Congestive Heart Failure- Part I

Pharmacology: Electrophysiology of heart

1. ELECTROPHYSIOLOGY OF HEART AND CARDIAC GLYCOSIDES

2. Impulse generation Non automatic fibres Automatic fibres : SA node, AV Node, His purkinje system

3. Impulse conduction Physiology: conducting system

4. CliniCal Features of C H F Reduced force of cardiac contraction Reduced cardiac output Reduced tissue perfusion Oedema (congestion) Increased peripheral vascular resistance

5. Goals and Drugs of Therapy Relief of congestive/Low output symptoms and restoration of Cardiac performance: Inotropic : Digoxin, Dopamine, Dobutamine, Amrinone/Milrinone Diuretics : Furosemide, thiazides Vasodilators : ACE inhibitors/ARBs, Hydralazine, Nitroprusside and Nitrates Beta-blockers : Metoprolol, Bisoprolol, Carvedilol

6. Arrest/Reversal of disease progression and prolongation of survival ACE inhibitors/ARBs, Beta-blockers Aldosterone antgonist : Spironolactone Non-pharmacological measures: Rest and salt restriction (for all grades of CHF)

7. NYHA Classification Asymptomatic : Left ventricular dysfunction Class I: no limitation of physical activity O rdinary physical activity does not cause fatigue or breathlessness Cass II: slight limitation of physical activity C omfortable at rest. Ordinary physical activity results in fatigue , palpitation, breathlessness or angina pectoris . ('mild' heart failure) Class III: marked limitation of physical activity A lthough patients are comfortable at rest, less than ordinary activity will lead to symptoms (symptomatically 'moderate' heart failure ) Class IV: inability to carry out any physical activity without discomfort S ymptoms of congestive cardiac failure are present even at rest. Increased discomfort with any physical activity (symptomatically 'severe' heart failure)

8. Thank you