ass

2. Objectives
At the end of the presentation students should will be able to:
Describe CHF
Identify etiologies of CHF
 Identify types of CHF
 Describe pathophysiology of CHF
 clinical manifestations of CHF
 Explain diagnostic methods of CHF
Explain management of CHF
 Describe complication

3. What is congestive heart failure?
• congestive Heart failure means that your heart can't pump
enough oxygen-rich blood to meet your body's needs.
• Heart failure doesn't mean that your heart has stopped or is
about to stop beating.
• But without enough blood flow, your organs may not work well,
which can cause serious problems.

4. Heart failure…
Incidence
The incidence of HF increases with age.
Nearly 5 million people in the US have HF, with more than one-
half million new cases diagnosed each year.
High prevalence in blacks
Most common reason for hospitalization of older people.

5. Risk factors

6. Common causes of CHF
CAD
Cardiomyopathy
Systemic or pulmonary hypertension
Valvular heart disease
ed CO (anemia, hypoxia)
Rheumatic heart disease
Congenital heart disease

7. II. Precipitating (secondary) causes.
H = Hypertension
E = Infective Endocarditis
A = Anemia
R = Rheumatic –fever (Recurrence)
T = Thyrotoxicosis
F = Fetus (pregnancy)
A = Arrhythmias
I = Infections
L = Lung problems (pathologies)
S = Stress, salts, etc.

8. Classification of HF
Systolic Vs Diastolic dysfunction
 Systolic Dysfunction: the ventricle is unable to contract forcefully
enough during systole
 Diastolic dysfunction: the left ventricle is unable to relax adequately
during diastole
Based on the side of the heart involved
 left heart failure
 right heart failure

9. Left heart failure
LHF results from LV dysfunction,
 Increased Pulmonary pressure
Fluid extravagation from the pulmonary capillary bed into the
interstitial spaces & then to the alveoli
Pulmonary congestion & Edema

10. Pathophysiology of Left sided HF
 LV dysfunction, causes blood to back up in the left atrium and
pulmonary veins
 The increased left ventricular end-diastolic blood volume increases
the left ventricular end-diastolic pressure
 Decreases blood flow from the left atrium into the left ventricle
during diastole
 The blood volume and pressure in the left atrium increases,

11. Pathophysiology…
Decreases blood flow from the pulmonary vessels
Pulmonary venous blood volume and pressure rise, forcing
fluid from the pulmonary capillaries into the pulmonary tissues
and alveoli,
Impairment of gas ex-change.
Backward failure

12. Or Pathophysiology…
The decrease in SV stimulation of the sympathetic nervous system
impedes perfusion to many organs.
Blood flow to the kidneys decreases reduced urine output
(oliguria).
Renal perfusion pressure falls release of renin aldosterone
secretion Sodium and fluid retention increases intravascular
volume.

13. II. Right sided failure (cor pulmonale)
 RHF results from a diseased RV that causes back ward flow of
blood to the RA and venous circulation.
Causes
Left ventricular failure (the usual cause)
CAD e.g. RV MI
Pulmonary hypertension

14. Pathophysiology
RV failure

Inability of RV to empty completely

Increased volume & pressure in the
systemic veins

Systemic venous congestion

15. Functional Classification of NYHA

18. Compensatory Physiological Mechanisms in HF
1. Increased sympathetic activity( Baroreceptors)
↑HR and ↑ force of contraction
Vasoconstriction → ↑venous return and preload → ↑stroke volume →↑ CO
2. Activation of the renin- angiotensin- aldosterone system
↓ CO → ↓ renal blood flow → ↑ renin-angiotensin-aldosterone system →
↑ PVR ( afterload) & blood volume
3. Myocardial hypertrophy
↑ The heart size, stretching of muscles and chambers dilates

19. Clinical Manifestations

20. Clinical manifestation LHF cont’d…

21. Clinical manifestation of Right sided HF

23. Diagnosis
History
Physical Examination
Lab tests
ECG
Chest X-ray
Pulse oximetry
Cardiac catheterization

24. Diagnostic procedures
Cardiac enzymes
• markers for cardiac ischemia or injury should also be drawn and
analyzed
BNP ( b type natriuretic peptide )
Biomarker released by ventricle when there is excessive pressure on
heart due to heart failure
- < 100 no heart failure
- 100 -300 present
- > 300 mild
- > 600 Moderate
- > 900 sever

25. Chest X-ray
• Cardiomegaly
• Bilateral pleural effusions can be viewed by X-ray
Echocardiography (ECHO) – used to Identify the regional wall motion
abnormalities that are associated with congestive heart failure.
Electrocardiogram (ECG) – This is a non-specific test that may be useful
in diagnosing cardiac ischemia

26. Management of Congestive heart Failure
Bed rest
 Fluid restriction
Moderate sodium restriction (2-3g/day)
Smoking cessation
 Daily weight
Avoid alcohol intake

27. PHARMACOLOGICAL MANAGEMENT
ACE inhibitor ( Angiotensin – converting enzymes )
 First line treatment prescribed with beta blockers
 Blocks conversion of Angiotensin l to ll ( vasodilator , ↓ Bp , kidney excreta
Na+
 end in ‘ pril ‘ Lisinopril
 Side effect is ↑ k+ , Dry nagging cough
2, ARBs ( Angiotensin ll receptor blockers
 used in place of ACE inhibitor
 end in ‘ sartan’ Losartan
 Have same effect as ACE inhibitor

28. Diuretics ( Loop or potassium – sparing )
 Used in combination with ACE or ARBs
 ↓ H2O + Na+ retention(↓ edema )
 E.g Lasix
 Side effect – urinate a lot
4, Beta Blockers block Norepinephrine effect on the heart muscle
Negative inotropic effect ↓ myocardial contraction
End in ‘’ lol ‘’ - Metoprolol
Side effect is Bradycardia

29. 5, Diagoxin
• Which belongs to a class of drugs called cardiac glycosides
• Positive inotropic ; ↑ increasing the strength and efficiency of the heart
muscle
• Negative chronotropic that cause HR to be at slower
• Normal diagoxin range 0.5 to 2 mg /ml
• Some common side effect of digoxin include Nausea , vomiting and visual
disturbance
• In case of overdose, digoxin toxicity can occur, leading to more symptoms
such as confusion, hallucination, and abnormal heart rhythms.
• Check apical pulse before giving > 60

30. Complications
Complications of CHF include:
• Reduced quality of life
• Arrhythmia and sudden cardiac death
• Cardiac cachexia
• Cardiorenal disease
• Liver dysfunction
• Recurrent hospitalizations and nosocomial infection