1.
Congestive Heart Failure
Dr. Noura Noreddin

2.
Definition:
The heart fail to maintain body needs

3.
Causes of heart failure:
•Congenital heart disease at infancy
•Viral myocarditis at any age
•Rheumatic heart disease
•Dilated cardiomyopathy
•Cor-pulmonale
•Fluid overload
•Hypertension
•Arrhythmia
•Metabolic
•Anemia
•SAM
•SBE
•HIE

4.
Causes of heart failure:
HEART MAY DIE
 Hypertension
 Embolism
 Anemia
 Rheumatic
 Thyrotoxicosis
 Myocardial infarction
 Arrhythmia
 Y
 Diet& lifestyle
 Infection/ Ischemia
 Endocarditis

5.
Causes of heart failure:
FAILURE
 Forgot medications
 Anemia/Arrhythmia/Anomalies
 Infection/Infarction/Ischemia
 Lifestyle
 Up regulation
 Rheumatic/Renal failure
 Embolism/Endocarditis

6.
Clinical picture of CHF:
•Tachypnea
•Tachycardia
•Tender hepatomegaly
•Cardiomegaly in Chest-X-ray

7.
Types of CHF:
Acute& chronic
Left side& right side

8.
Right side heart failure:
Raised JVP
Hepatomegaly
Lower limb edema
Left side heart failure:
Orthopnea
Shortness of breath
Paroxysmal nocturnal dyspnea

9.
CHF signs& symptoms:
Left side FORCED Right side BACONED
Fatigue Bloating
Orthopnea Anorexia
Restless/Rales Cool legs
Confusion/Cyanosis Oliguria
Extreme weakness Nausea
Dyspnea Edema (bipedal)
Distended neck veins

10.
CHF signs& symptoms:
Left side FORCED Right side AW HEAD
Fatigue Anorexia
Orthopnea Weight gain
Restless/Rales Hepatomegaly
Confusion/Cyanosis Edema (bipedal)
Extreme weakness Ascites
Dyspnea Distended neck veins

11.
Investigations:
CXR: cardiomegaly
ECG: arrhythmia
Echo: CHD, RHD, SBE, CMP
CBC, S.E, KFT, LFT, CPK, LDH& Digoxin level

12.
Stages of heart failure
1 Cardiac disease but no symptoms
No limitation in ordinary activity
2 Mild symptoms
Slight limitation of ordinary activity
3 Symptoms disappear at rest
Significant limitation of activity
4 Symptoms even at rest
Severe limitation of daily activity

13.
Daily living activities:
ADL assessment
BATTED
 Bathing
 Ambulation
 Transfers
 Toileting
 Eating
 Dressing

14.
Stages of heart failure in CXR
1
Redistribution
Cardiomegaly
Broad vascular pedicle
2
Interstitial edema
Kerley lines
Peribronchial cuffing
Hazy vessels contour
Thickened interlobar fissure
3
Alveolar edema
Consolidation
Air bronchogram
Cottonwood appearance
Pleural effusion

15.
Stages of heart failure in CXR
A B C D E
A Alveolar edema
B Kerley B lines
C Cardiomegaly
D Dilated upper lobe BV
E Effusion (pleural)

16.
Supportive treatment:
 Oxygen
 Salt restriction
 Fluid restriction
 Semi-sitting position
Management:

17.
Specific treatment:
 Detect the cause
 Diuretics
 Digoxin
 Dilator
Management:

18.
Management:
UNLOAD FAST
 Upright position
 Nitrates
 Lasix
 Oxygen
 ACE inhibitor
 Digoxin
 Fluid 
 Afterload 
 Sodium 
 Test digoxin level

19.
Management of CHF+Pulmonary edema:
MAD DOG
 Morphine
 Aminophyline
 Dopamine
 Diuretics
 Oxygen
 Gases ABG

20.
Management of CHF+ Pulmonary edema:
DOLMA
Dopamine
Oxygen
Lasix
Morphine
Aminophylline

21.
Thank you