Acute and long term management.

1. Heart Failure
DR. TAYYABA FATIMA
HOUSE OFFICER CARDIOLOGY

2. Definition
 It is a clinical syndrome characterized by decreased
myocardial performance leading to over activation
of neuro-endocrine system, hypo perfusion of
peripheral system, systemic and pulmonary
congestion.

3. Pathophysiology

4. Systolic VS Diastolic
 Systolic: inability of ventricles to contract Resulting
in dec. Cardiac output ( IHD, MI, cardiomyopathies)
EF <40%
 Diastolic: inability of ventricles to relax fully to
allow filling Normally causing filling pressure. (
Constrictive Pericarditis, restrictive
cardiomyopathy, Cardiac temponade) EF>50%

5. Left vs right sided
 Clinically left sided is more symptomatic while right sided shows more signs

6. Aggravating Factors
Major
 Ischemia
 Infection
 Arrhythmias
Minor:
 Poor/non compliance with medication
 Poor dietry management
 Uncontrolled hypertension
 Pulmonary embolism

7. Complications
 Renal Failure
 Liver hypoperfusion
 Hypokalemia
 Hyperkalemia

8. Investigations
 CXR
 ECG
 Echocardiography
 RFTs
 Serum Electroytes
 BNP (>500 pg/ml)

9. Management
 Symptomatic relief
1. Diurestics
2. Nebulization
3. Propup position
 Beta blockers if CI then Ivabredine if CI then Digoxin
 ARNIs/ACEi/ARBs if CI then Hydralazine/ Nitrates
 MRAs (spiromide)
 SGLT2 inhibitors (Empagloflozin)

10. Cntd.
 Patient education
 HTN, DM management
 Lifestyle modification
 Salt and water restriction
 Encourage exercise if tolerable