Heart failure

Heart failure is a state in which the ventricle at normal filling pressures cn't maintain an adequte cardiac output to meet the metabolic needs of peripheral tissues or cn do so only wit an elevated filling pressure.

PaTHOPHYSIOLOGY
 - it is charactesised by dercrases in caradiac out put. In heart failure, preload is increase, afterload is increase n myocadrdibl contractibility is decrease.

TYPES OF HEART FAILURE(HF)
 - acute n chronic hf
 - High output n low out put hf.
 - left, right sided n biventricular hf.
 - forward n backward hf.
 - systolic n diastolic hf.

CAUSES
1 PRESSURE OVERLOAD OF VENTRICLE
 - Systemic HT
 - Pulmonary HT
 - AS
 - pulmonary stenosis

2 VOLUME OVERLOAD OF VENTRICLE
 - mitral regurgitation
 - aortic regurgitation
 - VSD
 - ASD

3 INFLOW OBSTRUCTION OF VENTRICLE
 - MS
 - Tricuspid stenosis
 - endomycardial fibrosis

4 IMPAIARED VENTRICLE FUNCTION
 - myocarditis
 - cardiomyopathy
 - MI

C/F
1 Dyspnoea
 - intially on exertional. But on progresse even at rest.
2 Orthopnoea
3 PND
4 Cardiac asthama
 - characterised by wheezing 2ndry to bronchospasm.
 - prominent at night.

5 Acute pulmnary odema
 - sever form elevate pulmonary pressur leading to alveolar oedema.
 - characterised by severe breathlessness, cough wit copious, pinkish, frothy expectoration.

6 Cheyne strokes respirtation
 - periodic breathing wit alternate periods of apnoea n hyperventilation seen in advancf hf.

7 Nocturia
 - its feuture of early hf.

8 Cerebral symp.
 - confusion, difficulty in concentration. Memory impairment:) headache insomnia n anxity.

9 Non specific symptoms
 - fatigue n weakness
 - low garde fever
 - anorexia, nausea, abdominal pain

10 Cardiac oedema
 - due to gravity, cardiac oedema accumulates over dependent parts.
 - in advanced stages, there is anasarca

11 Cyanosis
 - mainly affects lip n nail beds.

12 Pulse
 - sinus tachycardia
 - pulsus alterance is the sign of sever hf

13 BP
 - Decrease due to reduced stroke volume.
 - hypotension is prominent in acute hf.

14 JVP
 - Raised

15 Heart sounds
 - 3rd heart sounds in an adult is suggestive of hf.

16 RS
 - Dull percussion note over the lung bases.
 - inspiratory crepitation over lung base.

17 Liver
 - rt upper quadrant pain from stretching of the capsule of the liver.
 - liver is enlarge n tender
 - jaundic is late feture.

18 Kidney
 - oliguria
 - prerenal azotaemia.

19 Cardiac cachexia

INVESTIGATION
1 CHEST x ray - may shows cardiomegaly
 - prominence of upper lobe veins.
 - kerley A n B lines.
 - other feuture of pulm. Oedema

2 ECG

3 ECHOCARDIOGRAPHY

4 EXERCISE STRESS TESTING

MANAGEMENT O HF
1 Physical n emotional rest
2 Correction of obesity
3 ACE inhibitors in all pts
 - captopril 6.25 mg tid
 - enalapril 2.5 mg/day
 - lisinopril 2.5 mg/day

4 Beta blocker in all pts
 - carvedilol 3.125 mg/day
 - bisoprolol 1.25 mg /day

5 Diuretics use if pt has volume overload
 - furosemide 20-60 mg PO, IV, IM
 - Spironolactone 50-200 mg PO

6 Digoxin
 - Loading dose 0.25-0.5 mg orally or iv followed by 0.25 mg 6 hrly to dose of 1- 1.5 mg
 - maintaince dose 0.125-0.375 orally

7 aldosterone receptor blockade wit spironolactone is recommended for pt who remain severely symptomatic despite appropriate doses of ACE inhibitores n diurfatics.

8 Vasodilators

9 Restiction of sodium intake

10 mechanisn of removal of fluid by thoracentesis, paracentesis n dailysis use in sever case.