Heart Failure.pptx very intense for medical

Heart failure

1. Heart Failure pump failure Prepared by : Specialist Dr . Mohammad Qais Nabizada

2. Definition : According to ACCF and AHA is defined as a complex clinical syndrome that results from structural or functional impairment of ventricular filling or ejection of blood which in turn leads to clinical symptoms of dyspnea and fatigue and signs of HF edema and rales .

3. Pathogenesis : HF occurs when cardiac output fails to meet the demands of the circulation cardiac output is determined by these mechanisms which are : Preload (the volume and pressure of blood in the ventricles at the end of diastole ) Afterload ( the volume and pressure of blood in the ventricles during systole ) Myocardial contractility .

4. Causes of heart Failure : Myocardial dysfunction ( IHD, cardiomyopathies and myocarditis ) Volume overload ( aortic or mitral regurgitation ) Pressure overload ( aortic valve stenosis and hypertension ) Obligatory high output ( anemia , thyrotoxicosis , paget disease and beri beri ) Ventricle filling dysfunction ( pericardial tamponade and restrictive pericarditis ) Rhythm disturbance ( AF)

5. Exacerbating factors : HTN MI Pulmonary embolism Increased physical activity Increased salt intake Increased fluid intake Stress Paget disease Infection Anemia Thyrotoxicosis Pregnancy

6. Clinical symptoms : Dyspnea : Orthopnea Paroxysmal nocturnal dyspnea Cardiac asthma Acute pulmonary edema Hemoptysis Fatigue

7. NYHA Classification of HF : Class one : ( asymptomatic ) Class two : symptomatic with moderate activity ) Class three : symptomatic with mild activity ) Class four : symptomatic at rest )

8. Physical Examination : General appearance and vital signs : Jugular veins Pulmonary examination ( pulmonary crackles ) Cardiac examination ( s3 gallop , tricuspid regurgitation and displaced PMI ) . Abdomen and extremities ( hepatomegaly , ascites , peripheral edema ) . Cardiac cachexia . Increased level of TNF in circulation Increased metabolic rate Nausea /vomiting , anorexia , digoxin toxicity and congested hepatomegaly . Due to intestinal congestion and malabsorption of foods .

9. Framingham criteria :

10. Diagnosis : Routine laboratory testing : CBC , electrolytes , FBS , KFT , hepatic enzymes TFT and lipid profile ) . Electrocardiogram Chest X ray Echocardiography Biomarkers ( BNP and pro BNP )

11. DDX: COPD Pulmonary embolism Anxiety Renal failure Liver cirrhosis

12. Complications : Uremia Hypokalemia Hyponatremia Liver functions abnormality Thrombo embolism Arrythmia

13. Diagnosis :

14. Treatment of HF : Treatment of HF with reduced ejection fraction : ( EF > 40% ) Correction of reversible causes : Pharmacological treatment : Diuretic therapy Inhibitors of RAAS ( ACE-I, angiotensin ii receptor blockers , spironolactone and Eplerenon combination sacubitral and valsartan ) . Beta blockers SGLT2 inhibitors ( dapagliflozin and empagliflozin and dagliflozin ) . Digitalis glycosides Nitrates and hydralazine Ivabradine

15. Cont… Vericiguate ( a soluble guanylate cyclase inhibitor ) Combination of medical therapies ( ACE-I + beta blockers or sacubitril+ valsartan ) . Anticoagulation Antiarrhythmic therapy Statin therapy

16. Non pharmacological treatment : Implantable cardioverter defibrillators Biventricular pacing ( resynchronization ) Case management , diet and exercise training . Coronary secularization Cardiac transplantation