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HEART FAILURE 2 PROF. DR. MUHAMMAD AKBAR CHAUDHRY M.R.C.P.(U.K) F.R.C.P.(E) F.R.C.P.(LONDON) F.A.C.C. DESIGNED AT A.V. DEPTT F.J.M.C. BY RABIA KAZMI

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C.Arginine vasopressin (increased preload and afterload) D.Atrial Natriuretic peptides (decreased afterload) E.Prostaglandins F.Peptides G.Frank-starling law of the heart H.hypertrophy COMPENSATORY MECHANISMS IN HEART FAILURE :

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I.Peripheral oxygen delivery Redistribution of cardiac output Altered oxygen-haemoglobin dissociation Increased oxygen- extraction by tissues J.Anaerobic metabolism COMPENSATORY MECHANISMS IN HEART FAILURE :

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PATHOGENESIS OF PULMONARY EDEMA

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Scheme of the sequence of events in heart failure

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INVESTIGATIONS IN HEART FAILURE de hy s

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INVESTIGATIONS IN HEART FAILURE

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Abnormality Preload Afterload Contractility Heart rate and rhythm Therapy Salt restriction, diuretics Venous vasodilators Arterial vasodilators Angiotensin-converting enzyme inhibitors, angiotensin ii receptor blockers Inotropic agents Beta blockers(??) Pacemaker Antiarrhythmic agents, Devices, beta blockers THERAPY OF HEART FAILURE

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HEART FAILURE Management A. MILD HEART FAILURE: Search for curable cause Decrease physical activity slightly Omit salt Diuretics; thiazide (with k) digitalis

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Management B. Moderately severe heart failure Search for curable cause Decrease physical activity moderately Thiazide / frusemide diuretics with k Digitalis Vasodilators A.C.E. Inhibitors HEART FAILURE +

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MANAGEMENT OF SEVERE CHRONIC HEART FAILURE Management C. Severe chronic heart failure Search for curable etiology Strict bed rest Loop diuretics with potassium supplement Digitalis If no response add k sparing Diuretics Add Thiazide diuretics Vasodilators A.C.E. inhibitors Nitroglycerine locally at night +

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ACUTE HEART FAILURE, PULMONARY OEDEMA Prop- up position O therapy Morphine 5-10 mg (if no contra -indication) If Bronchospasm Aminophylline Loop diuretics I/V Vasodilators Treatment of Arrhythmias Treat underlying cause 2

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VASODILATOR Rx IN HEART FAILURE Peripheral resistance Venous tone Stroke volume Peripheral perfusion BP Wall tension MVo End diastolic volumeMR LEVDP Pulm congestion Collar CBF 2 BP SV T PR SCHEMATIC DIAGRAM OF THE MAJOR ACTION OF VASODILATOR THERAPY IN HEART FAILURE

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POSSIBLE MECHANISIMS BY WHICH BETA- ADRENERGIC BLOCKERS IMPROVE VENTRICULAR FUNCTION IN CHRINIC CONGESTIVE HEART FAILURE

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CHRONIC HEART FAILURE____CHOICE OF PHARMACOLOGIC THERAPY

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