Congestive Heart Failure Lecture

8/9/2019 Congestive Heart Failure Lecture

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CONGESTIVE HEARTCONGESTIVE HEARTFAILUREFAILURE


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IS CHF AN ACTUAL MEDICALIS CHF AN ACTUAL MEDICALDIAGNOSIS?DIAGNOSIS?


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CHF is the common end point fo m!n"CHF is the common end point fo m!n"

foms of c!di!c dise!se !nd t"pic!##"foms of c!di!c dise!se !nd t"pic!##"

is ! po$essi%e condition th!t c!iesis ! po$essi%e condition th!t c!ies

!n e&teme#" poo po$nosis!n e&teme#" poo po$nosis


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Con$esti%e He!t F!i#'eCon$esti%e He!t F!i#'e

The in!(i#it" of the he!t to s'pp#"The in!(i#it" of the he!t to s'pp#"

eno'$h (#ood cic'#!tion to meet theeno'$h (#ood cic'#!tion to meet the

(od")s needs*(od")s needs*

Res'#ts in !cc'm'#!tion ofRes'#ts in !cc'm'#!tion of

e&t!%!sc'#! f#'idse&t!%!sc'#! f#'ids


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C!di!c c!thetei+!tion is 'sed to st'd" the %!io's

f'nctions of the he!t*


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, mi##ion c!ses in the US, mi##ion c!ses in the US

,,-.--- ne/ conditions0"e!,,-.--- ne/ conditions0"e!

1--.-- de!ths pe "e!1--.-- de!ths pe "e!In !## !$e $o'ps CHF is the fo'thIn !## !$e $o'ps CHF is the fo'th

most common medic!# conditionmost common medic!# condition


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2oo po$nosis2oo po$nosis

,-3 de!th !te (" "e! ,,-3 de!th !te (" "e! ,,- 4 5-3 de!th !te /ithin one "e! if,- 4 5-3 de!th !te /ithin one "e! if

s"mptoms !e se%ees"mptoms !e se%ee


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6ho Gets CHF?6ho Gets CHF?

He!t f!i#'e c!n h!ppen toHe!t f!i#'e c!n h!ppen to

!n"one. ('t it is moe common!n"one. ('t it is moe common

in7in72eop#e 5, "e!s of !$e !nd o#de2eop#e 5, "e!s of !$e !nd o#de

Afic!n Ameic!nsAfic!n Ameic!ns


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CHF in Afic!n Ameic!nsCHF in Afic!n Ameic!ns

Afic!n Ameic!ns !e moe #i8e#" toAfic!n Ameic!ns !e moe #i8e#" to

h!%e he!t f!i#'e !nd s'ffe moeh!%e he!t f!i#'e !nd s'ffe moe

se%ee#" fom it7se%ee#" fom it7

De%e#op s"mptoms !t !n e!#ie !$eDe%e#op s"mptoms !t !n e!#ie !$e

H!%e thei he!t f!i#'e $et /ose f!steH!%e thei he!t f!i#'e $et /ose f!ste

H!%e moe hospit!# %isitsH!%e moe hospit!# %isitsDie fom he!t f!i#'eDie fom he!t f!i#'e


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Gende diffeences in CHFGende diffeences in CHF

Men !#so h!%e ! hi$he !te of he!tMen !#so h!%e ! hi$he !te of he!t

f!i#'e th!n /omen*f!i#'e th!n /omen*9't in !ct'!# n'm(es. moe /omen9't in !ct'!# n'm(es. moe /omen

h!%e he!t f!i#'e (ec!'se m!n"h!%e he!t f!i#'e (ec!'se m!n"

moe /omen #i%e into thei :-s !ndmoe /omen #i%e into thei :-s !nd

;-s /hen he!t f!i#'e is common*;-s /hen he!t f!i#'e is common*


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Con$esti%e He!t Dise!seCon$esti%e He!t Dise!se

C!'sed (" the in!(i#it" of the he!t toC!'sed (" the in!(i#it" of the he!t to

f'nction efficient#" !s ! p'mpf'nction efficient#" !s ! p'mp


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Physiology Terms You MUSTPhysiology Terms You MUST

