous system and renin-angiotensin-aldosterone system. Pharmacological treatment focuses on blocking these neurohormonal mechanisms, reducing preload and afterload, and increasing contractility. The goals of therapy are to improve quality of life, relieve symptoms, prevent hospitalizations, and slow disease progression.
This document provides an overview of heart failure, including definitions, epidemiology, etiology, signs and symptoms, diagnosis, and treatment. Heart failure is defined as a condition where the heart loses its ability to pump sufficient blood to the body. It may involve the left ventricle, right ventricle, or both, and can be acute or chronic. Common causes include coronary artery disease, defective heart valves, arrhythmias, cardiomyopathy, and hypertension. Diagnosis involves echocardiogram, BNP levels, and chest x-rays. Treatment includes lifestyle changes, medications to reduce preload and afterload, increase contractility, and eliminate fluid, as well as surgical procedures like angioplasty, bypass, or
Echo assessment of lv systolic function and swmaFuad Farooq
This document discusses various techniques for assessing left ventricular systolic function using echocardiography, including:
- Visual assessment of endocardial motion and wall thickening to evaluate global and regional function
- Quantitative measures like fractional shortening, ejection fraction, and volumes
- Tissue Doppler imaging of mitral annular velocities
- Tissue tracking and strain imaging to evaluate timing and extent of myocardial contraction
- Wall motion scoring to characterize regional abnormalities
Approach to heart failure medicos notes-comMedicosNotes
1. Heart failure is a clinical syndrome where the heart cannot pump enough blood to meet the body's needs due to structural or functional abnormalities.
2. Common causes include coronary artery disease, hypertension, valvular heart disease, and cardiomyopathies. Precipitating factors include non-compliance with medications, arrhythmias, and infections.
3. Symptoms include respiratory distress, peripheral edema, fatigue, and reduced exercise tolerance due to elevated cardiac filling pressures and inadequate perfusion. Diagnosis involves physical exam, labs like BNP, echocardiogram, and criteria like Framingham or NYHA class.
1. Heart failure affects 1.5-2% of the global population and is characterized by the heart's inability to pump an adequate amount of blood to meet the body's needs.
2. Common causes include coronary heart disease, hypertension, cardiomyopathies, and arrhythmias.
3. Heart failure progresses through stages from no limitation of physical activity to severe limitations where any physical activity causes deterioration of health. Treatment aims to reduce preload and afterload on the heart.
Complications of Myocardial Infarction (MI)Eneutron
Ischemic complications are common after acute myocardial infarction and include infarct extension, recurrent infarction, and recurrent angina. Left ventricular failure is a major predictor of mortality, ranging from mild congestive heart failure to cardiogenic shock. Other mechanical complications include ventricular septal rupture, mitral regurgitation, and cardiac wall rupture. Prompt treatment with medications, percutaneous coronary intervention, or surgery can help manage complications and reduce mortality risks.
Ventricular tachycardia can occur due to various causes like acute myocardial infarction, chronic infarction, dilated cardiomyopathy, etc. It is classified as sustained, non-sustained, monomorphic, polymorphic, etc. based on characteristics. Diagnosis involves ECG, echocardiogram, and monitoring. Treatment depends on hemodynamic stability and includes electrical cardioversion, antiarrhythmic drugs like amiodarone, lidocaine, ablation, and ICD implantation in selected cases. Recurrence risk is high in structurally abnormal hearts and prevention involves controlling triggers, antiarrhythmics, and ICDs.
Echocardiography plays an essential role in diagnosing hypertrophic cardiomyopathy (HCM) by demonstrating left ventricular hypertrophy of 15mm or greater that is asymmetric and cannot be attributed to another cause. Echocardiography can also identify the characteristic patterns of hypertrophy such as sigmoid septum, reverse curvature of the septum, and apical hypertrophy. It is used to detect complications of HCM such as left ventricular outflow tract obstruction, mitral regurgitation, and apical aneurysms. Risk stratification for sudden cardiac death utilizes echocardiography to identify features such as massive hypertrophy, abnormal blood pressure response to exercise, and nonsustained ventricular tachycard
Infective endocarditis and heart massesFuad Farooq
This document discusses infective endocarditis and heart masses as seen on echocardiography. It provides details on:
- The causes, presentation, and complications of infective endocarditis and how vegetations appear echocardiographically. Vegetation size and location impact detection.
- Other masses that can be seen on echocardiograms like thrombi, tumors, and normal anatomical variants. Cardiac tumors can be primary or secondary and include myxomas, fibromas, and rhabdomyomas.
- How to differentiate masses through characteristics like size, shape, location, mobility and attachment site as well as clinical presentation. Accurate diagnosis is important for proper patient management and treatment.
Aortic stenosis is a narrowing of the aortic valve that obstructs blood flow from the left ventricle to the aorta. It can be congenital due to conditions like bicuspid aortic valve, or acquired through rheumatic heart disease, atherosclerosis or idiopathic hypertrophic subaortic stenosis. Over time, the obstruction causes the left ventricle to hypertrophy to maintain cardiac output, which can lead to heart failure. Symptoms include chest pain, syncope and dyspnea that worsen with exertion. Examination may reveal murmurs, decreased pulses and elevated blood pressure. Echocardiography can diagnose the severity of stenosis. Treatment involves managing symptoms, avoiding
Mitral stenosis is commonly caused by rheumatic heart disease which leads to inflammation and fusion of the mitral valve leaflets, reducing the mitral valve orifice area. Severe mitral stenosis, defined as a mitral valve area less than 1.0 cm2, can cause pulmonary hypertension, pulmonary edema, atrial fibrillation, and right heart failure as the heart tries to maintain sufficient cardiac output against the back pressure. Physical exam may reveal signs of pulmonary hypertension like a loud pulmonary component to S2, as well as a tapping apex, opening snap, and mid-diastolic rumble on cardiac auscultation. Echocardiography can determine the severity of mitral stenosis and assess
The document discusses the anatomy and physiology of the heart's conducting system. It describes the locations and functions of the sinoatrial node, atrioventricular node, bundle of His, bundle branches, and Purkinje fibers. It then explains different types of heart block including first-, second-, and third-degree heart block and their characteristics as seen on ECG. Treatment options are provided for the various heart block classifications.
