Congestive heart failure Ivan Cerovečki Mentor: A. Žmegač Horvat

Elementary notions Cardiac output Peripheral circulation Preload Afterload

Definition of CHF Complex syndrome Impaired function of the heart Compromised peripheral perfusion

Epidemiology Prevalence in Europe: 2 % Prevalence > 65 yrs: 10 % 1st year mortality: 30 – 40 % 5 year mortality: 60 – 70 %

Clinical characteristics Acute heart failure Chronic heart failure

Clinical characteristics Left heart failure Right heart failure Biventricular (congestive) heart failure

Aetiology Cardiac pathology Ischaemic heart disease Hypertensive heart disease Cardiomyopathy Valvular heart disease Congenital heart disease Pericardial disease

Aetiology Extracardiac pathology Pulmonary disease: pulmonary embolism Endocrine and metabolic disease Infective disease Toxic substances: alcohol

Pathophysiology Sympathetic activation Increased heart rate Increased myocardial contractility Venous vasoconstriction Arteriolar vasoconstriction

Pathophysiology RAAS system Arteriolar vasoconstriction Fluid retention

Pathophysiology Natriuretic peptides Diuretic effect Natriuretic effect Hypotensive effect

Pathophysiology Ventricular dilatation Increase in metabolic requirements

Clinical features Common symptoms Fatigue Dyspnoea Palpitations Weight gain

Clinical features Left heart failure Paroxysmal nocturnal dyspnoea Orthopnoea Basal lung crackles Presence of the third heart sound

Clinical features Right heart failure Jugular venous distension Hepatomegaly Peripheral oedema

Diagnostics Chest X-ray ECG Blood tests Echocardiography Natriuretic peptide

Treatment Vasodilator therapy ACE inhibitors Angiotensin II receptor antagonists Nitrates Hydralazine

Treatment β – blockers Metoprolol Bisoprolol Carvedilol

Treatment Diuretics Loop diuretics Thiazide diuretics Potassium–sparing diuretics

Treatment Digoxin Dopamine Dobutamine Antiarrhythmic drugs

Treatment Revascularization Biventricular pacemaker Cardiac transplantation

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

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