UnderstandUnderstand

PreloadPreload

AfterloadAfterload

Stroke VolumeStroke VolumeCardiac OutputCardiac Output

aroreceptor !efle"aroreceptor !efle"

!enin#Angiotensin System!enin#Angiotensin System


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rief O$er$ie%rief O$er$ie%


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2oo p'mpin$2oo p'mpin$

mech!nism #e!ds to7mech!nism #e!ds to7

Incomp#ete fi##in$ of theIncomp#ete fi##in$ of the

%entic#es d'in$ di!sto#e%entic#es d'in$ di!sto#e

Dece!se in c!di!c o'tp'tDece!se in c!di!c o'tp'tIn!de


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2oo p'mpin$2oo p'mpin$

mech!nism #e!ds to7mech!nism #e!ds to7

In!deNom!#>,,>:-3,,>:-3

CHFCHF>,>,-3 !nd (e#o/>,>,-3 !nd (e#o/


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C!din!# M!nifest!tions of CHF7C!din!# M!nifest!tions of CHF7

F!ti$'eF!ti$'e

D"spne!D"spne!

Con$estion ofCon$estion of

p'#mon!" %esse#sp'#mon!" %esse#s


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The He!tThe He!t

t/o p'mps in !t/o p'mps in !

seiesseies

connected %i!connected %i!p'#mon!" !ndp'#mon!" !nd

s"stemic cic'#!tions"stemic cic'#!tion

e!ch side of he!te!ch side of he!t

h!s @ %!#%es /hichh!s @ %!#%es /hich

m!int!in one sidedm!int!in one sided

(#ood f#o/(#ood f#o/


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Ri$ht %entic#eRi$ht %entic#ep'mps #!$e %o#'mes ofp'mps #!$e %o#'mes of

(#ood !t #o/ pess'e tho'$h the(#ood !t #o/ pess'e tho'$h thep'#mon!" cic'#!tionp'#mon!" cic'#!tion

Left %entic#eLeft %entic#eis ! thic8 /!##ed !ndis ! thic8 /!##ed !nd

p'mps !t hi$he pess'e !nd is moep'mps !t hi$he pess'e !nd is moeeffected (" dise!se pocesseseffected (" dise!se pocesses


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NHA CHF C#!ssific!tionNHA CHF C#!ssific!tion

C#!ss IC#!ss I B!s"mptom!ticB!s"mptom!tic No #imit!tion of ph"sic!# !cti%it"No #imit!tion of ph"sic!# !cti%it"

C#!ss IIC#!ss II S#i$ht #imit!tion of ph"sic!# !cti%it"S#i$ht #imit!tion of ph"sic!# !cti%it"

C#!ss IIIC#!ss III

M!8ed #imit!tion of !cti%it"M!8ed #imit!tion of !cti%it"C#!ss IVC#!ss IV S"mptoms !t estS"mptoms !t est


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Ameic!n He!t Associ!tion0Ameic!n He!t Associ!tion0

Ameic!n Co##e$e of C!dio#o$"Ameic!n Co##e$e of C!dio#o$"Stage AStage A

Patients ha$e risk factors predisposing to &' (ut noPatients ha$e risk factors predisposing to &' (ut no

symptomssymptoms

CA)* &T+* )MCA)* &T+* )M

Stage Stage

!isk factors plus ,V& and-or dysfunction!isk factors plus ,V& and-or dysfunction

Stage CStage C

Past or present symptoms of &' %ith heart damagePast or present symptoms of &' %ith heart damage

Stage )Stage )

Patients ha$e se$ere &' needing ad$anced treatment orPatients ha$e se$ere &' needing ad$anced treatment or

end of life careend of life care


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CAUSES OF CHFCAUSES OF CHF

Most commonMost common

'nde#"in$ c!'se'nde#"in$ c!'se

Coon!" Ate"Coon!" Ate"

Dise!se BCADDise!se BCADInce!sed %!sc'#!Ince!sed %!sc'#!