1) Aortic stenosis is a chronic progressive disease that causes obstruction to left ventricular emptying, leading to symptoms like chest pain, breathlessness, syncope, and fatigue.
2) It is commonly caused by calcific aortic valvular disease in elderly patients or a bicuspid aortic valve. Other potential causes include rheumatic fever and familial hypercholesterolemia.
3) The pathophysiology involves increased left ventricular pressure and hypertrophy due to the obstruction, which can lead to ischemia, arrhythmias, and heart failure over time if left untreated. Symptomatic patients require aortic valve replacement.
HCM is a common genetic heart disease reported in populations globally
Inherited in an autosomal dominant pattern
The distribution of HCM is equal by sex, although women are diagnosed less commonly than men
The prevalence of unexplained asymptomatic hypertrophy in young adults has been reported to range from 1:200 to 1:500
Valvular heart disease accounts for 10-20% of cardiac surgery procedures in the US. The document discusses the causes, symptoms, diagnosis and treatment of two common types: mitral stenosis and mitral regurgitation. Mitral stenosis is usually caused by rheumatic fever and results in obstruction of blood flow from the left atrium to ventricle. Symptoms range from mild shortness of breath to pulmonary edema. Diagnosis involves echocardiography and treatment may involve medications, balloon valvuloplasty or valve replacement surgery. Mitral regurgitation occurs when the mitral valve does not close properly, allowing blood to flow back into the left atrium. It can be acute or chronic, with symptoms
The document discusses congestive cardiac failure (heart failure) and its management. It provides details on:
- The high prevalence and mortality of heart failure.
- Current medical therapies including ACE inhibitors, beta-blockers, and aldosterone antagonists that have been shown to improve survival.
- Device therapies like cardiac resynchronization therapy and implantable cardioverter defibrillators that treat symptoms and reduce mortality.
- The benefits of multidisciplinary and integrated care approaches including telehealth monitoring in improving outcomes for heart failure patients.
1) Congestive heart failure results from any structural or functional abnormality that impairs the ventricle's ability to eject or fill with blood.
2) The renin-angiotensin-aldosterone system plays a role in the vicious cycle of congestive heart failure by stimulating sodium and water retention.
3) Treatment for systolic heart failure involves lifestyle modifications, medications like diuretics, ACE inhibitors, beta blockers, and devices or transplantation for refractory cases.
This document discusses heart failure, including causes, symptoms, classifications, treatment options and guidelines. It covers systolic and diastolic heart failure, risk factors, physical findings, NYHA functional classes, medications like ACE inhibitors, beta blockers, ARBs and more. It also discusses device options, special populations like African Americans, and the cardio-renal syndrome.
Aortic regurgitation occurs when the aortic valve does not close properly, allowing blood to flow back into the left ventricle. It can be caused by conditions that damage the aortic valve such as rheumatic fever or a congenital heart defect. Symptoms may include breathlessness, fatigue, and chest pain. Diagnosis is made through echocardiogram which can assess the severity. Treatment depends on severity but may involve lifestyle changes, medications, or aortic valve replacement surgery if symptoms worsen or damage to the heart progresses. Prognosis depends on severity and treatment, with severe untreated cases having a high risk of heart failure or sudden cardiac death.
Heart failure is a complex clinical syndrome that results from any structural or functional impairment of the heart that limits its ability to fill with or eject blood. The pathophysiology involves neurohormonal activation of the sympathetic nervous system and renin-angiotensin-aldosterone system. Pharmacological treatment focuses on blocking these neurohormonal mechanisms, reducing preload and afterload, and increasing contractility. The goals of therapy are to improve quality of life, relieve symptoms, prevent hospitalizations, and slow disease progression.
This document provides an overview of heart failure, including definitions, epidemiology, etiology, signs and symptoms, diagnosis, and treatment. Heart failure is defined as a condition where the heart loses its ability to pump sufficient blood to the body. It may involve the left ventricle, right ventricle, or both, and can be acute or chronic. Common causes include coronary artery disease, defective heart valves, arrhythmias, cardiomyopathy, and hypertension. Diagnosis involves echocardiogram, BNP levels, and chest x-rays. Treatment includes lifestyle changes, medications to reduce preload and afterload, increase contractility, and eliminate fluid, as well as surgical procedures like angioplasty, bypass, or
Echo assessment of lv systolic function and swmaFuad Farooq
This document discusses various techniques for assessing left ventricular systolic function using echocardiography, including:
- Visual assessment of endocardial motion and wall thickening to evaluate global and regional function
- Quantitative measures like fractional shortening, ejection fraction, and volumes
- Tissue Doppler imaging of mitral annular velocities
- Tissue tracking and strain imaging to evaluate timing and extent of myocardial contraction
- Wall motion scoring to characterize regional abnormalities
Approach to heart failure medicos notes-comMedicosNotes
1. Heart failure is a clinical syndrome where the heart cannot pump enough blood to meet the body's needs due to structural or functional abnormalities.
2. Common causes include coronary artery disease, hypertension, valvular heart disease, and cardiomyopathies. Precipitating factors include non-compliance with medications, arrhythmias, and infections.
3. Symptoms include respiratory distress, peripheral edema, fatigue, and reduced exercise tolerance due to elevated cardiac filling pressures and inadequate perfusion. Diagnosis involves physical exam, labs like BNP, echocardiogram, and criteria like Framingham or NYHA class.
