HEART FAILURE/CARDIAC FAILURE
Def: Heart failure is a clinical syndrome where heart is unable to maintain an adequate C.O to meet the metabolic demand of the body or can do so only at the expense of an elevated filling pressure.
Causes of HF:
A. Myocardial depression:
a. Myocardial infarction(MI)
b. Cardiomyopathy(CM)
c. Myocarditis
B. Pressure overload (ventricular outflow obstruction):
Left HF : HTN. AV Stenosis, Coarctation of aorta.
Right HF: Pulmonary Stenosis, Pul. HTN
C. Volume overload:
LHF: AR, MR, anaemia, thyrotoxicosis.
RHF: TR, PR ASD, VSD
D. Inflow obstruction:
LHF: MS. LA Myxoma
RHF: TV Stenosis.
E. Arrhythmia
Atrial Fibrillation
Complete heart block
Common causes are:
Myocardial infarction, 2.HTN, 3.Rheumatic valvular diseases, 4.Dilated CM
Congenital heart disease
Types of Heart Failure:
A. According to chamber involvement:
1. Left sided HF(2 chambers-LA,LV & 2 Valves-MV,AOV) e.g. MI, HTN, AV disease, MV disease.
2. Right sided HF(2 chambers-RA,RV & 2 Valves-PV,TV) e.g. secondary to LHF, RV MI, TV disease, PV disease, PHT
3. Biventricular failure: DCM, Multiple valvular lesion, IHD
B. According to onset:
Acute HF: Develop suddenly e.g. M.I
Chronic HF: Develop gradually e.g. valvular heart diseases.
C. According to output:
High output failure ( CO) Thyrotoxicosis, Severe Anaemia, Beriberi.
Low output failure ( CO) MI.
D. According to function:
Systolic dysfunction: Impaired ventricular contraction ( EDV & EF) e.g. MI, DCM. valvular heart disaese.
Diastolic dysfunction: Impaired relaxation of ventricle (normal EDV & normal EF but LVEDP) e.g. HOCM, HTN (Early).
Clinical Features:
A. Features of LHF:
(a) Symptoms: 1. Dyspnoea- May be on exertion, Orthopnoea, PND, dyspnoea at
rest
2. Cough , Sputum
3. Fatigue , Weakness ,
(b) Signs : 1. Pulsus alternans . Tachycardia, Low vol. pulse
2. Low Systolic BP
3. Increased HR . Cardiomegaly, 3rd and /or 4th Hs. Gallop rhythm
4. Pulmonary basal Creps
B. Features of RHF :
Symptoms : 1.Weight gain 2 oedema 3. Epigastric discomfort
Signs : 1. Raised JVP 2. Enlarged tender Lever
3.Ascitis 4. Oedema
Complications of HF :
1. Atrial & Ventricular Arrhythmias
2. Thromboembolism
3. Electrolyte impairment eg. Hypokalaemia, Hyperkalaemia, Hyponatremia
4. Renal function impairment
5. Liver function impairment.
Investigations :
(a) To establish the diagnosis-
ECG, 2. X- ray chest, 3.Echo cardiogram,4.Haemoglobin
Thyroid function
(b) To see Complications
1. Urea & Creatinine, 2. Electrolytes, 3. LFT
MANAGEMENT:
A. Acute LVF /Acute Pulmonary Oedema :
Hospitalization in CCU, ECG monitoring, I/V access
Propped up position – to reduce pulmonary congestion
O2 inhalation – high flow , high concentration
Diuretics – to reduce pulmonary oedema 40-80 mg I/V frusemide
S/L GTN or I/V GTN till clinical improvement or systolic BP falls <110mmof mg
Inj. Morphine –3mg I/V slowly in alequate(1mg/ml morphine ample dissolved in 14ml of D/A=15ml) to reduce sympathetic mediated peripheral vasoconstriction in extremities.
If above measures fails –I/V Inotropic agent eg. Dopamine / Dobutamine to
be given
8. Treatment of Cause and precipitating factors.
B. Management of Chronic HF:
a. General Measure:
1. Diet(Salt restriction, Increase intake of fruits & vegetable 2. Avoidance
of smoking & alcohol 3. Exercise- regular aerobic exercise within limits of
symptoms
b. Drugs Treatment :
Diuretic – Mild to moderate cases – Thiazide, Severe cases -loop
diuretic
Vasodilators : Nitrates
ACEI / Angiotensin receptor blockers- Captopril, Enalapril, Remipril, Losartan etc.
Beta-blockers
Carvidelol (alpha & beta-blocker)
Digoxin : specially in HF with AF
Specific measure
Removal of cause & ppt factors
2. Heart transplantation.
DIAGNOSTIC CRITERIA OF CONGESTIVE HEART FAILURE : ( H-1323 )
A. Major Criteria |
B. Minor Criteria |
PND |
Leg oedema |
Raised JVP |
Night cough |
Basal cripitation |
Dyspnoea on eisertin |
Enlarged Heart |
Liver |
S3 Gallop |
PL effusion |
Positive Hepatojugular reflux |
Decreased Vital capacity |
NB: For details see the text book
Dear Clinical students (Specially 5th year) hopefully you are well and passing a crucial time in this running pandemic COVID-19 condition. Please go through the above lecture of Heart Failure which may be helpful.
Prof. Md. Roushon Ali
5 LECTURE ON THE SEARCHES IN CONRAD’S HEART OF
556 MILBRODALE ROAD FORDWICH NSW 2330 IN THE HEART
A CHANGE OF HEART CHANGES EVERYTHING SEND THIS ARTICLE
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