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CHF: Definition

CHF: Definition .

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CHF: Definition

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  1. CHF: Definition Congestive cardiac failure is defined as “inability of the heart to maintain output at rest or during stress, necessary for the metabolic needs of the body (systolic failure) and inability to receive blood into the ventricular cavities at low pressure during diastole (diastolic failure) .

  2. Thus due to systolic failure it is unable to propel blood into the aorta and in diastolic failure it receive in adequate amount of blood .

  3. Etiology • Heart failure due to diastolic dysfunction • Mitral or tricuspid stenosis • Constrictive pericarditis • Restrictive cardiomyopathy • Acute volume overload • Myocardial ischemia • Marked vetricular hypertrophy

  4. Cause of systolic or mixed failure leading to CCF • Infants • Congenital heart disease • Myocarditis and primary myocardial dise • Paroxysmal tachycardia • Anemia • Miscellaneous cause-infection,hypoglycemia ,hypocalcemia, neonatal asphyxia, persistent fetal circulation

  5. . Children • Rheumatic fever and rheumatic heart disease. • Conginital heart disease complicated by anemia ,infection,endocarditis • Hypertension ,myocarditis ,upper respi. Obstruction.

  6. CHF: Classification New York Heart Association functional classification Class I: No limitation of physical activity Class II: Slight limitation Class III: Marked limitation Class IV: Inability to carry out any physical activity without discomfort.

  7. CHF: Renin angiotensin system activation • Increase sympathetic tone • Decrease parasympathetic tone • Angiotensinogen is converted into angiotensin I with the help of renin • Angiotensin I is converted into angiotensin II by converting enzyme

  8. CHF: Renin angiotensin system Angiotensin II • Stimulates aldosterone from the adrenals • Aldosterone secretion results in sodium accumulation & also produces arteriolar constriction

  9. CHF: Renin angiotensin system Angiotensin II • Increases ventricular pre- load & after-load • Increases peripheral resistance • Serves as growth factor producing myocardial hypertrophy. • Can produce fibrosis & myocyte loss by enhancing apoptosis.

  10. Symptoms of CCF • Poor weight gain • Difficulty in feeding • Breathes too fast • Breathes better when hold against the shoulder • Persistent cough and wheezing • Irritability ,excessive perspiration, restlessness • Pufiness of face ,pedal edema

  11. Sign of CCF in infants Left sided failure Right sided failure Hepatomegaly Facial edema Jugular venous engorgement Edema on feet Failure of either side Cardiac enlargement Gallop rhythm(S3) Peripheral cynosis Small volume pulse Absence of weight gain • Tachypnea • Tachycardia • Cough • Wheezes • Rales in the chest

  12. CHF: Medical Treatment Principles of treatment • Treatment of underlying disease • Defining the stage of disease: LVEF and by symptoms • Intensity of care

  13. CHF: Principles of treatment • Reduce volume overload • Reduce pre- load & after load • Improve ventricular contractility

  14. CHF: treatment of the cause • Hypertension • Ischaemic Heart Disease • Valvular Heart Disease • Congenital Heart Disease

  15. CHF: precipitating causes • Anaemia • Infection • Acute arrhythmias - AF • Poor compliance with treatment • Pulmonary embolism • Silent Myocardial infarction

  16. CHF: treatment • ACE inhibitors • Beta Adrenergic blockade • Spiranolactone • Loop diuretic • Digitalis • Anticoagulation ?

  17. ACE Inhibitors & Betablockers • Betablocker reverses remodeling • ACE inhibitors improve vascular process

  18. CHF: ACE inhibitors • Improvement in vascular endothelial function • Stabilizing athero-sclerotic plaques by reducing smooth muscle growth. • Maximum tolerable dose is beneficial

  19. CHF: ACE inhibitors • Captopril. • Enalapril . • Lisinopril . • Ramipril.

  20. Pharmacological treatment of left ventricular systolic dysfunction • ACE inhibitors • Hydralazine and Isosorbide dinitrate in patients who can not take ACE inhibitors • Digoxin not responding to ACEI & diuretic

  21. Digoxin and diuretic dose in children

  22. Pharmacological treatment of left ventricular systolic dysfunction • Digoxin in AF • Diuretic for patients with fluid overload • Anticoagulation in AF, previous history of pulmonary embolism • Beta-blockers after an acute MI

  23. Pharmacologic Treatment of Left Ventricular Diastolic Dysfunction • Diuretic • Nitrates • Drugs suppressing AV conduction to control ventricular rate in patients with AF • Anticoagulation in patients with AF or previous systemic or pulmonary embolism

  24. Activity recommendation in CHF • Regular exercise for all patients with sable NYHA class I- III heart failure

  25. Diet: CHF • Diet : sodium 2 gm/ day • Not more than one drink per day

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