1. Heart failure affects 1.5-2% of the global population and is characterized by the heart's inability to pump an adequate amount of blood to meet the body's needs.
2. Common causes include coronary heart disease, hypertension, cardiomyopathies, and arrhythmias.
3. Heart failure progresses through stages from no limitation of physical activity to severe limitations where any physical activity causes deterioration of health. Treatment aims to reduce preload and afterload on the heart.
Complications of Myocardial Infarction (MI)Eneutron
Ischemic complications are common after acute myocardial infarction and include infarct extension, recurrent infarction, and recurrent angina. Left ventricular failure is a major predictor of mortality, ranging from mild congestive heart failure to cardiogenic shock. Other mechanical complications include ventricular septal rupture, mitral regurgitation, and cardiac wall rupture. Prompt treatment with medications, percutaneous coronary intervention, or surgery can help manage complications and reduce mortality risks.
Ventricular tachycardia can occur due to various causes like acute myocardial infarction, chronic infarction, dilated cardiomyopathy, etc. It is classified as sustained, non-sustained, monomorphic, polymorphic, etc. based on characteristics. Diagnosis involves ECG, echocardiogram, and monitoring. Treatment depends on hemodynamic stability and includes electrical cardioversion, antiarrhythmic drugs like amiodarone, lidocaine, ablation, and ICD implantation in selected cases. Recurrence risk is high in structurally abnormal hearts and prevention involves controlling triggers, antiarrhythmics, and ICDs.
Echocardiography plays an essential role in diagnosing hypertrophic cardiomyopathy (HCM) by demonstrating left ventricular hypertrophy of 15mm or greater that is asymmetric and cannot be attributed to another cause. Echocardiography can also identify the characteristic patterns of hypertrophy such as sigmoid septum, reverse curvature of the septum, and apical hypertrophy. It is used to detect complications of HCM such as left ventricular outflow tract obstruction, mitral regurgitation, and apical aneurysms. Risk stratification for sudden cardiac death utilizes echocardiography to identify features such as massive hypertrophy, abnormal blood pressure response to exercise, and nonsustained ventricular tachycard
Infective endocarditis and heart massesFuad Farooq
This document discusses infective endocarditis and heart masses as seen on echocardiography. It provides details on:
- The causes, presentation, and complications of infective endocarditis and how vegetations appear echocardiographically. Vegetation size and location impact detection.
- Other masses that can be seen on echocardiograms like thrombi, tumors, and normal anatomical variants. Cardiac tumors can be primary or secondary and include myxomas, fibromas, and rhabdomyomas.
- How to differentiate masses through characteristics like size, shape, location, mobility and attachment site as well as clinical presentation. Accurate diagnosis is important for proper patient management and treatment.
Aortic stenosis is a narrowing of the aortic valve that obstructs blood flow from the left ventricle to the aorta. It can be congenital due to conditions like bicuspid aortic valve, or acquired through rheumatic heart disease, atherosclerosis or idiopathic hypertrophic subaortic stenosis. Over time, the obstruction causes the left ventricle to hypertrophy to maintain cardiac output, which can lead to heart failure. Symptoms include chest pain, syncope and dyspnea that worsen with exertion. Examination may reveal murmurs, decreased pulses and elevated blood pressure. Echocardiography can diagnose the severity of stenosis. Treatment involves managing symptoms, avoiding
Mitral stenosis is commonly caused by rheumatic heart disease which leads to inflammation and fusion of the mitral valve leaflets, reducing the mitral valve orifice area. Severe mitral stenosis, defined as a mitral valve area less than 1.0 cm2, can cause pulmonary hypertension, pulmonary edema, atrial fibrillation, and right heart failure as the heart tries to maintain sufficient cardiac output against the back pressure. Physical exam may reveal signs of pulmonary hypertension like a loud pulmonary component to S2, as well as a tapping apex, opening snap, and mid-diastolic rumble on cardiac auscultation. Echocardiography can determine the severity of mitral stenosis and assess
The document discusses the anatomy and physiology of the heart's conducting system. It describes the locations and functions of the sinoatrial node, atrioventricular node, bundle of His, bundle branches, and Purkinje fibers. It then explains different types of heart block including first-, second-, and third-degree heart block and their characteristics as seen on ECG. Treatment options are provided for the various heart block classifications.
1) Aortic stenosis is a chronic progressive disease that causes obstruction to left ventricular emptying, leading to symptoms like chest pain, breathlessness, syncope, and fatigue.
2) It is commonly caused by calcific aortic valvular disease in elderly patients or a bicuspid aortic valve. Other potential causes include rheumatic fever and familial hypercholesterolemia.
3) The pathophysiology involves increased left ventricular pressure and hypertrophy due to the obstruction, which can lead to ischemia, arrhythmias, and heart failure over time if left untreated. Symptomatic patients require aortic valve replacement.
HCM is a common genetic heart disease reported in populations globally
Inherited in an autosomal dominant pattern
The distribution of HCM is equal by sex, although women are diagnosed less commonly than men
The prevalence of unexplained asymptomatic hypertrophy in young adults has been reported to range from 1:200 to 1:500
Valvular heart disease accounts for 10-20% of cardiac surgery procedures in the US. The document discusses the causes, symptoms, diagnosis and treatment of two common types: mitral stenosis and mitral regurgitation. Mitral stenosis is usually caused by rheumatic fever and results in obstruction of blood flow from the left atrium to ventricle. Symptoms range from mild shortness of breath to pulmonary edema. Diagnosis involves echocardiography and treatment may involve medications, balloon valvuloplasty or valve replacement surgery. Mitral regurgitation occurs when the mitral valve does not close properly, allowing blood to flow back into the left atrium. It can be acute or chronic, with symptoms
The document discusses congestive cardiac failure (heart failure) and its management. It provides details on:
- The high prevalence and mortality of heart failure.
