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Congestive heart failure MEF

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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 %

• 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)
The end

				
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posted:12/13/2011
language:English
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