Heart failure

heart failure

1. Heart failure By- kajal sansoya

2. Normal heart

3. Introduction Heart failure is defined as a state in which the ventricles at normal filling pressures cannot maintain an adequate cardiac output to meet the metabolic needs of peripheral tissue or can do so only with an elevated filling pressure.

4. Heart failure is a chronic condition in which heart does not pump well as it was supposed to be. I t results from any structural or functional impairment of ventricles filling or ejection of blood.

5. INCIDENCE More than 20 million people have heart failure worldwide. Prevalence of heart failure in India due to CHD, hypertension, RHD ,obesity to range from 1.3 to 4.6 million, with an annual incidence of 491600-1.8 million. Heart failure is leading cause of hospitalization in people older than 65.

6. Pathology Preload – refers to pressure that fills the left ventricles during diastole. After-load - refers to pressure against which the left ventricle contracts. Myocardial contractility - this mainly depends upon the adrenergic nervous activity and the levels of circulating catecholamines .

7. In heart failure there is an increase in preload , increase in after load, decrease myocardial contractility. cardiac output(CO)= stroke volume(SV)x heart rate(HR) SV determined by preload , after load, myocardial contractility.

8. Types of heart failure Acute or chronic Low output or high output Left side or right sided or biventricular Forward or backward Systolic or diastolic

9. Acute heart failure develops suddenly Sudden reduction in CO which results in systemic hypotension. Example- acute MI, rupture of valve, block blood flow to heart muscle.

10. Chronic heart failure develops gradually , aortic pressure is maintained but edema accmulate . Example – dilated cardiomyopathy multivalvular disease

11. Low output heart failure Associated with a low CO. Heart fails to generate adequate output or can do so with high filling pressure. Example – IHD, pericardial disease, cardiomyopathy

12. High output heart failure Heart fails to maintain sufficient circulation despite an increase CO. Example – hyperthyroidsm , anemia, pregnancy, paget’s disease.

13. Left-sided heart failure Reduction or decrease ventricular output Increase in left atrial pressure Increase pulmonary venous pressure Example – MI , aortic stenosis

14. Right-sided heart failure Excess fluid accumulates upstream behind the failing right ventricle. There is reduction in right ventricular output and increase in right atrial & systemic venous pressure. Decrease right ventricle output results in systemic venous congestion. Example – pulmonary valvular stenosis , multiple pulmonary emboli.

15. Biventricular heart failure Failure of both right and right side ventricles. Example – IHD, dilated cardiomyopathy .

16. Forward heart failure - Decrease in CO and inadequate perfusion of organs leading to poor tissue perfusion. Backward heart failure- normal CO, but marked salt, water retention, pulmonary & systemic venous congestion.

17. Systolic heart failure - abnormal ventricular contraction Diastolic heart failure - impaired ventricular relaxation and increase ventricular stiffness results in diastolic dysfunction.

18. Risk factors Hypertension Diabetes mellitus Thyroid CAD Hyperlipidaemia

19. Etiology Pressure overload of ventricles aortic stenosis , pulmonary stenosis , pulmonary hypertension. Volume overload of ventricles aortic regurgitation, ASD, PDA, mitral regurgitation. Inflow obstruction of ventricle mitral stenosis , tricuspid stenosis , endomyocardial fibrosis.

20. Impaired ventricular function diffuse myocardial disease, myocarditis , IHD, cardiomyopathy , segmental myocardial disease.

21. Aggravating factors Myocardial infarction Intercurrent illness Arrhythmia Pulmonary embolism Systemic hypertension Condition associated with increase metabolic demand ( pregnancy, anemia)

22. Clinical features Dyspnoea Orthopnoea Paronysmal noctural dyspnoea Cardiac asthma Cheyne -stokes ( periodic breathing) Nocturia (frequent urination at night) Cerebral symptoms( confusion, headache, insomia ) Acute pulmonary edema

23. Non-specific features Nausea fatigue Anorexia Cardiac cachexia Jugular venous pressure increase Oliguria Pleural effusion, ascities , pericardial effusion liver ( hepatomegaly , enlarged liver, jaundice)

24. Complications Renal heart failure Hyopkalaemia Hyperkalaemia Imparied liver function Hyonatraemia Thromboembolism Atrial and ventricular arrhytmias

25. Diagnosis Cardiomegaly CT, X-ray shows promience of upper lobe veins, increase bronchovascular markings, pleural effusion. ECG- hypertrophy, arrhythmias, active ischemia, MI Renal and liver test – FLP, LFT

26. X-ray findings of heart failure

27. ECG in heart failure

28. Management Life style changes Physical & emotional rest Diet changes Medical management Surgery

29. Medical management NSAIDS ACE inhibitors Beta-blockers Diuretics Vasodilators Digoxin Sympathominetics amines Dopamine used in acute heart failure

30. Management of heart failure Removal of precipitating or aggravating cause Correction of underlying cause Treatment of HF control of salt& water retention Diuretics decrease sodium intake

31. Thank you