- Current medical therapies including ACE inhibitors, beta-blockers, and aldosterone antagonists that have been shown to improve survival.
- Device therapies like cardiac resynchronization therapy and implantable cardioverter defibrillators that treat symptoms and reduce mortality.
- The benefits of multidisciplinary and integrated care approaches including telehealth monitoring in improving outcomes for heart failure patients.
1) Congestive heart failure results from any structural or functional abnormality that impairs the ventricle's ability to eject or fill with blood.
2) The renin-angiotensin-aldosterone system plays a role in the vicious cycle of congestive heart failure by stimulating sodium and water retention.
3) Treatment for systolic heart failure involves lifestyle modifications, medications like diuretics, ACE inhibitors, beta blockers, and devices or transplantation for refractory cases.
This document discusses heart failure, including causes, symptoms, classifications, treatment options and guidelines. It covers systolic and diastolic heart failure, risk factors, physical findings, NYHA functional classes, medications like ACE inhibitors, beta blockers, ARBs and more. It also discusses device options, special populations like African Americans, and the cardio-renal syndrome.
The document provides an overview of basic echocardiography techniques and measurements. It discusses how ultrasound is used to create 2D and Doppler images of the heart. Key metrics for assessing the left ventricle, valves, and other structures are defined. Case studies demonstrate how echocardiography is used to diagnose various conditions like mitral stenosis and evaluate their severity.
This document provides an overview of heart failure, including its definition, epidemiology, signs and symptoms, pathophysiology, and pharmacotherapy. It discusses the classification of heart failure, management guidelines, and recommendations for treating different stages of heart failure. The main drugs discussed are ACE inhibitors, ARBs, beta-blockers, diuretics, aldosterone receptor antagonists, digoxin, and inotropic drugs. The document provides details on the mechanisms of action and recommendations for use of these pharmacotherapies in heart failure.
This document summarizes several classes of antihypertensive drugs, including their mechanisms of action and effects. It discusses diuretics, ACE inhibitors, angiotensin receptor blockers, beta-blockers, calcium channel blockers, alpha-blockers, centrally acting drugs, and vasodilators. For each class, it describes their advantages and disadvantages in treating hypertension, as well as recommendations for use.
Heart failure is a condition where the heart cannot pump enough blood to meet the body's needs. It has many potential causes, but is often due to problems with the heart muscle itself or valves. Treatment focuses on managing symptoms with diuretics, and slowing progression with ACE inhibitors, beta-blockers, and aldosterone antagonists. Other therapies aim to improve heart function or treat underlying causes. Prognosis depends on severity but ranges from 5-50% annual mortality.
This document discusses antiarrhythmic drugs and their mechanisms of action. It begins by classifying arrhythmias and describing the electrophysiology of the heart. It then classifies antiarrhythmic drugs into four classes based on their mechanisms of action - sodium channel blockers (Class I), beta blockers (Class II), drugs that prolong the action potential (Class III), and calcium channel blockers (Class IV). Specific Class I drugs are discussed in detail, including quinidine, procainamide, and lignocaine. Their effects on cardiac sodium channels, action potentials, and refractory periods are summarized. Adverse effects and clinical uses are also briefly mentioned for key drugs.
Heart failure is a condition where the heart cannot pump enough blood to meet the body's needs. It affects over 5 million Americans. The prevalence increases with age, reaching nearly 10% in those over 80. Symptoms include fatigue, shortness of breath, swelling, and more. Treatment focuses on reducing cardiac workload through diuretics, beta blockers, ACE inhibitors, and other drugs. Device therapies like CRT can also help certain patients. Lifestyle changes and strict medication adherence are important for managing the condition.
The document discusses the heart and hypertension. It defines normal blood pressure and describes the types and causes of hypertension. Hypertension usually has no symptoms, but can sometimes cause headaches, confusion or vision changes. Untreated hypertension can damage blood vessels and the heart over time, so treatment is important even in asymptomatic cases. Treatment includes diuretics, ACE inhibitors, calcium channel blockers, and other drugs that work to lower blood pressure by various mechanisms.
This document discusses antihypertensive agents used to treat hypertension. It describes different categories of agents including adrenergic agents, ACE inhibitors, angiotensin II receptor blockers, calcium channel blockers, diuretics, and vasodilators. For each category, the document outlines mechanisms of action, examples of medications, therapeutic uses, and potential side effects. It emphasizes the importance of monitoring blood pressure during therapy and avoiding abruptly stopping medications.
Diastolic heart failure occurs when the ventricles become stiff and cannot relax fully during diastole. This prevents full ventricular filling and blood backs up in the organs. Around half of heart failure patients have diastolic heart failure. Diagnosis relies on echocardiogram showing diastolic dysfunction. Treatment focuses on controlling hypertension, volume overload, and other causes through medications like ACE inhibitors, diuretics and beta blockers.
Diastolic heart failure occurs when the ventricles become stiff and cannot relax fully during diastole. This prevents full ventricular filling and blood backs up in the organs. Around half of heart failure patients have diastolic heart failure. Diagnosis relies on echocardiogram showing diastolic dysfunction. Treatment focuses on controlling hypertension, volume overload, and other causes through medications like ACE inhibitors, diuretics and beta blockers.
1) Congestive heart failure results from structural or functional abnormalities that impair the heart's ability to pump or fill with blood adequately.
2) As a result, the heart cannot pump enough blood to meet the body's needs, leading to a buildup of fluid in the lungs or tissues.
3) Treatment focuses on lifestyle modifications, medications such as diuretics, ACE inhibitors, beta blockers, and device-based therapies as needed to manage symptoms and improve outcomes.
1. Heart failure occurs when the heart muscle is unable to pump enough blood to meet the body's needs. Initially, the heart tries to compensate by enlarging, increasing muscle mass, and pumping faster.
