CONGESTIVE HEART FAILURE

ANGELES A. YAP, MD, FPCP, FPCC Internist- Cardiologist

Congestive Heart Failure
 Heart failure, also called congestive heart

failure, is a condition in which the heart can no longer pump enough blood to the rest of the body.  a chronic, long-term condition, but can sometimes develop suddenly.

Congestive Heart Failure
Kinds:  Right-sided  Left sided  Both

Congestive Heart Failure
Types:

Systolic heart failure – the heart muscle cannot pump, or eject, the blood out of the heart very well
Diastolic heart failure - the heart muscles are stiff and do not fill up with blood easily

Normal anatomy of the heart

Normal anatomy of the heart

Circulation

Congestive Heart Failure
Causes:
Coronary artery disease (CAD) - most common cause - a narrowing of the small blood vessels that supply blood and oxygen to the heart

Cardiomyopathy - abnormality in the heart muscles causing ineffective pumping Dilated Hypertrophic Restrictive

Coronary artery disease

Dilated cardiomyopathy

Hypertrophic cardiomyopathy

Hypertrophic cardiomyopathy

Restrictive cardiomyopathy

Congestive Heart Failure
Causes: Congenital heart disease Heart attack
Valvular heart disease e.g. Rheumatic

Cardiac arrhythmias - abnormal heart rhythms

Others: Emphysema Severe anemia Hyperthyroidismor hypothyroidism

Congenital Heart Disease

Mitral stenosis

Mitral stenosis

Congestive Heart Failure
Symptoms:

- most often begin slowly - may begin suddenly after a heart attack or other heart problem

Congestive Heart Failure
Common symptoms: Shortness of breath with activity, or after lying down for a while
Cough Swelling of feet and ankles Swelling liver Weight gain

Congestive Heart Failure
New York Heart Association Classification (NYHA) - clinical classification of heart failure

I – SOB on more than ordinary activities II- SOB on ordinary activities III- SOB on less than ordinary activities IV- SOB even at rest

Congestive Heart Failure
Common symptoms: Irregular or rapid pulse Sensation of feeling the heart beat (palpitations)
Difficulty sleeping (orthopnea, paroxysmal nocturnal dyspnea Fatigue, weakness, faintness Loss of appetite, indigestion

Congestive Heart Failure
Other symptoms : Decreased alertnessor concentration Decrease urine production Nausea and vomiting Need to urinate at night

Congestive Heart Failure
Other symptoms : Infants may sweat during feeding (or other activity). Asymptomatic, the symptoms may develop only with these conditions: Abnormal heart rhythm (arrhtymias) Anemia Hyperthyroidism Infections with high fever Kidney disease

Congestive Heart Failure
Signs : Physical examination :
Fluid around the lungs (pleural effusion)

Irregular heartbeat Leg swelling (edema) Neck veins distention Hepatomegaly Crackles Abnormal heart sounds

Congestive Heart Failure
Diagnostic tests:
Chest x-ray ECG Echocardiogram Cardiac stress tests Heart CT scan Heart catheterization MRI of the heart Nuclear heart scans

Chest Xray

Congestive Heart Failure
Diagnostic tests: Blood chemistry BUN Complete blood count Creatinine Creatinine clearance Liver function tests Uric acid Sodium Urinalysis

Congestive Heart Failure
Treatment: MONITORING AND SELF CARE
Regular check-up every 3 to 6 months

Weight gain monitoring
Taking medications as directed

Do not smoke Stay active Lose weight if you are overweight Get enough rest Limit salt intake

Congestive Heart Failure
Some tips to lower salt and sodium intake:
Look for foods that are labeled “low-sodium,” “sodium-free,” “no salt added,” or “unsalted.” Check the total sodium content on food labels. Be especially careful of canned, packaged, and frozen foods Don’t cook with salt or add salt to what you are eating. Try pepper, garlic, lemon, or other spices for flavor instead. Be careful of packaged spice blends as these often contain salt or salt products (like monosodium glutamate, MSG). Avoid foods that are naturally high in sodium, like anchovies, meats (particularly cured meats, bacon, hot dogs, sausage, bologna, ham, and salami), nuts, olives, pickles, sauerkraut, soy and Worcestershire sauces, tomato and other vegetable juices, and cheese. Take care when eating out. Stick to steamed, grilled, baked, boiled, and broiled foods with no added salt, sauce, or cheese. Use oil and vinegar, rather than bottled dressings, on salads. Eat fresh fruit or sorbet when having dessert.

Congestive Heart Failure
Medications: ACE Diuretics Digitalis glycosides Angiotensin receptor blockers (ARBs) Beta-blockers

Congestive Heart Failure
Definitive treatment: Coronary artery bypass grafting Percutaneous transcoronary angioplasty Valvular heart surgery Pacemaker insertion Heart transplantation

LOVE YOUR HEART