Congestive Heart Failure pharmacotherpeutics

Etiology,Epidemology,Pathophysiology,Pharmacology of CHF

1. CHF

2. Definition: It is defined as the inefficiency of the heart to pump sufficient amount of oxygenated blood to the organs of the body to meet their normal metabolic demands. Epidemiology: Chronic heart failure is a common condition with a prevalence ranging from 0.3% to 2% in the population at large, 3–5 % in the population over 65 years old, and between 8% and 16% of those aged over 75 years.

3. ETIOLOGY Symptoms Dyspnea , particularly on exertion Orthopnea Paroxysmal nocturnal dyspnea Exercise intolerance Tachypnea Cough Fatigue Nocturia Hemoptysis Abdominal pain Anorexia Nausea Bloating Poor appetite, early satiety Ascites Mental status changes Signs Pulmonary rales Pulmonary edema S 3 gallop Cool extremities Pleural effusion Cheyne -Stokes respiration Tachycardia Narrow pulse pressure Cardiomegaly Peripheral edema JVD Hepatojugular reflux Hepatomegaly

4. Causes of CHF

5. Laboratory Tests BNP >100 pg/ mL Electrocardiogram may be normal, or it could show numerous abnormalities , including acute ST-T wave changes from myocardial ischemia, atrial fibrillation, bradycardia , and left ventricular hypertrophy. Serum creatinine may be increased due to hypoperfusion . Preexisting renal dysfunction can contribute to volume overload. Complete blood count (CBC) can be useful in determining if heart failure is due to a reduced oxygen-carrying capacity.

6. PATHOPHYSIOLOGY OF CHF

7. INVESTIGATIONS Patients with chronic heart failure are diagnosed and monitored on the basis of signs and symptoms from physical examination, history and an exercise tolerance test . Echocardiography is important when investigating patients with a suspected diagnosis of heart failure. An echocardiogram allows visualisation of the heart in real time and will identify whether heart failure is due to systolic dysfunction, diastolic dysfunction or heart valve defects . Chest radiograph A chest radiograph (X-ray) is performed to look for an enlarged cardiac shadow and consolidation in the lungs

8. DRUGS USEDIN CHF Based on ionotropic effects With Positive ionotropic effect: Cardiac Glycosides: Digitoxin , Digoxin,Ouabain b) Phosphodiesterase inhibitors: Inamrinone,Milrinone,Levosimendan c) B-adrenergic agonists: Dobutamine,Dopamine,Dopexamine .

9. 2)Without positive ionotropic effects: ACE inhibitors : Captopril , Enalapril,Losinopril,Fosinopril,Ramipril b) B1 Blockers : Metaprolol , Bisoprolol,Carvedilol c) Diuretics: Acetazolamide,Dorzolamide,Spironolactone,Hydrochlorthiazide,Bumetanide,Furosamide. d)Vasodilators: Hydralazine , Sodium nitroprusside , Isosorbide dinitrate .

10. MOA OF DIGOXIN