esist!nceesist!nce

H"petension in :,3H"petension in :,3

of CHF p!tientsof CHF p!tients HTN is not ! pim!"HTN is not ! pim!"

c!'se ho/e%ec!'se ho/e%e


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C!'ses of CHFC!'ses of CHF

Di#!ted o h"petophicDi#!ted o h"petophic

c!diom"op!th"c!diom"op!th"

Idiop!thicIdiop!thic

A#coho# !('seA#coho# !('se

Heedit!"Heedit!"

c!diom"op!th"c!diom"op!th"

Vi!# infectionVi!# infection


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& t i & t )i& t i & t )i


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&ypertensi$e &eart )isease.&ypertensi$e &eart )isease.Myocardial &ypertrophyMyocardial &ypertrophy

Left %entic'#! h"petoph"7Left %entic'#! h"petoph"7 ,V outflo% o(struction or,V outflo% o(struction orincreased peripheral $ascular resistanceincreased peripheral $ascular resistance4thic8ened LV4thic8ened LV /!##/!##

Ri$ht %entic'#! h"petoph" Bco p'#mon!#e7Ri$ht %entic'#! h"petoph" Bco p'#mon!#e7!V load increased due to pulmonary resistance !V load increased due to pulmonary resistance di#!ted RVdi#!ted RV ch!m(ech!m(e


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Othe C!'ses of CHFOthe C!'ses of CHF

V!#%'#! he!tV!#%'#! he!t

dise!sedise!se

M"oc!di!#M"oc!di!#

Inf!ctionInf!ctionM"oc!ditisM"oc!ditis

Infecti%eInfecti%e

Endoc!ditisEndoc!ditis

Con$enit!# he!tCon$enit!# he!t

dise!sedise!se

2'#mon!"2'#mon!"

h"petensionh"petension2'#mon!"2'#mon!"

em(o#ismem(o#ism

Endocine dise!seEndocine dise!se


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CardiomyopathiesCardiomyopathies

Di#!ted7Di#!ted7 symmetricallysymmetricallyenlargedenlarged /0#1" normal2 %ith/0#1" normal2 %ith

dilation in all cham(ersdilation in all cham(ers

H"petophic7H"petophic7 $entricular$entricular

hypertrophy %ithout dilationhypertrophy %ithout dilation**oftenoften asymmetricalasymmetricalseptalseptal

hypertrophyhypertrophy

Resticti%e7Resticti%e7 oftenoften (ilateral(ilateral

$entricular hypertrophy %ithout$entricular hypertrophy %ithoutdilationdilation/(ut atria are often/(ut atria are often

dilateddilated (ilaterally2#Ventricular(ilaterally2#Ventricular

%all is stiffer%all is stiffer


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Left sided he!t f!i#'eLeft sided he!t f!i#'e

HTNHTNAotic dise!seAotic dise!se

Mit!# dise!seMit!# dise!se

Coon!" he!t dise!seCoon!" he!t dise!se


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Ri$ht sidedRi$ht sidedhe!t dise!sehe!t dise!se

Most commonMost commonc!'se isc!'se is

left sided failureleft sided failure

Co p'#mon!#eCo p'#mon!#e


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S G S S O S OSIGNS d SM2TOMS OF


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SIGNS !nd SM2TOMS OFSIGNS !nd SM2TOMS OF

CHFCHF

LHF>2'#mon!"LHF>2'#mon!"

D"spne!D"spne!

Othopne!Othopne!

2!o&"sm!#2!o&"sm!#

noct'n!# d"spne!noct'n!# d"spne!

2'#mon!"2'#mon!"

h"petensionh"petension

RHF>S"stemicRHF>S"stemic

Distended ='$'#!Distended ='$'#!

%eins%eins

2eiphe!# edem!2eiphe!# edem!

Li%e p!inLi%e p!in

6ei$ht $!in6ei$ht $!in


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2ND2ND

2!o&"sm!# noct'n!# d"spne!2!o&"sm!# noct'n!# d"spne!

