Download - CONGESTIVE CARDIAC FAILURE
Presented by;
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 Endocarditis
AETIOLOGY
ETIOPATHOGENESIs
ADAPTIVE AND MALADAPTIVE MECHANISMS
1. The Frank-Starling mechanism
2. Compensatory hypertrophy
3. In ventricular remodeling
4.Redistribution of a subnormal cardiac
REDUCTION IN CARDIAC EFFICIENCY
ALTERATIONS IN ENERGY METABOLISM
ALTERATIONS IN SARCOMERIC PROTEINS
MYOCARDIAL CELL DEATH
ABNORMALITIES OF EXCITATION-CONTRACTION
COUPLING
Loss of contractile function due to;
•Pressure overload of the heart
•Work overload of the heart
•Loss of myocardium
•Generalized decrease in contractility
Impaired cardiac function(congestive signs & symptoms)
Compensatory mechanisms:
Cardiac compensatory mechanism
•Ventricular dilation
•Ventricular hypertrophy
Peripheral compensatory mechanism
•Increased sympathetic activity
•Activation of RAAS
•Increased afterload
•Increased blood volume
•Receptor changes
PATHOPHYSIOLOGY
CLINICAL 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
IMAGING
•Echocardiography
•Chest X-rays/ Chest Radiograph
ELECTROPHYSIOLOGY
Electrocardiogram (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 intake
PHARMACOLOGICAL MANAGEMENT•ACE’sCaptopril, Enalapril, Lisinopril, Perindopril, Ramipril, Trandolapril•ARB’sCandesartencilexetil, Eprosartan, Irbesartan, Losartan, Olmesartan, Telmisartan,Valsartan•Beta adrenergic blocking agentsBisoprolol, Metoprolol, Carvedilol•DiureticsThiazide- Chlorothiazide, Hydrochlorothiazide, Indapamide, ChlorthalidoneLoop diuretics- Furosemide, Ethacrynic acid, Bumetanide, TorsemidePotassium sparing diuretics- Amiloride, Spironolactone, Triamterene•Aldosterone antagonistsSpironolactone, Eplerenone•VasodilatorsNitroprusside, Hydralazine, Prazosin, Nitrates•Digitalis glycosidesDigitalis (Digoxin)•Calcium channel blockers•Inotropic agentsDopamine i.v, Dobutamine, Inamrinone, Milrinone, Nesiritide