Congestive Heart Failure a killer disease.ppt

Easiest slides about congestive heart failure.

1. Prepared by ASIF AHMAD
Lecturer GOMAL UNIVERSITY
DI KHAN
Congestive Heart Failure

3. •The heart does not pump efficiently. The heart is
not able to move as much blood as it should with
each beat
•Organs in the body do not get enough oxygen rich
blood that they need to work well.

4. CHF can be defined as a physiological state
in which the heart is unable to pump enough
blood to meet the metabolic needs of the
body at rest or during exercise even through
filling pressure are adequate.
Progressive condition
Life threatening

5. •Heart failure generally is referred to as congestive
heart failure (CHF).
•Results from any structural or functional
abnormality that impairs the ability of the ventricle
to eject blood (Systolic Heart Failure) or to fill with
blood (Diastolic Heart Failure)
•Biventricular heart failure

6. CHF occurs when the heart cannot generate
sufficient output to meet the metabolic
demands of the tissue.
In the United state 5million persons are
affected resulting in more than 1 million
hospitalization and 300,000 death each
year.

7. Various studies suggest that 40–60% of
cases of CHF may be due to diastolic
dysfunction.
valve dysfunction (e.g., due to
endocarditis)
occur in normal hearts suddenly burdened
with an abnormal load (e.g., with fluid or
pressure overload).

8. In CHF, the failing heart can no longer efficiently
pump the blood delivered to it by the venous
circulation. The result is an increased end-diastolic
ventricular volume, leading to increased end-
diastolic pressures and, finally, elevated venous
pressures. Thus, inadequate cardiac output—
called forward failure—is almost always
accompanied by increased congestion of the
venous circulation—that is, backward failure.

11. 2 Types of Heart Failure
Systolic Dysfunction( normal stroke volume 50 to
100ml)
(Contraction) Reduced ejection fraction
The heart becomes weak and enlarged and dilated
The weakened heart muscle can’t contract
Not enough blood is pumped from the chambers
Failed to contract efficiently
Less blood is pump out

13. Ejection fraction:
Amount of blood being pump out of the left
ventricle each time it contract.
Shows how the heart is pumping.
Normal EF in between 50% to 70%
Stroke volume/total volume

14. Causes
Coronary Artery Disease
Untreated High Blood Pressure
Faulty Heart Valves
dilated Cardiomyopathy
Lung Disease
Diabetes(can lead to CAD)
Large salt intake
Infections
Arrhythmias
heat valve disease

15. Diastolic Dysfunction
(Relaxation)
♥Chambers don’t fill up so less blood goes to the lungs
and body
♥Stiff heart muscle can’t relax
♥Not enough blood fills the chambers
Less blood to body during contraction

18. Causes
CAD
Hypertension
MI
Cardiomyopathy (hypertrophic)
Cardaic temponade
Myocarditis
Aortic stenosis

19. Clinical Presentation of Heart
Failure
Due to excess fluid accumulation:
Dyspnea (most sensitive symptom)
Edema
Hepatic congestion
Ascites
Orthopnea(shortness of breath), Paroxysmal
Nocturnal Dyspnea (PND)
Due to reduction in cardiac output:
Fatigue (especially with exertion)
Weakness

20. PATHOGENESIS
Decrease cardiac output(forward failure)
decrease cardiac output due to decreased
heart function results in diminished filling of
arterial tree. therefore blood supply of the
organ is reduced which may lead to
ischemia.

21. Damming of blood(backward failure)
Heart become fail to pump the whole blood
coming to it (venous return) resulting in
blood damming back into the venous
system. accumulation of deoxygenated
blood in the tissue venous system may
produce disturbed organ function.

22. The Frank-Starling mechanism
The Frank-Starling Law is the description of
cardiac hemodynamics as it relates to
myocyte stretch and contractility. The
Frank-Starling Law states thatthe stroke
volume of the left ventricle will increase as
the left ventricular volume increases due
to the myocyte stretch causing a more
forceful systolic contraction.