An !tt!c8 of s'dden !nd se%eeAn !tt!c8 of s'dden !nd se%eeshotness of (e!th th!t !/!8ens theshotness of (e!th th!t !/!8ens the

p!tient fom s#eep. 's'!##" /ithin top!tient fom s#eep. 's'!##" /ithin to

1 ho's !fte the p!tient $oes to (ed1 ho's !fte the p!tient $oes to (ed

!nd eso#%es /ithin 1- min'tes !fte!nd eso#%es /ithin 1- min'tes !fte

the p!tient !ises often $!spin$ fo !i*the p!tient !ises often $!spin$ fo !i*


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Othopne!Othopne!

2osition!#2osition!#

d"spne!d"spne!

/osened (" !/osened (" !

ec'm(ent oec'm(ent osemiec'm(entsemiec'm(ent

positionposition


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2ND 0 Othopne!2ND 0 Othopne!

)ue to increased $enous return)ue to increased $enous return

encouraged (y the semi#reclined positionencouraged (y the semi#reclined position

resulting in increases in pulmonaryresulting in increases in pulmonary

$enous pressure and al$eolar edema$enous pressure and al$eolar edema

Cheyne#Stokes reathingCheyne#Stokes reathing

Alternating cycles of hyper$entilation andAlternating cycles of hyper$entilation and

apneaapnea


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Side Effects of He!t F!i#'eSide Effects of He!t F!i#'e

Renin>An$iotensin s"stem stim'#!tedRenin>An$iotensin s"stem stim'#!ted

S"mp!thetic Ne%o's s"stem stim'#!tionS"mp!thetic Ne%o's s"stem stim'#!tion

Res'#ts in7Res'#ts in7

Ince!sed he!t !te0cont!cti#it" of he!tInce!sed he!t !te0cont!cti#it" of he!t

Ince!sed peiphe!# esist!nceInce!sed peiphe!# esist!nce

Sodi'm 0 6!te etention BSodi'm 0 6!te etention BR!#es0C!c8#esR!#es0C!c8#es

9#ood edisti('tion to he!t !nd (!in9#ood edisti('tion to he!t !nd (!in

Ince!sed efficienc" of o&"$en 'se ("Ince!sed efficienc" of o&"$en 'se ("

tiss'estiss'es


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3hat is the difference43hat is the difference4

Compens!tedCompens!ted

Decompens!tedDecompens!ted


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Pitting 5demaPitting 5dema

@ 1


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Symptoms of &eart 'ailure

)


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6 )yspnea

6 'atigue and %eakness

6 Orthopnea

6 Paro"ysmal nocturnal dyspnea6 Acute pulmonary edema

6 5"ercise intolerance

6 )ependent edema /after standing or

%alking26 !eport of %eight gain or increased

a(dominal girth /fluid accumulation7 ascites2

6 !ight upper 8uadrant pain /li$er congestion2

6 Anore"ia* nausea* $omiting* constipation

/(o%el edema26 &yper$entilation follo%ed (y apnea during

sleep /Cheyne#Stokes respiration2


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Signs of C&'Signs of C&'

)isplaced Apical pulse)isplaced Apical pulse

Mitral regurgitationMitral regurgitation

S1 - S9 :allopS1 - S9 :allop

Pulsus AlternansPulsus Alternans


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Pulsus AlternansPulsus Alternans

Arterial (lood pressureArterial (lood pressure%a$e form%a$e form

Most accurate measureMost accurate measureof (lood pressure perof (lood pressure perheart (eatheart (eat

Pulsus Alternans ;Pulsus Alternans ;alternating strong andalternating strong and

%eak (eats%eak (eats


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,a(oratory 'indings,a(oratory 'indings

Tests for )iagnosis.Tests for )iagnosis.

Chest


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INCREASED VASCULARINCREASED VASCULAR

RESISTANCERESISTANCE2RIMAR CAUSE2RIMAR CAUSE

H"petensionH"petension :,3 of c!ses:,3 of c!ses

Aotic StenosisAotic Stenosis

Co!ct!tion of the Aot!Co!ct!tion of the Aot!