2. There are two main types of heart failure - left-sided and right-sided - depending on which side of the heart is unable to function effectively.
3. Pharmacological therapies for heart failure include ACE inhibitors, beta-blockers, diuretics, aldosterone receptor antagonists, and digoxin, which work to reduce symptoms, decrease hospitalizations, and improve survival.
The document discusses congestive right heart failure (RSHF). RSHF occurs when the right side of the heart cannot pump blood to the lungs effectively, usually triggered by left-sided heart failure which stresses the right ventricle. Clinical features of RSHF include jugular vein distension, hepatosplenomegaly, edema, and ascites. Treatment focuses on controlling symptoms, reducing workload on the heart, and improving function through medications, lifestyle changes, and devices.
Congestive heart failure (CHF) is a condition where the heart cannot pump enough blood to meet the body's needs. It can be caused by systolic or diastolic dysfunction. Common symptoms include fatigue, weight gain, cough, and shortness of breath. Treatment includes drugs that increase cardiac contractility, reduce fluid retention, block the renin-angiotensin system, dilate blood vessels, and reduce heart rate. New drugs like ivabradine and sacubitril/valsartan may also help lower hospitalization rates.
sheikh Jeelani sadiq internal disease.pptxPeerzadaUmair
This document provides an overview of left ventricular failure, hypertensive crises, their diagnosis, complications, and emergency care. It begins with definitions and types of left ventricular failure, risk factors, and symptoms. Physical exam findings and diagnostic tests for left ventricular failure are outlined. Differential diagnoses and potential complications are described. Emergency care steps for left ventricular failure are mentioned. Hypertensive crisis is defined and causes, symptoms, diagnostic tests, complications are outlined. The conclusion summarizes that left ventricular failure reduces the heart's ability to pump blood, while hypertensive crisis is very high blood pressure that requires immediate treatment to prevent organ damage.
Heart failure is a complex progressive disorder where the heart is unable to pump sufficient blood to meet the body's metabolic requirements. The main causes include impaired ability of the ventricles to fill and eject blood, abnormal increases in blood volume, and diseases affecting the heart such as coronary artery disease, hypertension, and valvular issues. Treatment strategies aim to increase cardiac output, reduce preload and afterload, and increase contractility through various drug classes including diuretics, ACE inhibitors, beta-blockers, and vasodilators.
The document provides information on the pharmacotherapy of heart failure, including:
- Heart failure results from the heart's inability to pump sufficient blood due to problems with structure or function.
- It discusses the causes, pathophysiology, classification, clinical manifestations, diagnosis, and treatment of heart failure.
- Treatment involves managing symptoms, improving cardiac function, and slowing disease progression through medications, lifestyle changes, and procedures. The goal is to improve quality of life and survival.
Basic understandings in the Heart FailureAryendu kumar
Congestive heart failure occurs when the heart is unable to pump enough blood to meet the body's needs. Common causes include high blood pressure, cardiomyopathy, abnormal heart rhythms, and coronary artery disease. Symptoms include fluid retention leading to peripheral edema and pulmonary edema. Treatment involves reducing preload and afterload on the heart to increase cardiac output and relieve symptoms. Key drug classes used are diuretics, ACE inhibitors, beta blockers, vasodilators, and inotropic drugs. Non-pharmacological treatments include sodium and fluid restriction and exercise. The goal of treatment is management of symptoms and slowing disease progression.
This document provides an overview of chronic heart failure for nursing students. It defines heart failure as the heart's inability to pump enough blood to meet the body's needs. It explains the pathophysiology of heart failure including compensatory mechanisms and the differences between left and right sided heart failure. The document discusses medical treatments to reduce workload on the heart including diuretics, ACE inhibitors, and beta blockers. Nursing diagnoses and interventions for patients with heart failure are also reviewed.
The document summarizes several topics related to pathophysiology:
1. It discusses the structure of the heart and key features like the foramen ovale and ductus arteriosus that normally close after birth.
2. It summarizes the conduction system of the heart and locations like the PMI.
3. Several conditions are summarized like hypertension, heart failure, arrhythmias, and kidney function and disorders. Causes, signs, treatments, and important details are provided for each topic.
This document discusses drugs used to treat congestive heart failure (CHF). CHF occurs when the heart cannot pump enough blood to meet the body's needs. Key drugs mentioned include digitalis glycosides like digoxin, which increase the force of heart contractions; diuretics like furosemide that reduce fluid buildup; ACE inhibitors and ARBs that lower blood pressure and prevent further heart damage; and inotropic drugs like dobutamine that strengthen heart contractions. Adverse effects, mechanisms of action, and guidelines for use are provided for several common CHF medications.
Congestive heart failure in an orthopedic patientIgbinlade Damola
This document discusses heart failure in an orthopedic patient. It begins with definitions and classifications of heart failure, including systolic vs diastolic, left vs right sided, acute vs chronic, and low vs high output failure. It then covers the pathophysiology, risk factors, clinical manifestations, diagnosis, lab findings, and treatment of heart failure, including medication and patient counseling.
The document provides information on congestive cardiac failure (CCF), including:
1. CCF occurs when the heart cannot pump enough blood to meet the body's needs, causing fluid buildup in tissues.
2. Risk factors include age, hypertension, diabetes, smoking, and coronary artery disease. Symptoms include shortness of breath, fatigue, and swelling.
3. Diagnosis involves medical history, physical exam, chest X-ray, echocardiogram and blood tests. Treatment focuses on lifestyle changes, medications, procedures and managing underlying causes.
This document discusses myocardial ischemia and myocardial infarction. It defines myocardial ischemia as a temporary lack of oxygen-rich blood to the heart, while myocardial infarction involves the death of heart muscle cells due to a lack of blood supply. It describes the differences between stable, unstable, and variant types of myocardial infarction. It lists symptoms, risk factors, diagnostic tests, and treatments for myocardial infarction, including medications like beta blockers, calcium channel blockers, and antiplatelet drugs.
