2. Cardiologydr.mon5@hotmail.com 2. Congestive Heart Failure

3. Definition Cardiologydr.mon5@hotmail.com 3 It is inability of the heart to pump sufficient amount of blood to meet the metabolic need of the body. It is a syndrome resulting from a diseases that interfere with cardiac function.

4. Etiology I. Systolic Dysfunction. II. Diastolic Dysfunction. Cardiologydr.mon5@hotmail.com 4

5. Cardiologydr.mon5@hotmail.com 5 Systolic Dysfunction 1- Decrease contractility of the myocardium: myocardium: A) Myocardial infarction: B) Valvular heart disease:. C) Hypertension. D) Cardiomyopathy. Disease direct injury to the myocardium: - toxic - idiopathic - Infilrative

6. Cardiologydr.mon5@hotmail.com 6 2- Increase After load: - Def. The force against which the heart must contract. - Increase after load makes it harder for the ventricular muscle fibre to shorten, so reducing cardiac output.. 3- Decrease Preload - -Decrease preload volume..... Sascromere stretch ---- number of actin and myosin cross bridges---- strength of contraction

7. Cardiologydr.mon5@hotmail.com 7 Diastolic Dysfunction Two component of diastolic process: a) Active: Active uptake of the ca++ from the myocardium ----- Cessation of actin- myosin cross bridges------ relaxation. b) Passive filling after opening the valves. Any disturbance in these two processes: 1- Abnormalities in ca++ uptake. 2- Abnormalities in passive filling: Stiffer myocardium Hypertension

8. Cardiologydr.mon5@hotmail.com 8 Types of Heart Failure 1- High out-put failure: Cardiac out-put is still not adequate to maintain tissue perfusion---- high filling pressure. 2- Left side heart failure: (nor. Rt side). 3- Right side heart failure: - Secondry to left side heart failure. - Secondary to pulmonary congestion.

9. Cardiologydr.mon5@hotmail.com 9 Cl inical Picture Symptoms: 1- Dyspnea: vascular congestion: (due to OP) Reduced pulmonary Decrease lung oxygenation compliance----- work of breathing----- dyspnea. 2- Orthopnea: 3- Paroxysmal Nocturnal dyspnea. 4- Edema. 5- Nocturia.

10. Cardiologydr.mon5@hotmail.com 10 Signs: 1- Tachycardia: 2- Pulmonary Rales : left ventricular filling pressure………….. 3- Cardiac Enlargement. 4- Fourth heart sound. Late diastole. 5- Third --------------------------------. 6- Distension neck vein. 7- hepatic enlargement. 8- Ascitis.

11. Cardiologydr.mon5@hotmail.com 11 Diagnosis 1- Chest x-ray.. 2- Echocardiogram. 3- Doopler. 4- Cardiac cathererization.

12. Cardiologydr.mon5@hotmail.com 12 Therapy 1- Etiologic Therapy: 2- Systolic heart failure: A)enhance survival and delay progression: - Renin angiotensin system blockage: - B- Blockers: B) Symptomatic therapy: 1- Reducing after load: vasodilators-----reducing ejection resistance. 2- Increase contractile force.

13. Cardiologydr.mon5@hotmail.com 13 3- Diastolic Heart Failure: - Diueretics. - Releif Iscaemia.

14. Cardiologydr.mon5@hotmail.com 14 4- Non- Pharmacological Agent: 1- Cardiac resynchronization. 2- Sodium restriction. 3- Diueretics. 4- fluid restriction. 5- Weight reduction. 6- Moderate physical activity.

15. Cardiologydr.mon5@hotmail.com 15