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DECREASED MOCARDIALDECREASED MOCARDIAL


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DECREASED MOCARDIALDECREASED MOCARDIAL

FUNCTIONFUNCTION

Ischemic he!t dise!seIschemic he!t dise!se

Infi#t!ti%e dise!sesInfi#t!ti%e dise!ses

Am"#oidosisAm"#oidosis

Met!(o#ic disodesMet!(o#ic disodes

H"poth"oidismH"poth"oidism

2h!m!co#o$ic s'ppession2h!m!co#o$ic s'ppession

2op!no#o#2op!no#o#


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INCREASED 9LOODINCREASED 9LOOD

VOLUMEVOLUME

V!#%'#! ins'fficienc"V!#%'#! ins'fficienc" Aotic o mit!# %!#%e ins'fficienc"Aotic o mit!# %!#%e ins'fficienc"

Ati!# o Ventic'#! sept!# defectAti!# o Ventic'#! sept!# defect

Chonic en!# f!i#'e /ith f#'idChonic en!# f!i#'e /ith f#'id

etentionetention


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ECESSIVE META9OLICECESSIVE META9OLICDEMANDDEMAND

Se%ee !nemi!Se%ee !nemi!

Th"oto&icosisTh"oto&icosis

MEDICAL MANAGEMENT OFMEDICAL MANAGEMENT OF


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THE CHF 2ATIENTTHE CHF 2ATIENTSt!$e A7 2!tients !t Hi$h Ris8 fo HF. ('tSt!$e A7 2!tients !t Hi$h Ris8 fo HF. ('t

/itho't St'ct'!# He!t Dise!se o/itho't St'ct'!# He!t Dise!se o

S"mptoms of HFS"mptoms of HF

Treatment of hypertension* encourage smokingTreatment of hypertension* encourage smokingcessation* treatment of lipid disorders*cessation* treatment of lipid disorders*

encouragement of regular e"ercise* discourageencouragement of regular e"ercise* discourage

alcohol intake* illicit drug use* and control ofalcohol intake* illicit drug use* and control of

meta(olic syndromemeta(olic syndrome

AC5 inhi(itors or A!s as appropriate for treatmentAC5 inhi(itors or A!s as appropriate for treatment

of $ascular disease or dia(etesof $ascular disease or dia(etes



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THE CHF 2ATIENTTHE CHF 2ATIENTSt!$e 97 2!tients /ith St'ct'!# He!tSt!$e 97 2!tients /ith St'ct'!# He!t

Dise!se. ('t /itho't Si$ns o S"mptoms ofDise!se. ('t /itho't Si$ns o S"mptoms of

HFHF

All measures for stage A* plusAll measures for stage A* plusAC5 inhi(itors /or A!s2 as appropriateAC5 inhi(itors /or A!s2 as appropriate

eta (lockers as appropriateeta (lockers as appropriate



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THE CHF 2ATIENTTHE CHF 2ATIENTSt!$e C7 2!tients /ith St'ct'!# He!tSt!$e C7 2!tients /ith St'ct'!# He!t

Dise!se /ith 2e%io's o C'ent S"mptomsDise!se /ith 2e%io's o C'ent S"mptoms

of HFof HF

All measures for stages A and * dietary saltAll measures for stages A and * dietary salt

restriction*restriction* plusplus

)rugs for routine use. diuretics* AC5 inhi(itors* (eta)rugs for routine use. diuretics* AC5 inhi(itors* (eta

(lockers(lockers

)rugs in selected patients. aldosterone antagonists*)rugs in selected patients. aldosterone antagonists*

A!s* digitalis* hydrala=ine#nitratesA!s* digitalis* hydrala=ine#nitrates

)e$ices in selected patients. (i$entricular pacing)e$ices in selected patients. (i$entricular pacing

de$ice* implanta(le defi(rillatorde$ice* implanta(le defi(rillator



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THE CHF 2ATIENTTHE CHF 2ATIENTSt!$e D7 2!tients /ith Ref!cto" HFSt!$e D7 2!tients /ith Ref!cto" HF

