HEART FAILURECARDIAC FAILURE DEF HEART FAILURE IS A CLINICAL

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HEART FAILURE/CARDIAL FAILURE

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):

  1. Left HF : HTN. AV Stenosis, Coarctation of aorta.

  2. Right HF: Pulmonary Stenosis, Pul. HTN

C. Volume overload:

  1. LHF: AR, MR, anaemia, thyrotoxicosis.

  2. RHF: TR, PR ASD, VSD

D. Inflow obstruction:

  1. LHF: MS. LA Myxoma

  2. RHF: TV Stenosis.

E. Arrhythmia

Atrial Fibrillation

Complete heart block

Common causes are:

  1. Myocardial infarction, 2.HTN, 3.Rheumatic valvular diseases, 4.Dilated CM

  1. 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:

  1. Acute HF: Develop suddenly e.g. M.I

  2. Chronic HF: Develop gradually e.g. valvular heart diseases.

C. According to output:

  1. High output failure ( CO) Thyrotoxicosis, Severe Anaemia, Beriberi.

  2. Low output failure ( CO) MI.

D. According to function:

  1. Systolic dysfunction: Impaired ventricular contraction ( EDV & EF) e.g. MI, DCM. valvular heart disaese.

  2. 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 :

    1. Symptoms : 1.Weight gain 2 oedema 3. Epigastric discomfort

    2. 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-

    1. ECG, 2. X- ray chest, 3.Echo cardiogram,4.Haemoglobin

  1. Thyroid function

(b) To see Complications

1. Urea & Creatinine, 2. Electrolytes, 3. LFT


MANAGEMENT:

A. Acute LVF /Acute Pulmonary Oedema :

  1. Hospitalization in CCU, ECG monitoring, I/V access

  2. Propped up position – to reduce pulmonary congestion

  3. O2 inhalation – high flow , high concentration

  4. Diuretics – to reduce pulmonary oedema 40-80 mg I/V frusemide

  5. S/L GTN or I/V GTN till clinical improvement or systolic BP falls <110mmof mg

  6. 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.

  7. 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 :

    1. Diuretic – Mild to moderate cases – Thiazide, Severe cases -loop

diuretic

    1. Vasodilators : Nitrates

    2. ACEI / Angiotensin receptor blockers- Captopril, Enalapril, Remipril, Losartan etc.

    3. Beta-blockers

    4. Carvidelol (alpha & beta-blocker)

    5. Digoxin : specially in HF with AF

  1. Specific measure

    1. 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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