23. Activation of neurohumoral systems:
Release of the neurotransmitter
norepinephrine by the autonomic nervous
system increases heart rate and augments
myocardial contractility and vascular
resistance.

24. Activation of the renin-angiotensin-
aldosterone system spurs water and salt
retention (augmenting circulatory volume)
and increases vascular tone. Release of
atrial natriuretic peptide acts to balance the
renin-angiotensin-aldosterone system
through diuresis and vascular smooth
muscle relaxation.

25. Hypertrophy and dilatation of heart
chambers.
Myocardial hypertrophy develops in response
to pressure overload and there is dilatation
of ventricles as a compensatory mechanism.
According to the frank starling law increase
length of the cardiac muscle fibers increase
their force of contraction.

26. In volume overload states (e.g., valvular
regurgitation or shunts), the new
sarcomeres are added in series with existing
sarcomeres, so that the muscle fiber length
increases. Consequently, the ventricle tends
to dilate, and the resulting wall thickness
can be increased, normal, or decreased;
thus, heart weight—rather than wall
thickness—is the best measure of
hypertrophy in volume-overloaded hearts.

27. Left sided heart failure
Left sided heart failure is characterized by reduction
in effective left ventricular output for a given
pulmonary venous or left atrial pressure.
An acute increase in left atrial pressure may cause
pulmonary congestion or pulmonary edema.
In chronic left ventricular failure decreased cardiac
output results in decreased tissue perfusion.
Decrease renal blood flow stimulates renin
angiotensin system and aldosterone formation
which causes sodium and water retention from
kidney. This sodium and water

28. retention increase blood volume, therefore
increasing venous return to already weak
heart resulting in congestion of lungs.
causes
Ischemic Heart Disease( Commonest)
Systemic Hypertension
Mitral And Aortic Valve Diseases
Cardiomyopathies

29. Symptoms
Dyspnea
Dyspnea on exertion
Orthopnea
Dyspnea on lying position is called orthopnea. It result
from increased amount of venous return to thorax
from lower extremities when patient is in lying
position. Heart is unable to pump all of this venous
return that leads to lung congestion and dyspnea

30. Paroxysmal Nocturnal Dyspnea
dyspnea during sleep which awakens the patient with
severe breathlessness, accompanied by a choking
sensation and coughing is called paroxysmal nocturnal
dyspnea. It also result from increased venous congestion
as the patient is lying on bed.

31. SIGN
Tachycardia
Cardiomegaly
Chronic dilation of left atrium may also occur which may
be associated with atrial fibrillation.

32. Right sided heart failure
Right heart failure usually is the consequence of left-
sided heart failure, since any pressure increase in the
pulmonary circulation inevitably produces an
increased burden on the right side of the heart.
Isolated right-sided heart failure also can occur in a
few diseases. The most common of these is severe
pulmonary hypertension, resulting in right-sided
heart pathology termed corpulmonale. In cor-
pulmonale, myocardial hypertrophy and dilation
generally are confined to the right ventricle and
atrium, although bulging of

33. the ventricular septum to the left can cause left
ventricular
dysfunction. Isolated right-sided failure also can occur in
patients with primary pulmonic or tricuspid valve
disease,
or congenital heart disease, such as with left-to-right
shunts
causing chronic volume and pressure overloads.

34. Cardiac tamponed.
Acute right ventricular failure occur when fluid
accumulated in pericardial cavity that interferes the
right ventricular diastolic filling , resulting in decreased
right ventricular output, the condition is called cardiac
tamponed.

35. Chronic right ventricular failure.
chronic right ventricular failure most commonly
occurs secondary to left ventricular failure and is
manifested clinically by systemic venous
congestion such as.
liver is enlarged and tender. enlargement due to
congestion and tenderness due to stretching of
liver capsule.
peripheral edema. occurring in dependent area the
ankles in ambulatory pts, pleural effusion and
pericardial effusion or ascites.

36. clinical feature
Elevated jugular venous pressure( DNV)
Lower extremity edema
Ascites
Hepatomegaly
Splenomegaly
Sudden death
Edema in dependent parts

37. r
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