Lecture 10

1. CARDIOVASCULAR SYSTEMCONGESTIVE HEART FAILURE Lecture 10

2. DEFINITION DIAGNOSIS 5 1 TYPES 2 CAUSES 3 SYMPTOMS TREATMENT 6 4 LECTURE CONTENTS

3. DEFINITION OF HERT FAILURE Your heart is an amazing powerhouse that pumps and circulates 5 or 6 gallons of blood each minute through your entire body.

4. DEFINITION OF HERT FAILURE • Inability of the heart to pump an adequate amount of blood to compensate the body’s needs. • Results from any structural or functional abnormality that impairs the ability of the ventricleeither to: • Eject blood (Systolic Heart Failure)or • To fill with blood (Diastolic Heart Failure).

5. DEFINITION OF HERT FAILURE • Pumping action of the heart becomes less and less powerful. • Thus blood does not move efficiently through the circulatory system and starts to back up. • This increases the pressure in the blood vessels and forces fluid from the blood vessels into body tissues.(edema,congesion )

6. Decreased Blood Pressure and Decreased Renal perfusion LV Dysfunction causes Decreased cardiac output Stimulates the Release of renin, Which allows conversion of Angiotensin I to Angiotensin II. Angiotensin II stimulates Aldosterone secretion which causes retention of Na+ and Water(edema) The Cycle of Congestive Heart Failure

7. DEFINITION DIAGNOSIS 5 1 TYPES 2 CAUSES 3 SYMPTOMS TREATMENT 6 4 LECTURE CONTENTS

9. TYPES OF HEART FAILURE • Systolic dysfunction(systolic heart failure) • occurs when the heart muscle doesn't contract with enough force, so there is less oxygen-rich blood that is pumped throughout the body. • Diastolic dysfunction (diastolic heart failure) • occurs when the heart contracts normally, but the ventricles do not relax properly or are stiff, and less blood enters the heart during normal filling. • *A calculation done during an echocardiogram, called the ejection fraction (EF) , is used to measure how well your heart pumps with each beat to help determine if systolic or diastolic dysfunction is present.

10. DR Noha Adel

11. DEFINITION DIAGNOSIS 5 1 TYPES 2 CAUSES 3 SYMPTOMS TREATMENT 6 4 LECTURE CONTENTS

12. CAUSES OF HEART FAILURE Coronary artery disease: Coronary artery disease (CAD), a disease of the arteries that supply blood and oxygen to the heart, causes decreased blood flow to the heart muscle. If the arteries become blocked or severely narrowed, the heart becomes starved for oxygen and nutrients. Heart attack: A heart attack occurs when a coronary artery becomes suddenly blocked, stopping the flow of blood to the heart muscle. A heart attack damages the heart muscle, resulting in a scarred area that does not function properly.

13. CAUSES OF HEART FAILURE Cardiomyopathy: Damage to the heart muscle from causes other than artery or blood flow problems, such as from infections or alcohol or drug abuse. Conditions that overwork the heart: Conditions including high blood pressure, valve disease, diabetes, or heart defects present at birth can all cause heart failure. In addition, heart failure can occur when several diseases are present at once.

14. Classification of Heart Failure • New York Heart Association (NYHA) Class I No symptoms and no limitation in ordinary physical activity, e.g. shortness of breath when walking, climbing stairs. Class II Mild symptoms(mild shortness of breath)and slight limitation during ordinary activity. Class III Marked limitation in activity due to symptoms, even during less-than-ordinary activity, e.g. walking short distances (20-100 m). Comfortable only at rest. Class IV Severe limitationssymptoms even while at rest. Mostly bed bound patients.

15. DEFINITION DIAGNOSIS 5 1 TYPES 2 CAUSES 3 SYMPTOMS TREATMENT 6 4 LECTURE CONTENTS

16. Clinical Manifestations of HF Heart Failure has the following 3 major symptoms Exercise intolerance and fatigue. Shortness of breath. Fluid retention and swelling. Congestive heart failure usually does not cause chest pain.

17. RV LV ALL Clinical Manifestations of HF • Fatigue • Weakness • Loss of appetite • Weight loss • Feels cold • Shortness of breath • Leg swelling • Abdominal pain • Weight gain • Loss of appetite • Shortness of breath. • Shortness of breath • when lying down. • Sudden shortness of • breath that awakens • from sleep. • Cadriomegaly

18. DR Noha Adel DR Noha Adel

19. Pulmonary Edema

20. Cardiomegaly

21. What are the symptoms ofheart failure? Think FACES... • Fatigue • Activities limited • Chest congestion • Edema or ankle swelling • Shortness of breath

22. DIAGNOSIS DEFINITION 5 1 TYPES 2 CAUSES 3 SYMPTOMS TREATMENT 6 4 LECTURE CONTENTS

23. Lab Analysis in Heart Failure • CBC Since anemia can cause heart failure. • Fasting Blood glucose To evaluate for possible diabetes mellitus. • Thyroid function tests Since thyrotoxicosis can result in HF. • Viral studies If viral mycocarditis suspected.

24. Cardiac Testing in Heart Failure • Chest X-ray • cardiomegaly • Electrocardiogram (ECG): • May show specific cause of heart failure: • Ischemic heart disease. • Left ventricular heart failure. • Echocardiogram: • Left ventricular ejection fraction.

25. DIAGNOSIS DEFINITION 5 1 TYPES 2 CAUSES 3 TREATMENT SYMPTOMS 6 4 LECTURE CONTENTS

26. Chronic Treatment of Systolic Heart Failure • Correction of systemic factors: • Thyroid dysfunction • Infections • Uncontrolled diabetes • Hypertension • Lifestyle modification: • Lower salt intake • Alcohol cessation • Medication compliance • Maximize medications: • Discontinue drugs that may contribute to heart failure (NSAIDS, antiarrhythmics, calcium channel blockers)

27. Order of Therapy • Diuretics • ACE inhibitor • Beta blockers • Digoxin • Hydralazine, Nitrate • Positive inotropic drugs (drugs that make muscle contract more forcefully) (dopamine)

28. Digoxin • Given to patients with HF to control symptoms such as fatigue, dyspnea, exercise intolerance.. • Shown to significantly reduce hospitalization for heart failure, but no benefit in terms of overall mortality..

29. THANK YOU!!!