HEART FAILURE

Definition

A clinical picture resulting from decreased cardiac performance with cardiac output lower in comparison with peripheral necessities.

Etiology

Cardiomyopathies (primary myocardial disease )Ischemic heart diseaseHaemodynamic overloadArrhythmiasIn fact any severe heart disease is possible to evolute towards heart failure syndrome

Pathology

myocardial cells performance of existing myocites

Pathophysiology

systolic performance (LV, RV or both) diastolic performance (LV, RV or both)forward heart failure ( cardiac output)backward heart failure (congestive syndrome)left side heart failureright side heart failurechronic heart failureacute heart failure

Pathogenesis

Adaptation mechanisms I

HypertrophyDilatation heart rate (tachycardia) contractility (notfunctionning)

Adaptation mechanisms II

peripheral A +V O2 extractionRedistribution of cardiac output

peripheral vasoconstriction

blood volume and of venous return

( Na and H2O retention)

Realised through:

CathecolaminesRAA system

The proposed explanation for the Starling effect, whereby a greater end-diastolic fiber length develops a greater force.

Signs and symptoms

Signs and symptoms

Heart:

- sinus tachycardia

- ventricular gallop (S3)

- regurgitation systolic murmur:

- mitral regurgitation

- tricuspid regurgitation

2. exercise capacity

Congestive syndrom

Lungs: - dyspnea,

- rales,

- dullness,

- pleural effusion

Liver: - hepathomegaly

- tenderness

Peripheral edemaAscites, pleural effusion, pericardial effusion (rare)Venous distention : jugular hepatojugular refluxCyanosis: - peripheral

- central

Low output syndrom

Weakness, fatiguePallor weightOliguria SBP DBPCerebral symptoms

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Investigations

Echocardiography

- LV, RV or both

- contractility

- LA, RA or both

- LVEF, RVEF or both

- PAPs

- MR, TR

- diastolic LV dysfunction:

- abnormal relaxation

- pseudonormalisation

- restriction

Rx (chest x ray)

cardiac chambersCardiothoracic ratio >0,55Pulmonary congestionPulmonary arterial hypertensionPleural effusion

ECG

- always abnormal

Morphologycal abnormalities

- of the underlying disease

- necrosis

- hypertrophy

- arrhythmias:

- atrial fibrillation

- ventricular: PVB, VT,

- sinus tachycardia

Exercise stress testing

To establish the exercise capacity (METS) and NYHA class (also possible an a clinical basis)

Rare investigations

Cardiac angiographyCoronarographyMyocardial biopsyMRI CT multislice

Biochemical date

BNP, ANPLipidsLiver function tetsGlycemiaIons: Na, KCreatinineHaematocrit

TREATMENT

TREATMENT

TREATMENT

Pulmonary Edema

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Pulmonary edema is a condition characterized by fluid accumulation in the lungs caused by back pressure in the lung veins. This results from malfunctioning of the heart.

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Pulmonary edema is a complication of a myocardial infarction (heart attack), mitral or aortic valve disease, cardiomyopathy, or other disorders characterized by cardiac dysfunction.

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PRECIPITANTS AND CAUSES OF ACUTE HEART FAILURE

Fluid backs up into the veins of the lungs. Increased pressure in these veins forces fluid out of the vein and into the air spaces (alveoli). This interferes with the exchange of oxygen and carbon dioxide in the alveoli.

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Extreme shortness of breath, severe difficult breathingFeeling of "air hunger" or "drowning" "Grunting" sounds with breathing Inability to lie down RalesWheezing Anxiety

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Restlessness Cough Excessive sweatingPale skinNasal flaringCoughing up bloodBreathing, absent temporarily

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Listening to the chest with a stethoscope (auscultation) may show crackles in the lungs or abnormal heart sounds.A chest x-ray may show fluid in the lung space. An echocardiogram may be performed in addition to (or instead of) a chest x-ray.

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Blood oxygen levels (low)

A chest X-ray may reveal the following:

Fluid in or around the lung space

Enlarged heart

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An ultrasound of the heart (echocardiogram) may reveal the following:

Weak heart muscle

Leaking or narrow heart valves

Fluid surrounding the heart

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INTRAVENOUS VASODILATORS USED TO TREAT ACUTE

HEART FAILURE