HEART FAILURE ELP BEING A COMMON DISEASE.pptx

Heart failure slides

1. Heart failure Dr Omondi Griffins

2. What’s heart failure C linical syndrome identified by presence of current or prior characteristic symptoms; List them Heart cannot pump blood commensurate to needs Usually elevated filling pressures to compensate for needs

3. Causes LV dysfunction: prior MIs,CADs , Cardiomyopathies RV dysfunction: Pulmonary HTN,MI, Cardiomyopathies ... Valvular heart diseases: RHD, others connective tissue diseases, arrhythmias Pericardial disease: TB, Uremic pericarditis, constrictive pericarditis... High out put states: Anemia , hyperthyroidism ,sepsis,...

4. Classification HF with LVEF ≤40 percent (HFrEF). HF with LVEF of 41 to 49 percent (HFmrEF). HF with LVEF ≥50 percent (HFpEF) Functional Status is usually with NYHA I - IV

5. Clinical Presentation History is the key Fluid overload: PND, orthopnoea, abdominal distension, bilateral lower limb swelling, Difficulty in breathing (pul.edema) Reduced cardiac output: Fatigue, exertional dyspnoea Any other presentation from the cause of decompensation: Infections,anemia etc

6. Examination findings Vary from case to case Always remember IPPA model CVS: Resp : Abdominal : General Exam :

7. Diagnosis Mainly Clinical plus a Echocardiogram Modified Framingham Criteria: Less favoured but still used Lab Tests: Based on history CBC: Anemia , sepsis UECs : Electrolytes, AKI or CKD LFTs: High GGT 2* UL Lipid profile: ASCVD score: Need for statins NT proBNP Troponins T or I

8. Approach To treatment Goals: Reduce mortality, Improve quality of life,reduce symptoms, Reduce hospital stay. Manage underlying condition: Cardiomyopathies, Arrhythmias Optimal BP Control: BP 140/90 Fluid restriction to 1.5 L/24 hrs .Input output monitoring Manage Concomitant conditions :DM, COPD Follow up plan devised: Volume status, compliance, BP control plus ... Patient Counselling

9. Approach To treatment Goals: Reduce mortality, Improve quality of life,reduce symptoms, Reduce hospital stay. Manage underlying condition: Cardiomyopathies, Arrhythmias Optimal BP Control: BP 140/90 Fluid restriction to 1.5 L/24 hrs .Input output monitoring Manage Concomitant conditions :DM, COPD Follow up plan devised: Volume status, compliance, BP control plus ... Patient Counselling

10. Pharmacologic treatment Diuresis in fluid overload The 4 major classes of drugs: Have mortality benefit and patient must be on them Clinical management of ascites BB in COPD Renal dosing of drugs if associated Kidney impairment Why SGLT 2: Mortality benefit: DAPA HF trial, EMPEROR trial

11. Questions