CIRCULATORY HEART FAILURE (CHF)‏ Katedra Kardiologii i Chorób Wewnętrznych Collegium Medicum im. Ludwika Rydygiera w Bydgoszczy Uniwersytet Mikołaja Kopernika w Toruniu CIRCULATORY HEART FAILURE (CHF)‏ Maria Bogdan

Congestive Heart Failure

HEART FAILURE The most common reason for hospitalization in adults >65 years old. 1 in 100 adults has HF

HEART FAILURE Normal heart function 04/11/2009

Pathophysiological mechanisms of CHF CARDIAC ABNORMALITIES Frank-Starling Mechanism Compensatory hypertrophy Ventricular remodeling Coronary arteries Mitral regurgitation Arrhythmias OTHER MECHANISMS Redistribution of cardiac output NEUROHORMONAL Renin-angiotensin- aldosterone system Sympathetic nervous system Natriuretic peptides Vasodilator peptides Cytokines Matrix Metalloproteinases

90/140= 64% EF: 55-65 normal

Congestive Heart Failure

Congestive Heart Failure Common Causes Chronic Acute CAD Hypertensive HD Rheumatic Heart Dis Congenital Heart Dis Cor pulmonale Cardiomyopathy Anemia Bacterial endocarditis Valvular disorders Acute MI Dysrhythmias Pulmonary emboli Thyrotixicosis Hypertensive crisis Rupture of papillary muscle VSD Myocarditis

The most common causes of CHF Remember that CHF is a syndrome, so always look for an underlying cause! Ischemic heart disease ~ 40 percent Dilated cardiomyopathy ~ 30 percent Primary valvular heart disease ~ 15 percent Hypertensive heart disease ~ 10 percent Other ~ 5 percent

Zawał serca ściany dolnej

Zawał serca ściany przedniej

Zawał serca ściany dolnej i prawej komory

Clinical Manifestations of CHF SYMPTOMS Fluid overload Dyspnea Orthopnea Paroxysmal nocturnal dyspnea Cardiac asthma Cheyne-Stokes Respiration Fatigue, weakness Exercise intolerance Decreased urine output Confusion Lethargy Nocturia Anorexia PHYSICAL SIGNS Rales Tachycardia Displaced PMI S3 (ventricular gallop) S4 (atrial gallop) Pulmonary HTN (loud P2) Neck vein distention Hepatic enlargement Peripheral edema Ascites Pleural effusion Cardiac Cachexia Jaundice Skin cold and clammy Pulsus alternans

Symptoms

Heart Failure Clinical Manifestations Acute decompensated heart failure (ADHF) Pulmonary edema, often life-threatening Early Increase in the respiratory rate Decrease in PaO2 Later Tachypnea Respiratory acidemia

Congestive Heart Failure

Congestive Heart Failure Pulmonary Edema

CHF/ Pulmonary Edema

Right Sided Congestive Heart Failure

Congestive Heart Failure Complications Pleural effusion Dysrhythmias Left ventricular thrombus Hepatomegaly – impaired liver function Acute Pulmonary Edema

Transesophageal echocardiogram TEE

PATIENT TEACHING Joint Commission has mandated 6 areas of discharge teaching

Discharge Teaching 6 areas Weight Monitoring Medications Activity Diet What to do if symptoms worsen Follow-up

Thank you for your attention