Re


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DRUGS USED IN THEDRUGS USED IN THE


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DRUGS USED IN THEDRUGS USED IN THE

TREATMENT OF CHFTREATMENT OF CHF

Di'eticsDi'etics

Ch#oothi!+ide. F'osemide. 2ot!ssi'm>Ch#oothi!+ide. F'osemide. 2ot!ssi'm>

sp!in$sp!in$

C!di!c G#"cosidesC!di!c G#"cosides Di$o&in. Di$it!#isDi$o&in. Di$it!#is

Afte#o!d Red'cin$ A$entsAfte#o!d Red'cin$ A$ents

ACE>inhi(itos. V!sodi#!tosACE>inhi(itos. V!sodi#!tosMost Common Side effect>Most Common Side effect> &eostomi!&eostomi!

C!di!c G#"cosides 'sed inC!di!c G#"cosides 'sed in


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C!di!c G#"cosides 'sed inC!di!c G#"cosides 'sed in

CHFCHF

Di$o&in BDi$it!#is. L!no&in.Di$o&in BDi$it!#is. L!no&in.

L!no&ic!pL!no&ic!p Ince!ses foce !nd %e#ocit" of c!di!cInce!ses foce !nd %e#ocit" of c!di!c

cont!ctioncont!ction Dece!ses cond'ction !te of A>V nodeDece!ses cond'ction !te of A>V node

O!# M!nifest!tionsO!# M!nifest!tions

Ince!sed $!$ ef#e& BimpessionsInce!sed $!$ ef#e& Bimpessionseostomi!eostomi!

Ince!sed c!iesInce!sed c!ies

Di it #i T i itDi it #i T i it


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Di$it!#is To&icit"Di$it!#is To&icit"

Di$it!#is To&icit"Di$it!#is To&icit"S"mptoms Si$nsS"mptoms Si$ns

Visual changesVisual changes/unusual2/unusual2

&alos or rings of light&alos or rings of light

around o(>ectsaround o(>ects Seeing lights or (rightSeeing lights or (right

spotsspots

Changes in colorChanges in color

perceptionperception

lind spots inlind spots in $ision$ision

lurred $isionlurred $ision

ConfusionConfusion

,oss of appetite,oss of appetite

+ausea+ausea** $omiting$omiting**

diarrheadiarrhea

PalpitationsPalpitations

?rregular?rregular pulsepulse

ACE I hi(it d i CHF
http://health.allrefer.com/health/vision-abnormalities-info.htmlhttp://health.allrefer.com/health/vision-abnormalities-info.htmlhttp://health.allrefer.com/health/vision-abnormalities-info.htmlhttp://health.allrefer.com/health/vision-abnormalities-info.htmlhttp://health.allrefer.com/health/vision-abnormalities-info.htmlhttp://health.allrefer.com/health/vision-abnormalities-info.htmlhttp://health.allrefer.com/health/appetite-decreased-info.htmlhttp://health.allrefer.com/health/appetite-decreased-info.htmlhttp://health.allrefer.com/health/nausea-and-vomiting-info.htmlhttp://health.allrefer.com/health/nausea-and-vomiting-info.htmlhttp://health.allrefer.com/health/nausea-and-vomiting-info.htmlhttp://health.allrefer.com/health/nausea-and-vomiting-info.htmlhttp://health.allrefer.com/health/pulse-info.htmlhttp://health.allrefer.com/health/pulse-info.htmlhttp://health.allrefer.com/health/heartbeat-sensations-info.htmlhttp://health.allrefer.com/health/heartbeat-sensations-info.htmlhttp://health.allrefer.com/health/pulse-info.htmlhttp://health.allrefer.com/health/pulse-info.htmlhttp://health.allrefer.com/health/pulse-info.htmlhttp://health.allrefer.com/health/heartbeat-sensations-info.htmlhttp://health.allrefer.com/health/pulse-info.htmlhttp://health.allrefer.com/health/nausea-and-vomiting-info.htmlhttp://health.allrefer.com/health/nausea-and-vomiting-info.htmlhttp://health.allrefer.com/health/appetite-decreased-info.htmlhttp://health.allrefer.com/health/vision-abnormalities-info.htmlhttp://health.allrefer.com/health/vision-abnormalities-info.htmlhttp://health.allrefer.com/health/vision-abnormalities-info.html


