Objectives

At the end of the presentation students should will be able to:

Describe CHF
Identify etiologies of CHF
 Identify types of CHF
 Describe pathophysiology of CHF
 clinical manifestations of CHF
 Explain diagnostic methods of CHF
Explain management of CHF
 Describe complication
What is congestive heart failure?
• congestive Heart failure means that your heart can't pump enough
oxygen-rich blood to meet your body's needs.
• Heart failure doesn't mean that your heart has stopped or is about to
stop beating.
• But without enough blood flow, your organs may not work well,
which can cause serious problems.
Heart failure…

Incidence

The incidence of HF increases with age.

Nearly 5 million people in the US have HF, with more than one-half
million new cases diagnosed each year.

High prevalence in blacks

Most common reason for hospitalization of older people.

Risk factors
Common causes of CHF

CAD

Cardiomyopathy

Systemic or pulmonary hypertension

Valvular heart disease

ed CO (anemia, hypoxia)

Rheumatic heart disease

Congenital heart disease

II. Precipitating (secondary) causes.

H = Hypertension
E = Infective Endocarditis
A = Anemia
R = Rheumatic –fever (Recurrence)
T = Thyrotoxicosis
F = Fetus (pregnancy)
A = Arrhythmias
I = Infections
L = Lung problems (pathologies)
S = Stress, salts, etc.
Classification of HF
Systolic Vs Diastolic dysfunction

 Systolic Dysfunction: the ventricle is unable to contract forcefully enough during

systole

 Diastolic dysfunction: the left ventricle is unable to relax adequately during

diastole

Based on the side of the heart involved

 left heart failure

 right heart failure

Left heart failure

LHF results from LV dysfunction,

 Increased Pulmonary pressure

Fluid extravagation from the pulmonary capillary bed into the

interstitial spaces & then to the alveoli

Pulmonary congestion & Edema

Pathophysiology of Left sided HF

 LV dysfunction, causes blood to back up in the left atrium and pulmonary

veins

 The increased left ventricular end-diastolic blood volume increases the left
ventricular end-diastolic pressure

 Decreases blood flow from the left atrium into the left ventricle during
diastole

 The blood volume and pressure in the left atrium increases,

Pathophysiology…

Decreases blood flow from the pulmonary vessels

Pulmonary venous blood volume and pressure rise, forcing fluid from
the pulmonary capillaries into the pulmonary tissues and alveoli,

Impairment of gas ex-change.

Backward failure
Or Pathophysiology…

The decrease in SV stimulation of the sympathetic nervous system

impedes perfusion to many organs.

Blood flow to the kidneys decreases reduced urine output (oliguria).

Renal perfusion pressure falls release of renin aldosterone secretion

Sodium and fluid retention increases intravascular volume.

sometimes called forward failure.

II. Right sided failure (cor pulmonale)

 RHF results from a diseased RV that causes back ward flow of

blood to the RA and venous circulation.

Causes
Left ventricular failure (the usual cause)
CAD e.g. RV MI
Pulmonary hypertension
Pathophysiology
RV failure

Inability of RV to empty completely

Increased volume & pressure in the
systemic veins

Systemic venous congestion
Functional Classification of NYHA
Compensatory Physiological Mechanisms in HF

1. Increased sympathetic activity( Baroreceptors)

↑HR and ↑ force of contraction
Vasoconstriction → ↑venous return and preload → ↑stroke volume →↑
CO
2. Activation of the renin- angiotensin- aldosterone system
↓ CO → ↓ renal blood flow → ↑ renin-angiotensin-aldosterone system →
↑ PVR ( afterload) & blood volume
3. Myocardial hypertrophy
↑ The heart size, stretching of muscles and chambers dilates
Clinical Manifestations
Clinical manifestation LHF cont’d…
Clinical manifestation of Right sided HF
Diagnosis

History
Physical Examination
Lab tests
ECG
Chest X-ray
Pulse oximetry
Cardiac catheterization
Diagnostic procedures
Cardiac enzymes
• markers for cardiac ischemia or injury should also be drawn and analyzed
BNP ( b type natriuretic peptide )
Biomarker released by ventricle when there is excessive pressure on heart due to
heart failure
- < 100 no heart failure
- 100 -300 present
- > 300 mild
- > 600 Moderate
- > 900 sever
Chest X-ray

• Cardiomegaly

• Bilateral pleural effusions can be viewed by X-ray

Echocardiography (ECHO) – used to Identify the regional wall motion abnormalities

that are associated with congestive heart failure.

Electrocardiogram (ECG) – This is a non-specific test that may be useful in

diagnosing cardiac ischemia
Management of Congestive heart Failure
Bed rest
 Fluid restriction
Moderate sodium restriction (2-3g/day)
Smoking cessation
 Daily weight
Avoid alcohol intake
PHARMACOLOGICAL MANAGEMENT
ACE inhibitor ( Angiotensin – converting enzymes )
 First line treatment prescribed with beta blockers
 Blocks conversion of Angiotensin l to ll ( vasodilator , ↓ Bp , kidney excreta
Na+
 end in ‘ pril ‘ Lisinopril
 Side effect is ↑ k+ , Dry nagging cough
2, ARBs ( Angiotensin ll receptor blockers
 used in place of ACE inhibitor
 end in ‘ sartan’ Losartan
 Have same effect as ACE inhibitor
Diuretics ( Loop or potassium – sparing )
 Used in combination with ACE or ARBs
 ↓ H2O + Na+ retention(↓ edema )
 E.g Lasix
 Side effect – urinate a lot
4, Beta Blockers block Norepinephrine effect on the heart muscle
Negative inotropic effect ↓ myocardial contraction
End in ‘’ lol ‘’ - Metoprolol
Side effect is Bradycardia
5, Diagoxin
• Which belongs to a class of drugs called cardiac glycosides
• Positive inotropic ; ↑ increasing the strength and efficiency of the heart muscle
• Negative chronotropic that cause HR to be at slower
• Normal diagoxin range 0.5 to 2 mg /ml
• Some common side effect of digoxin include Nausea , vomiting and visual
disturbance
• In case of overdose, digoxin toxicity can occur, leading to more symptoms such as
confusion, hallucination, and abnormal heart rhythms.
• Check apical pulse before giving > 60
Complications

Complications of CHF include:

• Reduced quality of life
• Arrhythmia and sudden cardiac death
• Cardiac cachexia
• Cardiorenal disease
• Liver dysfunction
• Recurrent hospitalizations and nosocomial infection