heart failure
DESCRIPTION
Presentaions of Heart FaliureTRANSCRIPT
Heart Failure
Noha Khalil , MD
Definition
Heart failure is a clinical syndrome usually due to left ventricular dysfunction, resulting in acute or chronic symptoms of cardiac pump failure.
Aetiology
The most common causes of heart failure are coronary heart disease, hypertension, alcohol abuse, and idiopathic dilated cardiomyopathy
Other causes are valvular and pericardial disease; or non-cardiac diseases causing high-output cardiac failure, such as anaemia, thyrotoxicosis, septicaemia, Paget's disease of bone, and arteriovenous fistulae.
Symptoms
DYSPNEA CHEST PAIN SYNCOPE PALPITATION EDEMA COUGH HEMOPTYSIS FATIGUE CYANOSIS
DYSPNEA Abnormally uncomfortable awareness of breathing Dyspnea after strenous activity- Normal Individual Dyspnea after moderate activity – Deconditioned
Individual Dyspnea becomes abnormal only if it occurs at rest
or at a level of activity not expected to cause dyspnea
DIFFERENTIAL DIAGNOSIS OF DYSPNEA
PULMONARY
- Reactive airways disease
- COPD
- Pulmoary edema
- Pulmonary hypertension
- Infection
- Pulmonary embolism
- Pleural diseases
- Interstitial lung disease
DIFFERENTIAL DIAGNOSIS OF DYSPNEA
CARDIAC
-Ischemic heart dsease
- Right sided heart failure
- Arrhythmias
- Dilated cardiomyopathy
- Hypertrophic cardiomyopathy
- Valve stenosis and regurgitation
ACUTE DYSPNEA
Sudden development of dyspnea
- Pulmonary embolism
- Pneumonia
- Airway obstruction
CHRONIC DYSPNEA
Symptom progress slowly or gradual
- HEART FAILURE
- COPD ( chronic obstructive pulmonary disease )
PAROXYSMAL NOCTURNAL DYSPNEA
Interstitial or interalveolar pulmonary edema Secondary to ventricular failure Symptom starts 2-4 hours after sleeping, patient
arise from sleep feeling short of breath Symptom ameliorated by sitting on the side of bed
and take about 15-30 min
ORTHOPNEA
Inability to breath comfortably when lying Severe pulmonary venous congestion is the cause
of orthopnea Usually seen in advanced heart failure were
resting pulmonary venous pressure is elevated
CHEST PAIN
Cardinal manifestation of coronary heart disease There are other structures that can casue chest
pain- Intrathoracic structures like aorta, pulmonary airway, pleura and mediastinum; tissue of the neck; thoracic wall and subdiaphragmatic structures
DIFFERENTIAL DIAGNOSIS OF CHEST PAIN
PULMONARY
- pulmonary embolism
- pneumothorax
- pneumonia
NEUROMUSCULAR
- Degenerative joint disease of cervical area
- Costochondritis
- Herpes zoster
PSYCHOGENIC
- Anxiety
- Depression
GASTROINTESTINAL
- Cholecystitis
- Esophageal spasm
- GERD
QUALITY OF PAIN
Angina means tightening Unpleasant sensation which is describe as either
heaviness, pressing, squeezing or constricting
LOCATION
Anginal pain is substrenal in location Pain at times radiates to the jaw, left arm, or neck
DURATION
The pain of angina pectoris is usually brief and last between 2-10 minutes
Chest pain lasting for more than 15 minutes would fall into either UNSTABLE ANGINA OR MYOCARDIAL INFARCTION
COUGH Cough due to left ventricular failure is dry,
irritating , spasmodic and nocturnal It is due to pulmonary venous congention Cough of pulmonary disease is usually productive Cough follwed by dyspnea is usally pulmonary in
nature while dyspnea follwed by cough is cardiac in nature
HEMOPTYSIS
Expectoration of blood in sputum RBC escapes into aleveoli Rupture of bronchial vessel Necrosis and hemorrahge into the alveoli
FATIGUE
Patient with impaired cardiovascular function Decrease peripheral perfusion Muscle weakness
Chronic Heart Failure
The most specific signs are: Laterally displaced apex beat Elevated jugular venous pressure Third heart sound Less specific signs include: Tachycardia Lung crepitations Hepatic engorgement (tender hepatomegaly) Peripheral oedema
Investigations Electrocardiogram (ECG) may show acute ischaemia, arrhythmias,
left ventricular hypertrophy, left bundle branch block, or prior MI. Heart failure is unlikely if the ECG is normal, and the diagnosis
should be reconsidered in this situation. Chest X-ray (CXR)
pulmonary vascular congestion (upper lobe diversion), pulmonary oedema effusions cardiomegaly
Chronic Heart Failure
B-type natriuretic peptide (BNP) and its N-terminal fragment (NTproBNP)
New diagnostic test A raised concentration of either has been shown to have a
sensitivity of greater than 90% and a specificity of 80-90% for the diagnosis of heart failure.
Heart failure is unlikely if the level of BNP or NTproBNP is normal, especially if the ECG is also normal, and the diagnosis should be reconsidered in this situation.
Medication
Drug treatments should be initiated in the following order:
ACE inhibitor - with diuretic if needed - for NYHA Grades I-IV.
Angiotensin-II receptor antagonist - if intolerant of ACE inhibitor.
Beta-blocker - for NYHA Grades I-IV. Spironolactone - for NYHA Grades III-IV. Digoxin - for NYHA Grades II-IV.
Thank you