congestive cardiac failure

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Aiswarya.A.T,First year M.Pharm.,Dept. of Pharmacy Practice,Grace college of pharmacy.Heart failure is a clinical syndrome in which an abnormality of cardiac structure or function is responsible for the inability of heart to eject or fill with blood at a rate commensurate with the requirements of the metabolizing tissues.

CLASSIFICATION Left ventricular dysfunction Right ventricular dysfunction Biventricular HF Left ventricular systolic dysfunction Left ventricular diastolic dysfunction Ischaemic HF Non-ischaemic HF Acute HF Chronic HF Low output HF High output HF Forward HF Backward HF Compensated HF Cardiac failure is a common condition with a prevalence ranging from 3-5% in the population over 65 years old & between 8-16% of those aged over 75years.

It is the leading cause for hospitalization in people older than 65. In developed countries, the mean age of patients with heart failure is 75years old.

Heart failure is more common in men than in women until age 65 years, reflecting the greater incidence of coronary artery disease in men.

Improved survival of patients after myocardial infarction is a likely contributor to the increased incidence and prevalence of heart failure.EPIDEMIOLOGY Infection Arrhythmias Physical, Dietary, Fluid, Environmental & Emotional Excesses Myocardial Infarction Pulmonary Embolism Anemia Thyrotoxicosis & Pregnancy Aggravation of Hypertension Rheumatic, Viral & Other Forms of Myocarditis Infective EndocarditisAETIOLOGYETIOPATHOGENESIs

ADAPTIVE AND MALADAPTIVE MECHANISMS1. The Frank-Starling mechanism2. Compensatory hypertrophy 3. In ventricular remodeling4.Redistribution of a subnormal cardiac

REDUCTION IN CARDIAC EFFICIENCY

ALTERATIONS IN ENERGY METABOLISM

ALTERATIONS IN SARCOMERIC PROTEINS

MYOCARDIAL CELL DEATH

ABNORMALITIES OF EXCITATION-CONTRACTION COUPLINGLoss of contractile function due to;Pressure overload of the heartWork overload of the heartLoss of myocardiumGeneralized decrease in contractilityImpaired cardiac function(congestive signs & symptoms)Compensatory mechanisms:Cardiac compensatory mechanismVentricular dilationVentricular hypertrophyPeripheral compensatory mechanismIncreased sympathetic activityActivation of RAASIncreased afterloadIncreased blood volumeReceptor changesPATHOPHYSIOLOGYCLINICAL MANIFESTATIONS

Signs Pulmonary rales Pulmonary edema Cool extremities Pleural effusion Tachycardia Narrow pulse pressure Cardiomegaly Peripheral edema Jugular venous distension Hepatojugular reflux Hepatomegaly Symptoms Dyspnea, particularly on exertion Orthopnea Paroxysmal nocturnal dyspnea Exercise intolerance Tachypnea Cough Fatigue Nocturia Hemoptysis Abdominal pain Anorexia Nausea Bloating Poor appetite, early satiety Ascites Mental status changes DIAGNOSIS

IMAGINGEchocardiographyChest X-rays/ Chest Radiograph

ELECTROPHYSIOLOGYElectrocardiogram (ECG/ EKG)

BLOOD TESTS

ANGIOGRAPHY

MONITORING

MANAGEMENT

NON PHARMACOLOGICAL MANAGEMENT

Bed rest

Consuming small but frequent meals (4 to 6 daily)

Moderate sodium restriction (2 to 4g / day)

Smoking cessation

Avoid alcohol intakePHARMACOLOGICAL MANAGEMENTACEsCaptopril, Enalapril, Lisinopril, Perindopril, Ramipril, TrandolaprilARBsCandesartencilexetil, Eprosartan, Irbesartan, Losartan, Olmesartan, Telmisartan, ValsartanBeta adrenergic blocking agentsBisoprolol, Metoprolol, CarvedilolDiureticsThiazide- Chlorothiazide, Hydrochlorothiazide, Indapamide, ChlorthalidoneLoop diuretics- Furosemide, Ethacrynic acid, Bumetanide, TorsemidePotassium sparing diuretics- Amiloride, Spironolactone, TriamtereneAldosterone antagonistsSpironolactone, EplerenoneVasodilatorsNitroprusside, Hydralazine, Prazosin, NitratesDigitalis glycosidesDigitalis (Digoxin)Calcium channel blockersInotropic agentsDopamine i.v, Dobutamine, Inamrinone, Milrinone, Nesiritide

THANK YOU..!

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