congestive cardiac failure

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Classification, signs and sypmtoms of congestive heart failure

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  • 1. Congestive Heart Failure

2. Classification 3. Generally classified as the following :

  • Left vs right failure
  • Systolic vs diastolic dysfunction
  • Backward vs forward failure
  • Low output vs high output cardiac failure
  • The degree of functional impairment conferred by the abnormality (as in the NYHA functional classification)

4. New York Heart Association Functional Classification

  • Class I:No limitation experienced in any activity and no symptoms from ordinary activities.
  • Class II : Mild limitation of activity and comfortable at rest or mild exertion
  • Class III : Marked limitation of any activity and comfortable only at rest
  • Class IV : Any physical activity brings discomfort and symptoms appear at rest

5. 6. Signs and symptoms 7. Left Sided Failure- Symptoms

  • Backward Failure :Respiratory compromise
  • Dyspnea on exertion
  • Dyspnea at rest (severe)
  • Orthopnea (on lying flat)
  • Paroxysmal nocturnal dyspnea (cardiac asthma)
  • Nocturnal cough

8. Left Sided Failure- Symptoms

  • Forward Failure:Poor systemic circulation
  • Dizziness
  • Confusion
  • Cool extremities at rest
  • Easy fatigueability
  • Exercise intolerance

9. Right Sided Failure- Symptoms

  • Backward Failure :Congestion of systemic capillaries
  • Excess fluid accumulation in the body
  • Peripheral edema/ anasarca
  • Dependent edema (foot, ankle, sacral)
  • Nocturia
  • Ascites
  • Liver congestion (hepatomegaly, jaundice and coagulopathy)
  • Forward Failure :Hypotension

10. 11. Left Sided Failure- Signs

  • Non specific signs of respiratory distress:
  • Tachypnea
  • Increased work of breathing
  • Decreased vital capacity
  • Development of pulmonary edema:
  • Rales/Crackles initially at base, throughout the lung when severe
  • Extremely severe pulmonary edema:
  • Cyanosis (severe hypoxemia)

12. Left Sided Failure- Signs

  • Laterally displaced apex beat (heart enlargement)
  • S3 gallop rhythm (increased blood flow/ increased intra cardiac pressure)
  • Heart murmurs- indicative of valvular diseases (Cause or result of heart failure)

13. Right Sided Failure- Signs

  • Peripheral pitting edema
  • Hepatomegaly
  • Jugular venous pulse accentuated by hepatojugular reflux (marker of fluid status)
  • Positive abdominojugular test
  • Parasternal heave (increased RV pressure)
  • Ascites (late onset)

14. Ascites Pitting Edema ofAnkle 15. Cardiomegaly Pulmonary Edema 16. Biventricular Failure

  • Pleural effusions- more common in biventricular failures.
  • Unilateral failures cause right sided effusions (large area of right lung)
  • Signs:
  • Dullness of lung fields
  • Reduced breath sounds at lung bases

17. Other signs

  • Cardiomegaly
  • Weight loss
  • Tachycardia (>120 bpm)
  • Pink frothy sputum (severe)

18. Measuring elevated JVP Common symptoms of CCF (overview) 19. References

  • Internet
  • www.wikipedia.org
  • www.wrongdiagnosis.com
  • www.medicinenet.com
  • Davidsons Principles and Practice of Medicine, 20 thEd.
  • Harrisons Manual of Internal Medicine, 17 thEd.

20. Thank You

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