cardiologydr.mon5@hotmail.com 2. congestive heart failure

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Congestive Heart Congestive Heart FailureFailure

Definition

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It is inability of the heart to pump sufficient amount of blood to meet the metabolic need of the body.

It is a syndrome resulting from a diseases that interfere with cardiac function.

EtiologyI. Systolic Dysfunction.

II. Diastolic Dysfunction.

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Systolic Dysfunction1- Decrease contractility of the 1- Decrease contractility of the

myocardium:myocardium:A) Myocardial infarction:B) Valvular heart disease:.C) Hypertension.D) Cardiomyopathy. Disease direct injury to the myocardium:- toxic - idiopathic - Infilrative

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2- Increase After load:2- Increase After load:- Def. The force against which the

heart must contract.- Increase after load makes it harder

for the ventricular muscle fibre to shorten , so reducing cardiac output..

3- Decrease Preload3- Decrease Preload

--Decrease preload volume..... Sascromere stretch ---- number of actin and myosin cross bridges---- strength of contraction

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Diastolic DysfunctionTwo component of diastolic process:a)Active: Active uptake of the ca++ from

the myocardium ----- Cessation of actin- myosin cross bridges------ relaxation.

b) Passive filling after opening the valves. Any disturbance in these two processes:1- Abnormalities in ca++ uptake.2- Abnormalities in passive filling: Stiffer myocardium Hypertension

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Types of Heart FailureTypes of Heart Failure1- High out-put failure:

Cardiac out-put is still not adequate to maintain tissue perfusion---- high filling pressure.

2- Left side heart failure: (nor. Rt side).3- Right side heart failure: - Secondry to left side heart failure . - Secondary to pulmonary congestion.

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Clinical PictureSymptoms:Symptoms:1- Dyspnea: vascular congestion: (due to OP)

Reduced pulmonary Decrease lung oxygenation compliance----- work of breathing----- dyspnea.2- Orthopnea:3- Paroxysmal Nocturnal dyspnea.4- Edema.5- Nocturia.

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Signs:Signs:1- Tachycardia:2- Pulmonary Rales : left ventricular

filling pressure…………..3- Cardiac Enlargement.4- Fourth heart sound. Late diastole.5- Third --------------------------------.6- Distension neck vein.7- hepatic enlargement8- Ascitis. .

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DiagnosisDiagnosis1- Chest x-ray..2- Echocardiogram.3- Doopler.4- Cardiac cathererization.

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TherapyTherapy1- Etiologic Therapy:2- Systolic heart failure: A)enhance survival and delay progression:- Renin angiotensin system blockage:- B- Blockers: B) Symptomatic therapy:1- Reducing after load: vasodilators-----reducing

ejection resistance. 2- Increase contractile force.

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3- Diastolic Heart Failure:3- Diastolic Heart Failure:- Diueretics.- Releif Iscaemia.

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4- Non- Pharmacological Agent:

1- Cardiac resynchronization.2- Sodium restriction.3- Diueretics.4- fluid restriction.5- Weight reduction.6- Moderate physical activity.

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