The Advanced Cardiovascular Life Support (ACLS) algorithm is a systematic, evidence-based approach designed to guide healthcare providers in the urgent treatment of: Cardiac arrest. Arrhythmias. Stroke. Other life-threatening cardiovascular emergencies.
This document provides an overview of heart failure, including its causes, symptoms, and goals of treatment. It discusses the key physiological compensatory mechanisms in heart failure progression, including increased sympathetic nervous system activity, renin-angiotensin-aldosterone system activation, and myocardial hypertrophy. These compensations initially help the failing heart but ultimately lead to further deterioration. The document outlines pharmacologic interventions for heart failure, focusing on inhibitors of the renin-angiotensin-aldosterone system like angiotensin-converting enzyme inhibitors and angiotensin receptor blockers, which reduce workload on the heart and improve outcomes.
- Video recording of this lecture in English language: https://youtu.be/Pt1nA32sdHQ
- Video recording of this lecture in Arabic language: https://youtu.be/uFdc9F0rlP0
- Link to download the book free: https://nephrotube.blogspot.com/p/nephrotube-nephrology-books.html
- Link to NephroTube website: www.NephroTube.com
- Link to NephroTube social media accounts: https://nephrotube.blogspot.com/p/join-nephrotube-on-social-media.html
Summer is a time for fun in the sun, but the heat and humidity can also wreak havoc on your skin. From itchy rashes to unwanted pigmentation, several skin conditions become more prevalent during these warmer months.
How to Control Your Asthma Tips by gokuldas hospital.Gokuldas Hospital
Respiratory issues like asthma are the most sensitive issue that is affecting millions worldwide. It hampers the daily activities leaving the body tired and breathless.
The key to a good grip on asthma is proper knowledge and management strategies. Understanding the patient-specific symptoms and carving out an effective treatment likewise is the best way to keep asthma under control.
STUDIES IN SUPPORT OF SPECIAL POPULATIONS: GERIATRICS E7shruti jagirdar
Unit 4: MRA 103T Regulatory affairs
This guideline is directed principally toward new Molecular Entities that are
likely to have significant use in the elderly, either because the disease intended
to be treated is characteristically a disease of aging ( e.g., Alzheimer's disease) or
because the population to be treated is known to include substantial numbers of
geriatric patients (e.g., hypertension).
These lecture slides, by Dr Sidra Arshad, offer a simplified look into the mechanisms involved in the regulation of respiration:
Learning objectives:
1. Describe the organisation of respiratory center
2. Describe the nervous control of inspiration and respiratory rhythm
3. Describe the functions of the dorsal and respiratory groups of neurons
4. Describe the influences of the Pneumotaxic and Apneustic centers
5. Explain the role of Hering-Breur inflation reflex in regulation of inspiration
6. Explain the role of central chemoreceptors in regulation of respiration
7. Explain the role of peripheral chemoreceptors in regulation of respiration
8. Explain the regulation of respiration during exercise
9. Integrate the respiratory regulatory mechanisms
10. Describe the Cheyne-Stokes breathing
Study Resources:
1. Chapter 42, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 36, Ganong’s Review of Medical Physiology, 26th edition
3. Chapter 13, Human Physiology by Lauralee Sherwood, 9th edition
Computer in pharmaceutical research and development-Mpharm(Pharmaceutics)MuskanShingari
Statistics- Statistics is the science of collecting, organizing, presenting, analyzing and interpreting numerical data to assist in making more effective decisions.
A statistics is a measure which is used to estimate the population parameter
Parameters-It is used to describe the properties of an entire population.
Examples-Measures of central tendency Dispersion, Variance, Standard Deviation (SD), Absolute Error, Mean Absolute Error (MAE), Eigen Value
Histololgy of Female Reproductive System.pptxAyeshaZaid1
Dive into an in-depth exploration of the histological structure of female reproductive system with this comprehensive lecture. Presented by Dr. Ayesha Irfan, Assistant Professor of Anatomy, this presentation covers the Gross anatomy and functional histology of the female reproductive organs. Ideal for students, educators, and anyone interested in medical science, this lecture provides clear explanations, detailed diagrams, and valuable insights into female reproductive system. Enhance your knowledge and understanding of this essential aspect of human biology.
Nano-gold for Cancer Therapy chemistry investigatory projectSIVAVINAYAKPK
chemistry investigatory project
The development of nanogold-based cancer therapy could revolutionize oncology by providing a more targeted, less invasive treatment option. This project contributes to the growing body of research aimed at harnessing nanotechnology for medical applications, paving the way for future clinical trials and potential commercial applications.
Cancer remains one of the leading causes of death worldwide, prompting the need for innovative treatment methods. Nanotechnology offers promising new approaches, including the use of gold nanoparticles (nanogold) for targeted cancer therapy. Nanogold particles possess unique physical and chemical properties that make them suitable for drug delivery, imaging, and photothermal therapy.
