TARUN KUMAR DHATARWAL GROUP NO.45

INTERNATIONAL SCHOOL OF MEDICINE BISHKEK

KYRGYZSTAN

THERAPY PRESENTATION

CHRONIC HEART FAILURE

CHRONIC HEART FAILURE

Heart failure, sometimes known as congestive heart failure, occurs when your heart muscle doesn't pump blood as well as it should. Certain conditions, such as narrowed arteries in your heart (coronary artery disease) or high blood pressure, gradually leave your heart too weak or stiff to fill and pump efficiently.

CAUSES

Chronic heart failure. More often, heart failure develops

slowly as observed in the following states:i) Myocardial ischaemia from atherosclerotic

coronary artery diseaseii) Multivalvular heart diseaseiii) Systemic arterial hypertensioniv) Chronic lung diseases resulting in hypoxia

and pulmonary arterial hypertensionv) Progression of acute into chronic failure

CAUSES (CONTINUE)

Other conditions that may increase your risk for developing heart failure include:

cardiomyopathy, which is a disorder of the heart muscle that causes the heart to become weak

a congenital heart defect a heart attack heart valve disease certain types of arrhythmias, or irregular heart rhythms high blood pressure emphysema, a disease of the lung diabetes an overactive or underactive thyroid HIV AIDS severe forms of anemia, which is a deficiency of red blood cells certain cancer treatments, such as chemotherapy drug or alcohol abuse

In chronic heart failure, compensatory mechanisms like tachycardia, cardiac dilatation and cardiac hypertrophy try to make adjustments so as to maintain adequate cardiac output. This often results in well-maintained arterial pressure and there is accumulation of oedema.

CHRONIC HEART FAILURE

Chronic heart failure is the most common cardiac cause of chronic dyspnoea. Symptoms may first present on moderate exertion, such as walking up a steep hill, and may be described as a difficulty in ‘catching my breath’.

As heart failure progresses, the dyspnoea is provoked by less exertion and ultimately the patient may be breathless walking from room to room, washing, dressing or trying to hold a conversation. Other symptoms may include:

SYMPTOMS

• Orthopnoea. Lying down increases the venous return to the heart and provokes breathlessness. Patients may prop themselves up with pillows to prevent this.

• Paroxysmal nocturnal dyspnoea. In patients with severe heart failure, fluid shifts from the interstitial tissues of the peripheries into the circulation within 1–2 hours of lying down. Pulmonary oedema supervenes, causing the patient to wake and sit upright, profoundly breathless.

SYMPTOMS

excessive fatiguesudden weight gaina loss of appetitepersistent coughing irregular pulseheart palpitationsabdominal swellingshortness of breathleg and ankle swellingprotruding neck veins

DIAGNOSIS

BLOOD TESTSECGECHOCARDIOGRAPHYTHYROID TESTELECTROLYTE AND SERUM UREA TESTBNP:-Brain natriuretic peptide(BNP) is elevated in heart failure and is a

marker of risk; it is useful in the investigation of patients with breathlessness or peripheral oedema

DIAGNOSIS CONTINUE

Echocardiography is very useful and should be considered in all patients with heart failure in order to:

determine the aetiologydetect hitherto unsuspected valvular heart

disease, such as occult mitral stenosis, and other conditions that may be amenable to specific remedies

identify patients who will benefit from long-term therapy with drugs, such as ACE inhibitors

OTHER TESTS:-CHEST X-RAY:-Specific abnormalities can

rule out CHF as an explanation for the person’s symptoms and signs.

Cardiomegaly, pulmonary venous changes and interstitial oedema of lung fields support the diagnosis o f C H F.

Normal chest X-ray does not exclude CHF.

SURGERY

Some people with heart failure will need surgery, such as coronary bypass surgery. During this surgery, your surgeon will take a healthy piece of artery and attach it to the blocked artery. This allows the blood to bypass the blocked, damaged artery and flow through the new one.

Your doctor may also suggest an angioplasty. In this procedure, a tube, or catheter, with a small balloon attached is inserted into the blocked or narrowed artery. Once the catheter reaches the damaged artery, your surgeon inflates a balloon to open the artery. Your surgeon may need to place a permanent stent into the blocked or narrowed artery. A stent is a wire mesh tube that permanently holds your artery open. A stent can help prevent further narrowing of the artery.

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