Eneutron Follow 259

Sudhanva
Studied at Grant Medical College University of Bombay · 3y

Congestive Heart Failure

Important Links

Therapy Lecture Notes - Eneutron

Next Lecture Notes - Mitral Regurgitation

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Heart failure

a. Inability of heart to pump adequate amount of blood to the body needs

b. Congestive Heart Failure - It is a state in which abnormal circulatory congestion exists as

a result of heart failure

c. Stroke Volume - It is the total amount of blood pumped by the heart for one beat.

d. Cardiac Output - It is the total amount of blood pumped by the heart for one minute.

i. Cardiac Output = Stroke volume × Heart rate

Classification of Heart failure

a. Systolic Heart failure

b. Diastolic Heart failure

Systolic Heart failure

a. It is a condition in which heart cant pump blood with enough force.

Underlying diseases (Etiology)

a. Heart muscle disease

i. Cardiomyopathy

b. Reduced blood supply(to the heart)

i. Coronary artery disease

ii. Heart attack

c. Valve diseases
 i. Regurgitation

ii. Stenosis

d. Arrhythmias

Ejection Fraction

a. In systolic heart failure the pumping ability of the heart is decreased.

b. Pumping ability of heart is calculated using ejection fraction.

c. Ejection fraction is the percentage of blood ejected for each beat.

d. Ejection fraction = (Volume ejected/Total volume filled) x 100

i. Normal : 55-70%

ii. Abnormal : 40-55%

iii. Heart failure : less than 40%

Diastolic Heart Failure

a. It is a condition in which the heart is not filling with enough blood

b. Ejection Fraction remains normal due to decreasing of both Volume ejected and Total
volume filled

Underlying diseases (Etiology)

a. Chronic Hypertension

b. Aortic Stenosis

c. Cardiomyopathies

i. Hypertrophic Cardiomyopathies

ii. Restrictive Cardiomyopathies

d. Other

i. Old age

ii. Coronary artery disease

Clinical Symptoms

1. Left sided heart failure

a. Forward Failure (Heart fails to pump enough blood out)

i. Tiredness & Fatigue

ii. Decrease in urine production

iii. Irregular heartbeat (Tachycardia)

 b. Backward Failure (Heart fails to receive enough blood in)

i. Difficulty breathing

ii. Coughing

iii. Weight gain

2. Right sided heart failure

a. Forward Failure (Heart fails to pump enough blood out)

i. Tiredness & Fatigue

ii. Irregular heartbeat (Tachycardia)

b. Backup Failure (Heart fails to receive enough blood in)

i. Swelling of lower extremity

ii. Ascites

iii. Body weight gain

iv. Increased urine production

Compensatory Mechanism in Heart Failure

a. Activation of sympathetic Nervous system

b. Tachycardia

c. Frank-Starling’s mechanism (Renin-Angiotensin System)

i. As the preload is increased, the stroke volume of heart increases

d. Ventricular Dilation

e. Ventricular Remodelling

Diagnosis

1. Physical Examination

a. Pleural Effusion

b. Edema

c. Rales

d. Jugular venous distention

e. Hepatomegaly

f. Ascites

2. Blood test

a. Increase in BNP level (B-type Natriuretic Peptide)

 i. Less than 100 pg/ml - No Heart Failure

ii. 100–300 pg/ml - Mild Heart Failure

iii. 300–900 pg/ml - Moderate Heart Failure

iv. More than 900 pg/ml - Severe Heart Failure

3. Chest X-ray

a. Enlarged heart ventricles

b. Congestion in lungs

4. Echo CG

a. Enlarged heart

b. Evaluate ejection fraction

Treatment

1. Chronic Heart Failure Treatment

a. ACE Inhibitors

i. Lisinopril (2.5–5.0 mg/day)

ii. Quinopril

b. Angiotensin II Receptor Antagonists(ARAs)

i. Losartan

ii. Ibersartan

iii. Candesartan

iv. Valsartan

c. Vasodilators

i. Isosorbide Mononitrate + Hydralazine

d. Beta blockers (To reduce chronically activated sympathetic system)

i. Bisoprolol (1.25 mg/day)

ii. Carvedilol

iii. Nebivolol

e. Loop Diuretics

i. Forosemide (20–40 mg/day)

ii. Bumetanide (0.5–1.0 mg 1–2 times/day)

f. Thiazide Diuretics

i. Bendroflumethiazide (2.5 mg/day)

 g. Aldosterone Antagonists

i. Spironolactone (25 mg/day)

ii. Eplerenone

h. Cardiac Glycosides

i. Digoxin (0.125 mg every other day)

i. Inotropes

2. Acute Heart Failure Treatment

a. Oxygen Therapy

b. Diuretics

i. Furosemide (50 mg Intra venously)

c. Vasodilator Therapy

i. Glyceryl trinitrate (50 mg intra venously)

3. Medical Devices

a. Ventricular Assist Device (VAD)

b. Cardiac Re-synchronization Therapy

4. Surgery

a. Coronary artery bypass surgery

b. Heart transplantation

Stages in Evolution of Heart Failure & recommended therapy

1. Stage A

a. Characteristics

i. High risk of Heart failure

ii. No structural heart disease

iii. No symptoms of Heart failure

b. Examples : Patients with

i. Hypertension

ii. Coronary artery disease

iii. Diabetes Mellitus

c. Treatment

i. Stop smoking, alcohol and drugs

 ii. Exercise

iii. ACE inhibitors

2. Stage B

a. Characteristics

i. Structural heart disease

ii. No symptoms of Heart Failure

b. Examples : Patients with

i. Previous Myocardial Infarction

ii. Left ventricular systolic dysfunction

iii. Asymptomatic valve disease

c. Treatment

i. Stop smoking, alcohol and drugs

ii. Exercise

iii. ACE inhibitors

iv. Beta-blockers

3. Stage C

a. Characteristics

i. Structural Heart diseases

ii. Current symptoms of Heart failure

b. Examples : Patients with

i. Structural heart disease

ii. Shortness of breath & fatigue

iii. Reduced exercise tolerance

c. Treatment

i. Stop smoking, alcohol and drugs

ii. Exercise

iii. ACE inhibitors

iv. Diuretics

v. Digitalis

4. Stage D

a. Characteristics
 i. Refractory Heart failure

b. Examples : Patients with

i. Symptoms at rest despite maximal medical therapy

c. Treatment

i. Stop smoking, alcohol and drugs

ii. Exercise

iii. ACE inhibitors

iv. Diuretics

v. Digitalis

vi. Mechanical Assist Device

vii. Heart transplantation

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About the Author

Sudhanva
Studied at Grant Medical College University of Bombay

Lives in Mumbai, Maharashtra, India