“Psychiatry and the Humanities”: An Innovative Course at the University of Mo...Université de Montréal
“Psychiatry and the Humanities”: An Innovative Course at the University of Montreal Expanding the medical model to embrace the humanities. Link: https://www.psychiatrictimes.com/view/-psychiatry-and-the-humanities-an-innovative-course-at-the-university-of-montreal
Travel vaccination in Manchester offers comprehensive immunization services for individuals planning international trips. Expert healthcare providers administer vaccines tailored to your destination, ensuring you stay protected against various diseases. Conveniently located clinics and flexible appointment options make it easy to get the necessary shots before your journey. Stay healthy and travel with confidence by getting vaccinated in Manchester. Visit us: www.nxhealthcare.co.uk
Giloy in Ayurveda - Classical Categorization and SynonymsPlanet Ayurveda
Giloy, also known as Guduchi or Amrita in classical Ayurvedic texts, is a revered herb renowned for its myriad health benefits. It is categorized as a Rasayana, meaning it has rejuvenating properties that enhance vitality and longevity. Giloy is celebrated for its ability to boost the immune system, detoxify the body, and promote overall wellness. Its anti-inflammatory, antipyretic, and antioxidant properties make it a staple in managing conditions like fever, diabetes, and stress. The versatility and efficacy of Giloy in supporting health naturally highlight its importance in Ayurveda. At Planet Ayurveda, we provide a comprehensive range of health services and 100% herbal supplements that harness the power of natural ingredients like Giloy. Our products are globally available and affordable, ensuring that everyone can benefit from the ancient wisdom of Ayurveda. If you or your loved ones are dealing with health issues, contact Planet Ayurveda at 01725214040 to book an online video consultation with our professional doctors. Let us help you achieve optimal health and wellness naturally.
4. CHF: we will talk about:
Part 1. Clinical Syndromes: Left
ventricle vs Right Ventricular Failure.
Part 2. Diagnostic Syndromes: Systolic
vs. Diastolic Failure.
Part 3. Treatment options.
5. Part 1. There are 3 clinical
“CHF” syndromes:
1. Pure RV failure.
2. Pulmonary edema.
3. Low output failure.
What are the symptoms of
these?
6. What are the symptoms of pure
Right Ventricle failure?
13. (Why does the patient experience
dyspnea?)
Not hypoxia, but interstitial fluid causing
stiff lungs and increased work of
breathing.
Don’t be reassured by a decent O2 sat.
14. So the first distinction is between
pure right ventricular failure and
pure left ventricular failure:
RV failure causes pedal edema.
LV failure causes pulmonary edema.
21. When else do you hear rales?
Rales can be present in other lung
conditions, such as pulmonary fibrosis,
especially if not basilar, or present in
entire respiratory cycle.
23. S3
S3 gallop in adults is considered
pathognomonic for heart failure.
S3 in children and adolescents can be
normal, and does not imply heart
failure.
S4 in elders can be a result of long
standing HTN, and not imply heart
failure.
29. What is the most common cause
of pedal edema?
Venous insufficiency.
30.
31. Another common sign of “CHF”
is the new onset of tachycardia.
Why do you get sinus tachycardia
with CHF?
32. Sinus Tachycardia.
CO = HR x SV. If SV is reduced and
fixed by heart failure, then an increase
in CO will require an increase in HR.
Always suspect HF in a
patient with unexplained
sinus tachycardia.
33. Part 2: the pathology of
“CHF.”
The distinction between systolic
and diastolic dysfunction.
34. Systolic dysfunction
Close to what was originally thought of
as “CHF.”
After infarction, muscle “scar” is
thinner and less contractile. After
several MI s one is left with a large
flabby heart.
Other causes of dilated
cardiomyopathy:
40. Systolic dysfunction in more
detail...
• Diffuse dilation of three (if not all
four) heart chambers.
• Thin ventricular walls, poor global
contractility.
• Chest x-ray with cardiac enlargement,
pear shaped heart: DDx includes
pericardial effusion.
41.
42.
43. Systolic dysfunction
• Most common cause is CAD and
infarctions, with remodeling of the
ventricular wall.
• Cardiomyopathies can also cause
systolic dysfunction CHF.
The heart no longer works well in
systole: it does not contract well.
45. Diastolic dysfunction:
The ventricle “fights” against
hypertension and against increased
afterload by becoming “stronger” and
the heart muscle hypertrophies.
Concentric hypertrophy, directed
inwardly, encroaches on the LV cavity.
Stiff, fibrotic LV muscle does not relax
in diastole, does not fill enough.
Thus, reduced end diastolic volume.
46.
47. Diastolic dysfunction over time:
• Reduced stroke volume, reduced
cardiac output.
• As it progresses, CAD will often
develop and the pathology will overlap
with systolic dysfunction.
48. Diastolic dysfunction:
• Common, especially in elders with long
standing HTN.
Can’t be distinguished on exam from
systolic dysfunction:
Chest film: the heart often looks normal.
need an echo
49. Diastolic dysfunction on echo:
• Contractility is preserved and ejection
fraction is usually normal.
• Concentric hypertrophy on echo.
Inwardly directed ventricular
hypertrophy.
51. A. Fib.
• In the normal heart, left ventricle fills
passively, right after the mitral valve
opens.
• In diastolic dysfunction, the stiff LV
does not relax, fills more slowly.
• Left atrium “tries” to overcome this by
dilating, which increases risk of
developing atrial fibrillation.
52. A. Fib.
• The cardiac output becomes
increasingly “dependent” on this
atrial kick.
• When the atrial kick is lost suddenly
with A. Fib, your patient may rapidly de-
compensate, and develop clinical heart
failure that was masked by the atrial
kick.
53.
54. Summary of diastolic vs systolic
dysfunction.
Diastolic:
Cause: HTN.
Result: thick LV.
Muscle does not
relax.
Failure of diastole.
Systolic:
Cause: MI
Result: thin LV wall.
Muscle does not
contract.
Failure of systole.
56. What is the treatment of
systolic dysfunction?
57. The treatment of systolic
dysfunction?
ACE-I is the drug of choice: Start Rx
early.
58. The treatment of systolic
dysfunction?
ACE-I is the drug of choice: Start Rx
early
Used in the immediate post MI setting,
ACE-I will prevent remodeling and thus
prevent CHF.
May use an ACE-I alone if no signs of
volume overload.
59. The treatment of systolic
dysfunction?
Diuretics only in patients with volume
overload or acute pulmonary edema.
Cautious use of beta-blockers.
(Negative inotrope.)
61. Digoxin can be used as a positive
inotrope.
