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Congestive heart failure. Ivan Cerovečki Mentor: A. Žmegač Horvat. Elementary notions. Cardiac output Peripheral circulation Preload Afterload. Definition of CHF. Complex syndrome Impaired function of the heart Compromised peripheral perfusion. Epidemiology. Prevalence in Europe: 2 %
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Congestive heart failure IvanCerovečki Mentor: A. Žmegač Horvat
Elementary notions • Cardiac output • Peripheral circulation • Preload • Afterload
Definition of CHF • Complex syndrome • Impaired function of the heart • Compromised peripheral perfusion
Epidemiology • Prevalence in Europe: 2 % • Prevalence > 65 yrs: 10 % • 1st year mortality: 30 – 40 % • 5 year mortality: 60 – 70 %
Clinical characteristics • Acute heart failure • Chronic heart failure
Clinical characteristics • Left heart failure • Right heart failure • Biventricular (congestive) heart failure
Aetiology • Cardiac pathology • Ischaemic heart disease • Hypertensive heart disease • Cardiomyopathy • Valvular heart disease • Congenital heart disease • Pericardial disease
Aetiology • Extracardiac pathology • Pulmonary disease: pulmonary embolism • Endocrine and metabolic disease • Infective disease • Toxic substances: alcohol
Pathophysiology • Sympathetic activation • Increased heart rate • Increased myocardial contractility • Venous vasoconstriction • Arteriolar vasoconstriction
Pathophysiology • RAAS system • Arteriolar vasoconstriction • Fluid retention
Pathophysiology • Natriuretic peptides • Diuretic effect • Natriuretic effect • Hypotensive effect
Pathophysiology • Ventricular dilatation • Increase in metabolic requirements
Clinical features • Common symptoms • Fatigue • Dyspnoea • Palpitations • Weight gain
Clinical features • Left heart failure • Paroxysmal nocturnal dyspnoea • Orthopnoea • Basal lung crackles • Presence of the third heart sound
Clinical features • Right heart failure • Jugular venous distension • Hepatomegaly • Peripheral oedema
Diagnostics • Chest X-ray • ECG • Blood tests • Echocardiography • Natriuretic peptide
Treatment • Vasodilator therapy • ACE inhibitors • Angiotensin II receptor antagonists • Nitrates • Hydralazine
Treatment • β – blockers • Metoprolol • Bisoprolol • Carvedilol
Treatment • Diuretics • Loop diuretics • Thiazide diuretics • Potassium–sparing diuretics
Treatment • Digoxin • Dopamine • Dobutamine • Antiarrhythmic drugs
Treatment • Revascularization • Biventricular pacemaker • Cardiac transplantation
References • Vrhovac B et al: Interna medicina, Naklada Ljevak, 2008 • Ballinger A, Patchett S: Pocket Essentials of Clinical Medicine, Elsevier Saunders, 2007 • United States National Library of Medicine (nlm.nih.gov) • Wikipedia (wikipedia.org)