Congestive Heart failure

1
Defintion
3
Compensatory Mechanisms:-

5
• Q) All of the following are true about Right Ventricular
Infarcts, Except ?
• A. Nocturia
• B. Hepatomepaly
• C. Ascitis
• D. Normal JVP

6
Features of Right Heart Failure

7
Features of Right Heart Failure

8
• Inability to carry out any physical activity without discomfort comes
under?
• a. NYHA l
• b. NYHA 2
• c. NYHA 3
• d. NYHA 4

9
Class Patient Symptoms

4
Features of Left Heart Failure

11
Features of Left Heart Failure

12
• Q) All of the following are true about Right Ventricular Infarcts, Except ?
A. Nocturia
B. Hepatomepaly
C. Ascitis
D. Normal JVP

13
• All the following are features of right sided heart failure, Except:
• A. Increased PCWP
• B. Pulsatile liver
• C. Increased JVP
• D. Positive hepatojugular reflex

14
• Q) Enlarged Pulsative liver with ascitis is typically seen in:
• A. Tricuspid Regurgitation (TR)
• B. Mitral Regurgitation (MR)
• C. Mitral stenosis
• D. Pulmonary stenosis (PS)

15
• Q) Increased hydrostatic pressure in left sided congestive heart failure
causes-
• A. Raised JVP
• B. Congestive Hepatomegaly
• C. Pedal Edema
• D. Orthopnea

16
17
• Cheyne stokes breathing is seen in:
• a. Intracranial hypotension
• b. Congestive heart failure
• c. Left atrial myoxma
• d. Pickwinian syndrome

18
Framingham Heart study Criteria
21
22
25
• Signs of Pulmonary Venous Hypertension:
• (In order of appearance with increasing pulmonary venous pressure)
• 1.Vascular Redistribution

• 2. Interstitial oedema

• 3. Alveolar edema

• 4. Pleural effusions
26
Which CXR is
suggestive of
increased
Pulmonary venous
pressure ?
• A
• B
• C
• D
Q) Assays of which of the following biomarkers is most
commonly used in the diagnosis of Heart failure
• A. Brain Natriuretic Peptide (BNP)
• B. Atrial Natriuretic Peptide (ANP)
• C. Endothelin- l (ET-1)
• D. Adrenomedullin

28
Biomarkers:
• Q) CCF is associated with increase in all the following
except:
• A. Right atrial mean pressure
• B. Serum Sodium
• C. Urea
• D. Nor epinephrine

30
• Heart failure – Blood Picture

31
• Q ) All of the following are used in the initial
management of acute life threatening cardiogenic
pulmonary edema, except:
• A. Digoxin
• B. Morphine
• C. Furosemide
• D. Positive Pressure Ventilation

32
 Treatment of Acute Heart Failure
Oxygen & Ventilatory Morphine Vasodilators Diuretics Ionotropic agents
support
34
35
36
The image shows presence of:
a. Implantable cardioverter
defibrillator

b. Cardiac resynchronization
therapy

c. Dual pacing

d. Transvenous pacemaker

37
• Rarely used, but potentially life-saving measures:

38
ENHANCED EXTERNAL COUNTERPULSATION (EECP)
• Q) All of the following are true about starting
betablocker therapy in cases of CHF, Except?
• A. They should be initiated at the effective doses
• B. They should be gradually increased over weeks
• C. Special precautions should be taken in NYHA class III
& IV
• D. Carvedilol and Metoprolol are the preferred drugs

40
ESSENTIALS OF DIAGNOSIS-Acute Heart Failure

• ► Acute onset or worsening of dyspnea at rest.

• ► Tachycardia, diaphoresis, cyanosis.

• ► Pulmonary rales, rhonchi; expiratory wheezing.

• ► Radiograph shows interstitial and alveolar edema with or without

cardiomegaly.

• ► Arterial hypoxemia.
 ESSENTIALS OF DIAGNOSIS – Chronic CHF

• ► LV failure: Either due to systolic or diastolic dysfunction.

• Predominant symptoms are those of low cardiac output and congestion, including dyspnea.

• ► RV failure: Symptoms of fluid overload predominate; usually RV failure is secondary to LV failure.

• ► Assessment of LV function is a crucial part of diagnosis and management.

• ► Optimal management of chronic heart failure includes combination medical therapies, such as ACE
inhibitors, aldosterone antagonists, and beta-blockers