Congestive heart failure

Clinical Pharmacy. An over view on Congestive heart failure....

1. CONGESTIVE HEART FAILURE Presented by Imran Ahammad Chowdhury

2. CONGESTIVE HEART FAILURE It is a situation or condition of the heart when heart fails to provide sufficient cardiac output so that there will be inadequate blood supply and oxygen supply throughout the body.In CHF cardiac muscle fails to contract sufficiently.

3. CARDIAC OUTPUT The cardiac output is the amount of blood ejected from each ventricle every minute.The amount expelled by each contraction is the stroke volume. C ardiac output is expressed in litre per minute(l/min)and is calculated by multiplying the stroke volume by the heart rate(masured in beats per minute). CARDIAC OUTPUT=STROKE VOLUME * HEART RATE In a healthy adult at rest the stroke volume is approximately 70ml and if the heart rate is 72 per minute,the cardiac output is 5l/minute.

4. RISK FACTOR OF CHF Major factors; Hyperlipidemia;mainly cholesterol and cholesterol esters. Hypertension Cigarette smoking DM Minor factors; Obesity Sedentary life style

5. Male sex Increasing age Family history Stress Oral contraceptive pill High CHO intake

6. PATHOPHYSIOLOGY OF CHF Heart failure decrease C.O. decrease B.P decrease GFR

7. increase Renin release ANG -2 formation direct vasoconstriction increase After load..

8. ADH secretion increase contractility. ADH secretion causes salt & water retention;which increase pre load..

9. DIAGNOSIS OF CHF Chest X-ray ;this is very helpful in identifying the buildup of fluid in the lungs.the heart is usually enlarges in CHF,this may be visible in X-ray film. Electrocardiogram(ECG); It is a painless test that measures the electrical activity of the heart(rhythm). Blood test; Low blood cell counts may cause symptoms much like CHF

10. MRI(Magnetic resonance imaging); It is used to provide images of the heart and its ability to pump bloob to the body. Cardiac catheterization(cath); In this case a small tube is inserted into and artery in the leg or arm.The catheter is moved to the heart to measure pressures inside the heart and to put contrast into the coronary arteries to look for blockages.

11. DRUGS USED IN CHF Drugs that decrease preload DIURETICS; Frusemide NITRATE; Isosorbide mono nitrate Drugs that decrease afterload VASODIALATORS; Hydralazine,Nitroprusside Drugs that decrease both preload & afterload ACE inhibitors; Captopril,Lisinopril

12. Drugs that increase contractility( CARDIOTONICS ) CARDIAC GLYCOSIDE; Digoxin,Digitoxin BETA AGONIST; Dopamine,Isoprenaline PDE inhibitors(Phosphodiesterase enzyme); Amrinone,Milrinone

13. AIM OF DRUGS The ultimate aim of drug is to increase force of contraction Increase stroke volume Increase cardiac output(C.O.) If C.O is increased, Cardiomegaly will be corrected Tachycardia will be corrected Oedema will be corrected Dyspnoea will be corrected

14. DIURETICS & NITRATES MECHANISM OF ACTION: DIURETICS salt &water loss decrease blood volume decrease venous filling pressure decrease heart wall stretch

15. NITRATES Dilates venous capacitance Increase venous vascular bed decrease vascular return Decrease preload

16. CARDIOTONIC DRUGS Cardiotonic drugs are the drugs which increase the force of contraction of failing heart,either normal or decrease heart rate and maintain effective circulation. Example:Digoxine,Dopamine,Atropine,Theophyline. Some new cardiotonics are ;Nicorandil(potassium channel activator),Xamoterol(Inotropic drug),Pimobendan(Calcium channel sensitizer)

17. CARDIAC GLYCOSIDE DIGOXIN Binds with Na+ - K+ ATPase (-)Na+ - Ca++ exchange intracellular Na+ conc. influx of Ca++ increase intracellular Ca++ conc.

18. Excitation contraction coupling (+)ve inotropic action increase myocardial contractility complete systolic emptying of ventricle decrease heart size reliefs oedema & improve cardiac function.

19. Cardiotonics also decrease K+ conc. Which results decrease H.R..

20. ACE inhibitors Ang -1 Captopril (-) No Ang -2 (-) direct vasocostriction (-) aldosterone sec. Arteriole & vasodilatio No salt & water retention Decrease after & preload.(-) formation of edema

21. Vasodilators HYDRALAZINE Dilates arterioles directly decrease total pheripheral resistant decrease blood pressure..

22. THE END