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Heart Failure

Heart failure is a clinical syndrome where the heart cannot maintain adequate cardiac output to meet metabolic needs. It can be left-sided or right-sided, and caused by conditions like myocardial infarction, cardiomyopathy, or valvular disease. Symptoms include dyspnea, edema, fatigue, and reduced exercise tolerance. Investigations may include chest X-ray, ECG, echocardiogram, and BNP levels. Treatment involves addressing underlying causes, precipitating factors, and specific therapies like diuretics, vasodilators, beta-blockers, and lifestyle modifications like salt and fluid restriction.

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46 views4 pages

Heart Failure

Heart failure is a clinical syndrome where the heart cannot maintain adequate cardiac output to meet metabolic needs. It can be left-sided or right-sided, and caused by conditions like myocardial infarction, cardiomyopathy, or valvular disease. Symptoms include dyspnea, edema, fatigue, and reduced exercise tolerance. Investigations may include chest X-ray, ECG, echocardiogram, and BNP levels. Treatment involves addressing underlying causes, precipitating factors, and specific therapies like diuretics, vasodilators, beta-blockers, and lifestyle modifications like salt and fluid restriction.

Uploaded by

rsheedmahdii
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© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
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Lec2

Heart Failure
By: dr.Manal AL-Abed

▪ Definition :
is a clinical syndrome in which the heart can’t maintain adequate
cardiac output to meet the metabolic needs of the body.
▪ Etiology:
I- Left – sided heart failure II- Right sided heart failure:
A) Left atrial failure: A) Right atrial failure:
-Mitral Stenosis - Tricuspid Stenosis
- Myxoma -Myxoma
B) Left ventricular failure: B) Right ventricular failure:
1- Muscle disease: 1- Muscle disease:
- Myocardial infarction - Myocardial infarction
- Myocarditis - Myocarditis
- Cardiomyopathy - Cardiomyopathy
2- Volume (diastolic) overload: 2- Volume (diastolic) overload:
- Hyperdynamic circulation - Hyperdynamic circulation
- Valvular disease: - Valvular disease:
Mitral Regurgitation Tricuspid Regurgitation
Aortic Regurgitation Pulmonary Regurgitation
- Congenital disease: - Congenital disease:
- VSD - PDA - VSD - ASD
3- pressure (systolic) overload: 3- Pressure (systolic) over load:
- Systemic hypertension. - pulmonary hypertension
- Aortic Stenosis - pulmonary Stenosis
- Coarctation of aorta -pulmonary embolism
▪ Precipitating factors:
1- Infections: chest infections, infective endocarditis.
2- Iatrogenic: Calcium channel blocker, Cortisone, Discontinuation of
anti- failure therapy.
3- Physical & emotional stress. 4- Pregnancy & delivery.
5- Anemia. 6- Arrhythmias
▪ Clinical Picture:
Manifestations of Low COP:
1- CNS : Dizziness, headache, syncope
2-CVS : Ischemic heart disease
3-Kidney : Oliguria
4-Skin : Cold, peripheral cyanosis
5-Skletal m: fatigue, intermittent claudication
6-BP : low systolic blood pressure
7-Pulse : Weak
І- Left sided heart failure:
1) Manifestations of Low COP: as above
2) Manifestations of pulmonary congestion:
1-Dyspnea: Exertional, orthopnea, paroxysmal nocturnal dyspnea or
dyspnea at rest
2-Exertional Cough 3-Recurrent chest infections
4-Hemoptysis 5-Pleural effusion
6-Pulmonary edema 7-Bilatera basal crepitation.
3) Cardiac signs:
a- Left ventricular enlargement. b- Tachycardia.
c- Pulsus alternans: (In advanced stage) d- Gallop rhythm
e- pansystolic murmur of functional MR
4)Features of the cause
II Right sided heart failure:
1)manifestations of LCOP: as above
2)manifestations of systemic congestion
1-Insomnia 2-Sweating on slight activity
3-Congested neck vein 4-Edema lower limb, later on ascites
5-Liver: enlarged, tender 6-GIT: dyspepsia, malabsorption
7-Pleural effusion.
3)Cardiac Signs:
1-Right ventricular enlargement 2-Tachycardia
3-gallop 4-murmure of functional TR
4)Features of the cause
▪ Investigations :
1 -X ray: o heart enlargement.
o Pulmonary congestion in LSHF.
o Pleural effusion
2-ECG : o Detect the cause e.g. MI
o hypertrophy
3-Echocardiography: o Chamber enlargement.
o Detect the cause.
o measures COP & Ejection fraction (EF)
n>/= 50%
4-cardiac catheterization: o Detect the cause .
5-BNP (B natriuretic peptide)
▪ Treatment:
A. Treatment of underlying cause e.g. valve replacement.
B. Treatment of precipitation factors e.g. anemia.
C. Specific treatment of CHF:
1-Rest
2-Diet:
- Salt restriction is essential
- Fluid restriction
- Low calories.
- Small frequent meals.
3- drugs:
- Diuretics,
- Vasodilators as Hydralazine, nitrates, ACEIs
- Inotropic agents as Digitalis(Digitoxin), Dopamine,
Dobutamine
- β-blockers

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