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ACE>Inhi(itos 'sed in CHFACE>Inhi(itos 'sed in CHF

Sho/n to ince!se #ife e&pect!nc"Sho/n to ince!se #ife e&pect!nc"

En!#opi# > V!sotecEn!#opi# > V!sotec

C!ptopi# > C!potenC!ptopi# > C!potenLisinopi# > 2ini%i#. Jesti#Lisinopi# > 2ini%i#. Jesti#

K'in!pi# > Acc'pi#K'in!pi# > Acc'pi#

O!# M!nifest!tionsO!# M!nifest!tions

Co'$hCo'$h

O!# '#ce!tion. ('nin$ p!in of m'cos!O!# '#ce!tion. ('nin$ p!in of m'cos!

An$ioedem!An$ioedem!

V di# t d i CHFV di# t d i CHF


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V!sodi#!tos 'sed in CHFV!sodi#!tos 'sed in CHF

H"d!#!+ine > Apeso#ineH"d!#!+ine > Apeso#ine

2!+osin 4 Minipes B!>(#oc8e2!+osin 4 Minipes B!>(#oc8e O!# m!nifest!tionsO!# m!nifest!tions

D" mo'thD" mo'th

L'p's>#i8e #esionsL'p's>#i8e #esions

9e s'e to e!d T!(#e 5>9e s'e to e!d T!(#e 5>

COM2LICATIONS OF DRUGSCOM2LICATIONS OF DRUGS


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COM2LICATIONS OF DRUGSCOM2LICATIONS OF DRUGS

USED TO TREAT CHFUSED TO TREAT CHF

Di'eticsDi'etics

H"po8!#emi!. deh"d!tion. &eostomi!H"po8!#emi!. deh"d!tion. &eostomi!

C!di!c G#"coside O%edoseC!di!c G#"coside O%edose Life the!tenin$ !h"thmi!Life the!tenin$ !h"thmi!

V!sodi#!tosV!sodi#!tos

Othost!tic h"potensionOthost!tic h"potension

D Sid Eff t i CHFD Sid Eff t i CHF


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D'$ Side>Effects in CHFD'$ Side>Effects in CHF

Othost!tic h"potensionOthost!tic h"potension

Di'etics !nd %!sodi#!tosDi'etics !nd %!sodi#!tos

A"thmi!sA"thmi!s

Di$o&inDi$o&in

N!'se!. %omitin$N!'se!. %omitin$

Di$o&in !nd %!sodi#!tosDi$o&in !nd %!sodi#!tos

2!#pit!tions2!#pit!tions Di$o&in !nd %!sodi#!tosDi$o&in !nd %!sodi#!tos

Ri 8 f D t # T t tRi 8 f D t # T t t


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Ris8s of Dent!# Te!tmentRis8s of Dent!# Te!tment

Untreated or Poorly Managed C&'Untreated or Poorly Managed C&'

C!di!c Aest BAh"thmi!C!di!c Aest BAh"thmi!

CVACVA

MIMI

M di # C id tiM di # C id ti


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Medic!# Conside!tionsMedic!# Conside!tions

Thoo'$h Medic!# Histo" Thoo'$h Medic!# Histo"

Re%ie/ of s"stems BC!diop'#mon!"Re%ie/ of s"stems BC!diop'#mon!"