It also controls ventricular rate in A Fib.
Forth line therapy, after ACE-I, beta-
blockers, diuretics. Never proven to
decrease mortality.
Avoid in patients in sinus with diastolic
dysfunction.
62. What is the prognosis of patients
with systolic dysfunction?
63. Px of patients with systolic
dysfunction
terrible:
“cardiac cancer.”
Progressive deterioration over a few
years, to death.
65. Treatment of diastolic
dysfunction:
• Empiric treatment options only – no
decent data.
• The problem is not a weak pump, but a
stiff, un-relaxing pump.
• Making the heart pump harder will
make things worse: positive inotropic
agents, such as digoxin, are
contraindicated.
68. Treatment of diastolic
dysfunction:
• Nitrates can help, but as in all cases,
need to avoid excess lowering of BP.
• In addition, maintain your patient in
sinus rhythm and keep the atrial kick.
69. What is the prognosis of diastolic
dysfunction?
70. What is the prognosis of diastolic
dysfunction?
can be OK, with treated patients
surviving years.
72. When do you suspect diastolic
dysfunction?
• History of HTN.
Intermittent pulmonary edema.
• Sudden CHF episodes, with little
warning.
“Flash Pulmonary edema.”
73. When do you suspect diastolic
dysfunction?
• Worsening failure despite seemingly
appropriate therapy with dig and
diuretics.
Again, need echo in all new cases of
HF. This is the only way to determine if
dysfunction is diastolic or systolic.
74. Summary of treatment of CHF:
Systolic Failure:
ACE-I
diuretic
Beta-blocker
dig
Diastolic disfunction:
ACE-I
beta-blocker
Ca Ch. Blocker
nitrates.
76. Which ACE-I should be used?
• Look at cost, duration of action,
convenience. Otherwise, fairly
comparable.
• Dosing: usually under used and under
dosed. Aim for maximum dose
tolerated by BP.
79. ARBs
Bradykinins are great for decreasing
blood pressure and preserving renal
function, but also responsible for cough
and angioedema of ACE-I.
No mortality study, and only Losartan
shown to benefit in HF in a drug
company sponsored study.
83. Relative contraindications to
ACE-I: CRI
CRI: with creatinine 1.5-2.5, use with
caution and monitor creatinine.
Avoid with creat > 2.5. Often,
increasing creatinine can be caused by
over diuresis and renal hypo-perfusion.
May try to back off on diuretics first.
84. What about cough with ACE-I?
What is the most common cause of
cough in a patient with CHF on ACE-I?
85. Cough with ACE-I
most common cause of cough in a
patient with HF and ACE-I is
pulmonary edema
86. If ACE-I can not be used?
What can be used instead?
87. If ACE-I can not be used?
• Hydralazine and Nitrates. These have
been shown to decrease mortality, but
less than ACE-I.
• Hydralazine dosed multiple times per
day, can cause head aches,
palpitations, nasal congestion, reflex
tachycardia, tachyphylaxis.
90. Diuretics and CHF:
• Still best for acute symptoms of volume
overload.
• Not to be used alone long term. Can be
counter-productive, in decreasing
volume, renal perfusion, activating RAA,
promoting tachycardia.
91. Diuretics and CHF
• Used alone, they become increasingly
ineffective. Addition of ACE-I can
restore effectiveness.
• Loop diuretics most potent. Double the
dose of Lasix until effective. Single
daily does is best. (Lasix is short acting
[“Lasts Six – hours”] and not great for
BP control, but decent for diuresis.)
92. Diuretics and CHF
• Can often combine types for better
effect.
• Renal function may dictate type:
Creatinine Clearance of > 30 ml/m –
may use thiazides. ClCr of 20-30, may
use Lozol(indapamide) and
Zaroxolyn(metolazone). Lower ClCr
may use loops until you need dialysis.
93. Diuretics and CHF
• Spironolactone 25 mg PO qd has been
shown to reduce mortality (by 27%,
1600 patients, RALES study NEJM,
1999) but best effect in Class III & IV
heart failure. May be useful in other
patients. Again, blocks the aldosterone
of the RAA system. Can’t use if
Creatinine is greater than 2.0.
96. When can one use Dig?
• Systolic dysfunction, as a positive
inotrope.
• Reduce HR in A Fib.
• Forth line therapy, after ACE-I, beta-
blockers, diuretics. Never proven to
decrease mortality.
• Avoid in patients in sinus with diastolic
dysfunction.
98. When to use beta-blockers?
• Best for patients with diastolic
dysfunction, tachycardia. Use full
doses as for HTN.
• Can be used in systolic dysfunction,
with caution. Start low dose, and titrate
slowly, over months. Have been shown
to reduce mortality. Mechanism not
clear, perhaps restoring body’s
sensitivity to catecholamines.
• Don’t start during decompensation.
99. Can we use Calcium Channel
Blockers, and if so, which?
?
100. CCBs in CHF
• Think of CCB as two types:
–1. Verapamil and Diltiazem
–2. everything else…(Nifedipine,
etc…)
101. CCBs in CHF
• Verapamil: most negative inotropic, not
useful in systolic dysfunction, but useful
in diastolic dysfunction.
• Diltiazem. Less negative than
Verapamil, used in the same way.
102. CCBs in CHF: Everything else...
• Dihydropyridines: Nifedipine and all
other CCB. Should not be used with
HF. Can cause vaso-dilation, and reflex
tachycardia. Can cause non-cardiac
edema – complicating evaluation.
• Amlodipine may be different (Norvasc)
but best to group with Nifedipine.
103.
104. Treatment can save lives:
NNT (Number needed to treat)
ACE-I: NNT for 4 years to save one live
is 20.
Spironolactone: in Class IV only, NNT
for 2 years of treatment to save one life
is 9.
Beta-blocker: NNT for 9 months to save
one life is ~30.