CONGESTIVE HEART FAILURE - AS PER 2ND SEMESTER BPHARM SYLLABUS

Pathophysiology of congestive cardiac failure in brief.

1. CONGESTIVE HEART FAILURE Ms. FATHIMATH RAIHANA ASSISTANT PROFESSOR PA COLLEGE OF PHARMACY

2. Congestive heart failure is a long-term condition in which your heart cannot pump blood well enough to give your body a normal supply. It is unable to maintain an adequate circulation for the metabolic needs of the tissues of the body. So blood and body fluids accumulate in your lungs and legs over time.

3. TYPES : Acute and Chronic Heart F ailure Left-sided and Right-sided Heart Failure Backward and Forward Heart Failure Acute and chronic : Depends on whether the heart failure occurs rapidly or slowly. Acute heart failure : Sudden and rapid development due to following : Larger myocardial infarction Valve rupture Cardiac tamponade Pulmonary embolism, etc..

4. b. Chronic : Heart failure occurs slowly. May be due to : Myocardial ischaemia Mitral or aortic valve disease Ischaemic Heart Disease 2. Left-sided and Right sided Heart Failure: Heart fails as a whole but functionally the left and right heart act as independent units. a. Left- sided heart failure : May result from decreased ventricular output thereby accumulation of fluid upstream in the lungs. May be due to : Systemic hypertension Stenosis Ischaemic heart disease, etc ….

5. b. Right- sided heart failure : Upstream of the right heart such as systemic and portal venous congestion and reduced cardiac output. May result from : Ventricular failure Valvular disease Pulmonary hypertension, etc.. 3. Backward and Forward Heart Failure: Backward heart failure : Either of the ventricles fail to eject blood normally. This results in increase in pressure and volume to the atrium thereby transmitted backward producing elevated pressure in veins.

6. b. Forward Heart Failure : Failure of the heart to pump blood C ausing decrease in flow of blood to the tissues.

7. ETIOLOGY : Intrinsic pump failure : This is due to the weakening of the ventricular muscle due to any disease so that heart fails to pump blood to meet tissue needs. Ischaemic heart disease Myocarditis Abnormal heart rhythm Anaemia

8. ii. Increased workload on the heart : Increased mechanical load on the heart results in increased myocardial demand , that may lead to myocardial failure. a. Increased pressure load : Hypertension Valvular disease like stenosis Chronic lung disease b. Increased volume load : Anaemia Hypoxia due to lung diseases Thyrotoxicosis

9. iii. Impaired filling of Cardiac chambers : May be due to constrictive pericarditis or cardiac tamponade ( compression of heart by accumulation of fluid in the pericardial sac ). iv. Congenital heart disease : heart issue present at birth. v. Kidney disease vi. Tobacco, alcohol, smoking.

10. RISK FACTORS : Hypotension Fluid retention or edema Bradycardia and heart block Lifestyle Age (being older than 65 )

11. PATHOPHYSIOLOGY : Hypertension Increase afterload Coronary artery disease Obstruction of blood pump Decrease stroke volume Decrease cardiac output Increase heart rate Increase cardiac workload CHF Decrease in atrial pressure Kidney low blood – release Renin Angiotensin system Aldosterone Na + & water retention Increase in blood volume Increase Preload (volume of blood that enters left ventricles ) Increase cardiac workload Decreased force of contraction Structural changes to stroke volume Dilated cardiomyopathy Hypertrophic cardiomyopathy (pressure in the left ventricle ) (amount of blood pumped ) (volume of blood pumped )

12. SIGNS AND SYMPTOMS : F atigue A ctivity decrease C ough E dema S hortness of breath

13. COMPLICATIONS: Heart : SA and AV node suppression AV block Atrial arrhythmia Ventricular arrhythmia Hypotension GI : Vomiting Diarrhoea Abdominal pain Constipation Neuralgic : Headache Insomnia Vertigo Fatigue Visual : Colour vision ( green / yellow ) Miscellaneous : Allergy Necrosis Thrombocytopenia

14. DIAGNOSIS : Elecrocardiogram Chest X-ray Echocardiography Heart catheterization Stress test Blood test Heart MRI Cardiac computed tomography Genetic testing MultiGated Acquisition Scan (MUGA Scan )

15. TREATMENT : NON-PHARMACOLOGICAL TREATMENT : Lifestyle changes Physical activity Catheter ablations Resynchronization therapy / Physiological pacing Cardiac contractility modulation Sodium restriction Oxygen therapy

16. PHARMACOLOGICAL TREATMENT : Diuretics : Furosemide, torsemide , spironolactone Vasodilators : Enalapril , Ramipril, losartan, telmisartan Beta- blockers : Bisoprolol , Metoprolol Cardiac glycosides : Digoxin