Vit!# Si$nsVit!# Si$ns

2'#se. !te. h"thm. 92. esi!tions2'#se. !te. h"thm. 92. esi!tions

Identific!tion of !## medicines t!8enIdentific!tion of !## medicines t!8en

DENTAL EVALUATION OFDENTAL EVALUATION OF


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THE CHF 2ATIENT BROSTHE CHF 2ATIENT BROS

A(i#it" to /!#8 'p st!isA(i#it" to /!#8 'p st!is

S#eepin$ on ince!sed n'm(e ofS#eepin$ on ince!sed n'm(e of

pi##o/spi##o/sShotness of (e!thShotness of (e!th

9e!th#essness /hen f#!t9e!th#essness /hen f#!t

S/o##en !n8#esS/o##en !n8#es

As8 if di!$nosed /ith ! m'm'As8 if di!$nosed /ith ! m'm'



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THE CHF 2ATIENTTHE CHF 2ATIENT

Mot!#it" R!te > ,-3 !t fi%e "e!sMot!#it" R!te > ,-3 !t fi%e "e!s

2!tient !t #o/ is82!tient !t #o/ is8

Histo" of mi#d con$esti%e he!t f!i#'eHisto" of mi#d con$esti%e he!t f!i#'e

As"mptom!tic on the!p"As"mptom!tic on the!p"

Us'!##" on di'etics. /ith o /itho'tUs'!##" on di'etics. /ith o /itho't

c!di!c $#"cosidesc!di!c $#"cosides



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2!tient !t Mode!te is82!tient !t Mode!te is8

Histo" of mode!te#" se%ee CHFHisto" of mode!te#" se%ee CHF

As"mptom!tic !t est ('tAs"mptom!tic !t est ('t

s"mptoms on e&etions"mptoms on e&etion

Us'!##" on moe potent di'eticsUs'!##" on moe potent di'etics

!nd c!di!c $#"cosides!nd c!di!c $#"cosides


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2!tient !t Hi$h Ris82!tient !t Hi$h Ris8

S"mptom!tic despite the!p" BRef!cto"S"mptom!tic despite the!p" BRef!cto"

he!t f!i#'ehe!t f!i#'e

Often on esc!#!tin$ doses of medic!tions.Often on esc!#!tin$ doses of medic!tions.

inc#'din$ %!sodi#!tosinc#'din$ %!sodi#!tos

Dent!# M!n!$ement of theDent!# M!n!$ement of the


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$$

CHF 2!tientCHF 2!tient

eep p!tient in 'pi$ht o ,eep p!tient in 'pi$ht o ,oopositionposition

Est!(#ish NHA c#!ssific!tionEst!(#ish NHA c#!ssific!tion

Chec8 medic!tionsChec8 medic!tionsC!'tio's 'se of epinephineC!'tio's 'se of epinephine

Chec8 fo di$it!#is to&icit"Chec8 fo di$it!#is to&icit"

6!tch fo othost!tic h"potension6!tch fo othost!tic h"potensionShot monin$ !ppointmentsShot monin$ !ppointments


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9efoe An" Te!tment. M!8e9efoe An" Te!tment. M!8e

S'e The 9enefits O't/ei$hS'e The 9enefits O't/ei$h

The Ris8s In%o#%ed To TheThe Ris8s In%o#%ed To The2!tient2!tient

MANAGEMENT OF CHF AND ACUTEMANAGEMENT OF CHF AND ACUTE


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2ULMONAR EDEMA2ULMONAR EDEMA

Sit p!tient 'pi$htSit p!tient 'pi$ht

Administe o&"$enAdministe o&"$en

N!s!# c!nn'#! pefeedN!s!# c!nn'#! pefeed

Recod %it!# si$nsRecod %it!# si$ns

92. he!t !te !nd h"thm. espi!to" !te92. he!t !te !nd h"thm. espi!to" !te

A##e%i!te !ppehensionA##e%i!te !ppehension

S'mmon medic!# !ssist!nceS'mmon medic!# !ssist!nce

Loc!# An!esthetic in CHFLoc!# An!esthetic in CHF


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2!tients2!tients

C#!ss I !nd II BNHAC#!ss I !nd II BNHA

M!&im'm -*-15 m$ of epinephineM!&im'm -*-15 m$ of epinephine -*@- m$ of #e%onodephine-*@- m$ of #e%onodephine

C#!ss III !nd IV BNHAC#!ss III !nd IV BNHA

A%oid %!soconstictosA%oid %!soconstictos


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Documents

Congestive Heart Failure Lecture