1. Congestive heart failure
Ivan Cerovečki
Mentor: A. Žmegač Horvat

2. Elementary notions Cardiac output Peripheral circulation Preload
Afterload

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

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

5. Clinical characteristics
Acute heart failure
Chronic heart failure

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

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

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

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

10. Pathophysiology RAAS system Arteriolar vasoconstriction
Fluid retention

11. Pathophysiology Natriuretic peptides Diuretic effect
Natriuretic effect
Hypotensive effect

12. Pathophysiology Ventricular dilatation
Increase in metabolic requirements

13. Clinical features Common symptoms Fatigue Dyspnoea Palpitations
Weight gain

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

15. Clinical features Right heart failure Jugular venous distension
Hepatomegaly
Peripheral oedema

16. Diagnostics Chest X-ray ECG Blood tests Echocardiography
Natriuretic peptide

17. Treatment Vasodilator therapy ACE inhibitors
Angiotensin II receptor antagonists
Nitrates
Hydralazine

18. Treatment
β – blockers
Metoprolol
Bisoprolol
Carvedilol

19. Treatment Diuretics Loop diuretics Thiazide diuretics
Potassium–sparing diuretics

20. Treatment
Digoxin
Dopamine
Dobutamine
Antiarrhythmic drugs

21. Treatment Revascularization Biventricular pacemaker
Cardiac transplantation

22. 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)

23. The end