‫بسم هللا الرحمن الرحيم‬

‫‪CASE 3‬‬
Definition
 What Is CHF ?
♥ The heart does not pump efficiently

♥ The heart is not able to move as much blood as it

should with each beat

♥ Organs in the body do not get enough oxygen rich

blood that they need to work well
 What is an Ejection Fraction? (EF)
The amount of blood that pumps out of the heart
with each beat

♥ Normal EF = 50 – 65%

♥ Damaged Heart Muscle EF = 40%

♥ Potential Heart Transplant EF = 20%

The Major Causes
CAD (~70% of cases) 
Hypertension 
Valvular disease 
Diabetes Mellitus 
cardiomyopathy and progression of CAD 
 Less Common Causes
 Myocarditis
 Tachyarrhythmia
 Congenital Heart Defects (HOCM)
 Cardiomyopathy
 Stress-induced
 Toxins: Drugs (Cocaine, Methamphetamine, Chemotherapy, Radiation), Alcohol

 Pulmonary:
 Rheumatologic: Sarcoidosis, SLE
 Infiltrative: Hemochromatosis, Amyloidosis
 Chronic Disease
 DM, HIV, Thyroid Disorders
 How patients present

 Clinical Symptoms
 Dyspnea (100% sensitivity)
 PND
 Swelling/Dependent edema
 Fatigue, Weight gain
 Risk Factors:
 Obesity, smoking, physical inactivity, lower socioeconomic status factors.
 Diagnosis
 ECG (check for MI, PE, Arrhythmia, LVH)
 CXR
 Pulmonary venous congestion, interstitial edema
 Cardiomegaly, pleural effusions
 Labs
 CBC, Troponin, ABG, Thyroid function tests
 Echocardiography: evaluate severity, causes, characterization
 Coronary Angiogram in setting of STEMI/NSTEMI
A 25 years old female presented with
palpitation and grade IV breathlessness for
2days , she had history of fever and sore
. throat
Examination: pulse rate 110 beat/minute , 
BP 60/40mmhg
CVS : S3 gallop ……chest : bi lateral
crepitation
? What is the diagnosis . 1
. Infective endocarditis and Congestive heart failure
? How to manage 
1st we should increase BP by using noradrenaline 
Then give I.V antibiotic like : Benzyl penicillin 
g/4hr for 4 weeks with gentamicin for 4-6WKs 1.2 
OR;; flucloxcillin 2 g/6hr I.V for 4-6WKs with 
.gentamicin for at lest 1st week
And for heart failure 
diuretic (loop/thiazide).1 
ACE-I(ARBS) .2 
B-BLOCKERS .3 
.Nitrates /digoxin/ hydralzine .4 
What are the acute and chronic
?complication
Congestive cardiac failure 
Fluid retention 
Renal failure 
Hyper and hypo kalemia 
Impaired Liver function and GIT 
Thromboembolism
Atrial and ventricular arrhythmia