CONGESTIVE CARDIAC FAILURE

CCF, DEFINITION, CLASSIFICATION, MGT.

1. Presented by; Aiswarya.A.T, First year M.Pharm., Dept. of Pharmacy Practice, Grace college of pharmacy .

2. Heart failure is a clinical syndrome in which an abnormality of cardiac structure or function is responsible for the inability of heart to eject or fill with blood at a rate commensurate with the requirements of the metabolizing tissues.

3. CLASSIFICATION Left ventricular dysfunction Right ventricular dysfunction Biventricular HF Left ventricular systolic dysfunction Left ventricular diastolic dysfunction Ischaemic HF Non- ischaemic HF Acute HF Chronic HF Low output HF High output HF Forward HF Backward HF Compensated HF

4. Cardiac failure is a common condition with a prevalence ranging from 3-5% in the population over 65 years old & between 8-16% of those aged over 75years. It is the leading cause for hospitalization in people older than 65. In developed countries, the mean age of patients with heart failure is 75years old. Heart failure is more common in men than in women until age 65 years, reflecting the greater incidence of coronary artery disease in men. Im proved survival of patients after myocardial infarction is a likely contributor to the increased incidence and prevalence of heart failure. EPIDEMIOLOGY

5. Infection Arrhythmias Physical , Dietary, Fluid, Environmental & Emotional Excesses Myocardial Infarction Pulmonary Embolism Anemia Thyrotoxicosis & Pregnancy Aggravation of Hypertension Rheumatic , Viral & Other Forms of Myocarditis Infective Endocarditis AETIOLOGY

6. ETIOPATHOGENESIs ADAPTIVE AND MALADAPTIVE MECHANISMS 1. The Frank-Starling mechanism 2. Compensatory hypertrophy 3. In ventricular remodeling 4.Redistribution of a subnormal cardiac REDUCTION IN CARDIAC EFFICIENCY ALTERATIONS IN ENERGY METABOLISM ALTERATIONS IN SARCOMERIC PROTEINS MYOCARDIAL CELL DEATH ABNORMALITIES OF EXCITATION-CONTRACTION COUPLING

7. Loss of contractile function due to ; Pressure overload of the heart Work overload of the heart Loss of myocardium Generalized decrease in contractility Impaired cardiac function (congestive signs & symptoms) Compensatory mechanisms: Cardiac compensatory mechanism Ventricular dilation Ventricular hypertrophy Peripheral compensatory mechanism Increased sympathetic activity Activation of RAAS Increased afterload Increased blood volume Receptor changes PATHOPHYSIOLOGY

8. CLINICAL MANIFESTATIONS Signs ■ Pulmonary rales ■ Pulmonary edema ■ Cool extremities ■ Pleural effusion ■ Tachycardia ■ Narrow pulse pressure ■ Cardiomegaly ■ Peripheral edema ■ Jugular venous distension ■ Hepatojugular reflux ■ Hepatomegaly Symptoms ■ Dyspnea , particularly on exertion ■ Orthopnea ■ Paroxysmal nocturnal dyspnea ■ Exercise intolerance ■ Tachypnea ■ Cough ■ Fatigue ■ Nocturia ■ Hemoptysis ■ Abdominal pain ■ Anorexia ■ Nausea ■ Bloating ■ Poor appetite, early satiety ■ Ascites ■ Mental status changes

9. DIAGNOSIS IMAGING Echocardiography Chest X-rays/ Chest Radiograph ELECTROPHYSIOLOGY Electrocardiogram (ECG/ EKG) BLOOD TESTS ANGIOGRAPHY MONITORING

10. MANAGEMENT NON PHARMACOLOGICAL MANAGEMENT Bed rest Consuming small but frequent meals (4 to 6 daily) Moderate sodium restriction (2 to 4g / day) Smoking cessation Avoid alcohol intake

11. PHARMACOLOGICAL MANAGEMENT ACE’s Captopril , Enalapril , Lisinopril , Perindopril , Ramipril , Trandolapril ARB’s Candesartencilexetil , Eprosartan , Irbesartan , Losartan , Olmesartan , Telmisartan , Valsartan Beta adrenergic blocking agents Bisoprolol , Metoprolol , Carvedilol Diuretics Thiazide - Chlorothiazide , Hydrochlorothiazide, Indapamide , Chlorthalidone Loop diuretics - Furosemide , Ethacrynic acid, Bumetanide , Torsemide Potassium sparing diuretics - Amiloride , Spironolactone , Triamterene Aldosterone antagonists Spironolactone , Eplerenone Vasodilators Nitroprusside , Hydralazine , Prazosin , Nitrates Digitalis glycosides Digitalis ( Digoxin ) Calcium channel blockers Inotropic agents Dopamine i.v , Dobutamine , Inamrinone , Milrinone , Nesiritide

12. THANK YOU..!