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Congestive heart failure Ivan Cerovečki Mentor: A. Žmegač Horvat

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  • Congestive heart failureIvan CerovekiMentor: A. mega Horvat

  • Elementary notionsCardiac output

    Peripheral circulation

    Preload

    Afterload

  • Definition of CHFComplex syndrome

    Impaired function of the heart

    Compromised peripheral perfusion

  • EpidemiologyPrevalence in Europe: 2 %

    Prevalence > 65 yrs: 10 %

    1st year mortality: 30 40 %

    5 year mortality: 60 70 %

  • Clinical characteristicsAcute heart failure

    Chronic heart failure

  • Clinical characteristicsLeft heart failure

    Right heart failure

    Biventricular (congestive) heart failure

  • AetiologyCardiac pathology

    Ischaemic heart disease

    Hypertensive heart disease

    Cardiomyopathy

    Valvular heart disease

    Congenital heart disease

    Pericardial disease

  • AetiologyExtracardiac pathology

    Pulmonary disease: pulmonary embolism

    Endocrine and metabolic disease

    Infective disease

    Toxic substances: alcohol

  • PathophysiologySympathetic activation

    Increased heart rate

    Increased myocardial contractility

    Venous vasoconstriction

    Arteriolar vasoconstriction

  • PathophysiologyRAAS system

    Arteriolar vasoconstriction

    Fluid retention

  • PathophysiologyNatriuretic peptides

    Diuretic effect

    Natriuretic effect

    Hypotensive effect

  • PathophysiologyVentricular dilatation

    Increase in metabolic requirements

  • Clinical featuresCommon symptoms

    Fatigue

    Dyspnoea

    Palpitations

    Weight gain

  • Clinical featuresLeft heart failure

    Paroxysmal nocturnal dyspnoea

    Orthopnoea

    Basal lung crackles

    Presence of the third heart sound

  • Clinical featuresRight heart failure

    Jugular venous distension

    Hepatomegaly

    Peripheral oedema

  • DiagnosticsChest X-ray

    ECG

    Blood tests

    Echocardiography

    Natriuretic peptide

  • TreatmentVasodilator therapy

    ACE inhibitors

    Angiotensin II receptor antagonists

    Nitrates

    Hydralazine

  • Treatment blockers

    Metoprolol

    Bisoprolol

    Carvedilol

  • TreatmentDiuretics

    Loop diuretics

    Thiazide diuretics

    Potassiumsparing diuretics

  • TreatmentDigoxin

    Dopamine

    Dobutamine

    Antiarrhythmic drugs

  • TreatmentRevascularization

    Biventricular pacemaker

    Cardiac transplantation

  • ReferencesVrhovac B et al: Interna medicina, Naklada Ljevak, 2008Ballinger A, Patchett S: Pocket Essentials of Clinical Medicine, Elsevier Saunders, 2007United States National Library of Medicine (nlm.nih.gov)Wikipedia (wikipedia.org)

  • The end