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Heart Failure
Heart Failure
 It is the pethophysiological process in
which the heart as a pump is unable to
meet the metabolic requirement of
tissues for oxygen
End result is fluid retention
C.O.
Activation of
SNS
HR
Renal blood
flow
Renin angiotensin system activation
V.C.
Salt & water
retention
V.C.
CAUSES
1. Vascular
2. Valvular
3. Cardiomyopathy
4. Congenital heart disease
5. Hypertension
6. Cardiac arrhythmia
7. Infective
8. Infiltrative disease of heart
Precipitating factors
1. Increase demand
 Anaemia
 Fever
 Infection
 Salt intake
 Thyrotoxicosis
 Pregnancy
2. Arrhythmia
3. Alcohol Ingestion
4. Thiamine Deficiency
5. Uncontrolled HTN
6. Drugs
 Beta adrenergic blockers
 Salt retaining drugs e.g. steroids, NSAIDS
Classifying Heart Failure
1. RHF v/s LHF
2. Low output v/s High output
3. Acute v/s Chronic
4. Systolic v/s Diastolic
5. Forward v/s Backward
Pathophysiology
Left heart failure
failure of forward flow from LV into the aorta leads
to LV pressure . This pressure is transmitted
to LA/ P. vein.
pressure in pulmonary capillaries
Exudation of fluid in alveolar air
sac
dyspnoea In sufficient blood pumped
into aorta leads to
hypotension & poor
perfusion & oxygenation
Pathophysiology
Right heart
failure Pressure in
RV
Pressure in RA
SVC & IVC
JVP & Congestive symptoms
1. Dyspnoea
2. PND
3. Swelling over dependent part
4. Fatigue & Weakness
5. Anorexia & Nausea
6. Cerebral symptoms
7. Chyne stokes respiration
CLINICAL FEATURES
SIGNS
Tachycardia
JVP
Increased
SIGNS
SIGNS
Edema
Crepitation in chest
SIGNS
SIGNS
 Cardiac
 3rd heart sound may be audible
 Abdomen
 Liver is enlarged & tender
Laboratory Investigation
Normal Pulmonary
edema
Chest X-ray
Laboratory Investigation
ECG
Echocardiography
Laboratory Investigation
Treatment
1. Removal of precipitating causes
2. Correction of underlying cause
 Surgical correction
 CABG
3. Control of congestive heart failure states
 Restriction of Physical Activity
 Diet
 Pharmaco therapy
Treatment
 Pharmaco therapy
 Diuretics
 ACE inhibitors
 Beta blockers
 Inotropic drugs
 vasodilators
Thank you

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