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Sex
Age
Mortality/Morbidity
Pathophysiology
Hemodynamic changes
Neurohormonal changes
Cellular changes
1.Hemodynamic changes:
HF can be secondary to systolic dysfunction or
diastolic dysfunction
2. Cellular changes
Changes in Ca+2 handling
Changes in adrenergic receptors:
Slight in 1 receptors
1 receptors desensitization followed by down
regulation
Changes in contractile proteins
Program cell death (Apoptosis)
Increase amount of fibrous tissue
3. Neurohormonal changes
Acute Vs Chronic HF
Systolic Vs Diastolic HF
1. Vascular
Ischemic heart
disease,
myocardial
infarction
2. Valvular
3. Preesure- hypertension
4.Muscle- cardiomyopathy
Symptoms:
Left ventricular failure-
Dyspnea at rest
Palpitation in arrhythmia
Abdominal distention
Right hypochondrial pain
Epigastric fullness, early satiety , nausea ,
vomiting(stomach congestion)
Change of bowel habit constipation, diarrhea,
malabsorption
Bilateral leg swelling
Yellowish coloration of sclera
Change of urine frequency and colour
(cor
pulmonale)
3. Cardimyopathies and
myocarditis
SIGNS:
General appearance
Edema
Ascites
Cardiac cachexia
Medications!!! Anemia
Stress reaction
CXR
Cardiomegaly
Vascular redistribution
Kerley B lines
Interstitial edema
Peri-bronchial cuffing
Effusions
Electrocardiography
Echocardiogram
Chamber
enlargement
Wall motion
abnormalities
Diminished ejection
fraction
Possible LVH
Possible valvular
problems
Assess diastolic dysfunction
Improve symptoms
Improve survival
Treatment ::
Fluid Balance
Afterload Reduction
IV NTG, Nitroprusside
ACE-I / ARB
Ionotropic Support
3.10 cg/kg/min
A.-----------Diuretics
Advantages
Disadvantages
B-------------ACE Inhibitors
Slow progression
Reduce mortality
Increased bradykinin
Decreased norepinephrine
FDA Approved
Adverse effects :
Hyperkalemia
Angioedema
Fetal toxicity
C---------------Beta Blockers
Additional mechanisms
Propranolol/Timolol
Metoprolol/Atenolol
Carvedilol
Risks of Treatment
IN DIASTOLIC FAILURE;
Difficult to treat
Prevent tachycardia
Old Age,
Diabetes Mellitus,
Raised creatinine,
Hyponatremia , Hypoalbuminaemia,Anaemia
Presence of arrhythmia : AF / VT
Pump failure
Arrhythmia
Severe Anaemia
Cardiac Inotropes =
Dobutamine
MECHANISM OF ACTION:
ADVERSE RECTIONS
Niseritide
ADR- hypotension
OTHERS;
Implantable cardioverter-defibrillator
Heart transplant