Congestive cardiac failure

Heart failure is an imprecise term used to describe the state that developes when the heart cannot maintain an adequate cardiac output or can do so only at the expense of and elevated filling pressure.

OR

Heart failure is a complex clinical syndrome that can result from any structural or functional cardiac disorder that impairs the ability of the ventricle to fill with or eject blood. Congestive Heart Failure describes a condition where the heart muscle is weakened and cannot pump as strongly as before.

1. Congestive Cardiac failure Presented by: Anand Vaghasiya Guided By: Dr. Darshna Nariya

2. What will be covered inside Definition Pathophysiology Types of cardiac Failure Clinical features Complications Medical Investigation Medical Management/Treatment

3. Definition Heart failure is an imprecise term used to describe the state that developes when the heart cannot maintain an adequate cardiac output or can do so only at the expense of and elevated filling pressure. OR Heart failure is a complex clinical syndrome that can result from any structural or functional cardiac disorder that impairs the ability of the ventricle to fill with or eject blood. Congestive Heart Failure describes a condition where the heart muscle is weakened and cannot pump as strongly as before.

4. Pathophysiology In order to maintain normal cardiac output, several compensatory mechanisms play a role as under: Compensatory enlargement in the form of cardiac hypertrophy, cardiac dilatation, or both. Tachycardia due to activation of neurohumoral system. e.g. release of norepinephrine and atrial natrouretic peptide, activation of renin-angiotensin aldosterone mechanism. It is associated with Nuerohormonal changes including renin angiotensin aldosterone Axis. impaired renal perfusion and diuretic therapy leade to release of more renin in afterload, preload and myocardial infarction.

5. Types of Heart Failure  Acute Or chronic Left, Right or Biventricular HF forward and backward HF Diastolic Systolic HF High OutputHF Low Output HF

6. Low-Output Heart Failure Systolic Heart Failure: decreased cardiac output Decreased Left ventricular ejection fraction Diastolic Heart Failure: Elevated Left and Right ventricular end-diastolic pressures

7.  High-Output Heart Failure Seen with peripheral shunting, low-systemic vascular resistance, hyperthryoidism , beri-beri , carcinoid, anemia Often have normal cardiac output Biventricular Heart Failure Dilated cardiomyopathy, ischemic heart disease

8. Right-Ventricular Failure Reduction in Right ventricular Output reason can be Chronic lung disease, multiple pulmonary emboli, and pulmonary valvular stenosis Left-Ventricular Failure Reduction in left ventricular output and/or an increase in the left atrial or pulmonary venous pressure.

9. Clinical feature of heart failure

10. Clinical Features Left Sided Heart Failure: 1 ) Pulmonary Edema a ) Dyspnea (SOB ) b) Orthopnea c)Paroxysmal Nocturnal Dyspnea 2) Decreased forward Perfusion Activated Renin Angiotensin Aldosterone System, which cause fluid retention and worsenen CHF.

11. Clinical Features Right Sided Heart Failure: Most common cause of cause of Right Heart Failure is Left side Heart Failure . a ) Dyspnea b)Jugular Venous Distention c)Pitting Edema d) Ascitis e)Nutmeg Liver “Hepatomegaly”

12. Risk Factors

13. Investigations BNP >100pg/mL Electrocardiogram may be normal or it could show numerous abnormalities including acute ST-T–wave changes from myocardial ischemia, atrial fibrillation, bradycardia, left ventricular hypertrophy Serum creatinine may be increased because of hypoperfusion . Pre existing renal dysfunction can contribute to volume overload. Complete blood count useful to determine if heart failure is a result of reduced oxygen-carrying capacity   Chest radiography is useful for detection of cardiac enlargement, pulmonary edema , and pleural effusions Echocardiogram assesses left ventricle size, valve function, pericardial effusion, and ejection fraction Hyponatremia , serum sodium <130mEq/L, is associated with reduced survival and may indicate worsening volume overload and/or disease progression

14. Complication Uraemia Hypokalaemia Hyponatraemia: feature of Severe HF, due to extreme diuretic therapy, inappropriate water retention, and failure of ion pump in cell membrane impaired liver function: mild jaundice Thrmboembolism Arrhytmias : atrial and ventrical are common and may be related to electrolyte changes

15. Management of HF Non Pahrmacological therapy Palliative care and end-of-life care Modification of lifestyle Learning and reeducation to avoid factors such as smoking, obesity and sedentary lifestyle learn to copup with sign and symptoms with right precautions and care

16. Surgery Heart transplantation Coronary bypass surgery. Heart valve repair or replacement. Implantable cardioverter-defibrillators (ICDs). Cardiac resynchronization therapy (CRT), or biventricular pacing. Ventricular assist devices (VADs).

17. Drug Therapy/ Medication: Angiotensin-converting enzyme (ACE) inhibitors. Angiotensin II receptor blockers. Beta blockers.  Diuretics. Aldosterone antagonists. Inotropes. Digoxin ( Lanoxin ).

18. Thank you !