Congestive heart failureIvan CerovečkiMentor: A. Žmegač Horvat

Elementary notions• Cardiac output

• Peripheral circulation

• Preload

• Afterload

Definition of CHF

•Complex syndrome

•Impaired function of the heart

•Compromised peripheral perfusion

Epidemiology• Prevalence in Europe: 2 %

• Prevalence > 65 yrs: 10 %

• 1st year mortality: 30 – 40 %

• 5 year mortality: 60 – 70 %

Clinical characteristics• Acute heart failure

• Chronic heart failure

Clinical characteristics

•Left heart failure

•Right heart failure

•Biventricular (congestive) heart failure

Aetiology• Cardiac pathology

Ischaemic heart disease

Hypertensive heart disease

Cardiomyopathy

Valvular heart disease

Congenital heart disease

Pericardial disease

Aetiology• Extracardiac pathology

Pulmonary disease: pulmonary embolism

Endocrine and metabolic disease

Infective disease

Toxic substances: alcohol

Pathophysiology• Sympathetic activation

Increased heart rate

Increased myocardial contractility

Venous vasoconstriction

Arteriolar vasoconstriction

Pathophysiology• RAAS system

Arteriolar vasoconstriction

Fluid retention

Pathophysiology• Natriuretic peptides

Diuretic effect

Natriuretic effect

Hypotensive effect

Pathophysiology• Ventricular dilatation

Increase in metabolic requirements

Clinical features• Common symptoms

Fatigue

Dyspnoea

Palpitations

Weight gain

Clinical features

•Left heart failure

Paroxysmal nocturnal dyspnoea

Orthopnoea

Basal lung crackles

Presence of the third heart sound

Clinical features

•Right heart failure

Jugular venous distension

Hepatomegaly

Peripheral oedema

Diagnostics• Chest X-ray

• ECG

• Blood tests

• Echocardiography

• Natriuretic peptide

Treatment

•Vasodilator therapy

ACE inhibitors

Angiotensin II receptor antagonists

Nitrates

Hydralazine

Treatment

•β – blockers

Metoprolol

Bisoprolol

Carvedilol

Treatment

•Diuretics

Loop diuretics

Thiazide diuretics

Potassium–sparing diuretics

Treatment

•Digoxin

•Dopamine

•Dobutamine

•Antiarrhythmic drugs

Treatment

•Revascularization

•Biventricular pacemaker

•Cardiac transplantation

References

•Vrhovac B et al: Interna medicina, Naklada Ljevak, 2008

•Ballinger A, Patchett S: Pocket Essentials of Clinical Medicine, Elsevier Saunders, 2007

•United States National Library of Medicine (nlm.nih.gov)

•Wikipedia (wikipedia.org)

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