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Congestive heart failureIvan Cerovečki Mentor: A. Žmegač Horvat
Elementary notions Cardiac output Peripheral circulation PreloadAfterload
Definition of CHF Complex syndrome Impaired function of the heartCompromised peripheral perfusion
Epidemiology Prevalence in Europe: 2 % Prevalence > 65 yrs: 10 %1st year mortality: 30 – 40 % 5 year mortality: 60 – 70 %
Clinical characteristicsAcute heart failure Chronic heart failure
Clinical characteristicsLeft heart failure Right heart failure Biventricular (congestive) heart failure
Aetiology Cardiac pathology Ischaemic heart diseaseHypertensive heart disease Cardiomyopathy Valvular heart disease Congenital heart disease Pericardial disease
Aetiology Extracardiac pathology Pulmonary disease: pulmonary embolismEndocrine and metabolic disease Infective disease Toxic substances: alcohol
Pathophysiology Sympathetic activation Increased heart rateIncreased myocardial contractility Venous vasoconstriction Arteriolar vasoconstriction
Pathophysiology RAAS system Arteriolar vasoconstrictionFluid retention
Pathophysiology Natriuretic peptides Diuretic effectNatriuretic effect Hypotensive effect
Pathophysiology Ventricular dilatationIncrease in metabolic requirements
Clinical features Common symptoms Fatigue Dyspnoea PalpitationsWeight gain
Clinical features Left heart failure Paroxysmal nocturnal dyspnoeaOrthopnoea Basal lung crackles Presence of the third heart sound
Clinical features Right heart failure Jugular venous distensionHepatomegaly Peripheral oedema
Diagnostics Chest X-ray ECG Blood tests EchocardiographyNatriuretic peptide
Treatment Vasodilator therapy ACE inhibitorsAngiotensin II receptor antagonists Nitrates Hydralazine
Treatment β – blockers Metoprolol Bisoprolol Carvedilol
Treatment Diuretics Loop diuretics Thiazide diureticsPotassium–sparing diuretics
Treatment Digoxin Dopamine Dobutamine Antiarrhythmic drugs
Treatment Revascularization Biventricular pacemakerCardiac transplantation
References Vrhovac B et al: Interna medicina, Naklada Ljevak, 2008Ballinger 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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