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DEFINITION
Heart failure is the inability of the heart to supply adequate blood flow and therefore oxygen delivery to the peripheral tissues and organs
EPIDEMIOLOGY Only cardiovascular disease with
increasing incidence and prevalance
due to Aging population Increased survival after MI--thrombolysis Improvement of medical and surgical
treatment
PATHOPYSIOLOGY Heart is a pump which works with the
lungs. It pumps blood from the heart to the lungs
to pick up oxygen. The oxygenated blood returns to the heart It then pumps blood out into the circulatory
system
CLASSIFICATION OF HEART FAILUREThis is based on:How rapid symptoms develop---acute HF ---chronic HFWhich ventricle is involved---right side HF ---left side HFOver all cardiac output---systolic HF ---diastolic HF
CLASSIFICATION ACCORDING TO ONSET OF SYMPTOMS:
Acute heart failure--characterized by a rapid onset of heart failure that may
occur following 1- MI 2-myocarditis 3-arrythmias 4- infection 5- PEIf it is not fatal may progress to chronic heart failure
Chronic heart failureThis results from the heart undergoing
adaptive responses to precipitating cause and this cardiac response leads to impaired function.
1- anemia2-thyrotoxicosis3-non compliance to medications4- diet—high salt
CLASSIFICATION ACCORDING TO OVER ALL CARDIAC OUTPUT
Systolic heart failure
The ventricle loses its ability to contract so the heart is unable to pump forcefully enough to get blood into the circulation.
Diastolic heart failure
The ventricle loses its ability to relax , the muscle are stiff so the heart is unable to fill with blood during resting cycle
CLASSIFICATION ACCORDING TO VENTRICLE INVOLVED
Left side heart failure This involves the left atrium, left ventricle,mitral
and aortic valve Patient presents with --- dyspnoe,orthopnoe and PND --- basal crepitations --- 3rd heart sound--gallop
Right side heart failure
This involves the right atrium, the right ventricle , the tricuspid and the pulmonary valve.
Patient usually does not present with dyspnoe , orhtopnoe or PND
Raised JVP Clear lung field Ascites Lower limb edema
ETIOLOGY Myocardial infarction Coronary artery disease Valvular heart disease Idiopathic cardiomyopathy Viral or bacterial cardiomyopathy myocarditis
ETIOLOGY cont. Toxins—anthracyclines
amphetamine
cocaine Metabolic---haemachromatosis
wilson,s disease
pheochromocytoma
SYMPTOMS
NYHA classification of dyspnoe Class 1—no shortness of breath {SOB} Class 11—SOB on severe exertion Class 111—SOB on mild exertion Class 1v---SOB at rest
SYMPTOMS cont.{ FACES} Fatigue Activity decrease Cough { specially supine,frothy red sputum Edema Shortness of breath { NYHA }
SIGNS Non productive cough Diffuse laterally displaced apex beat Raised JVP Hepatojugular reflex Hepatomegaly Resting tachycardia
Oliguria Crepitations Pleural effusion Pulses alternans { severe cases} S3 gallop Unexplained weight gain Ankle swelling Ascites