Congestive heart failureIvan CerovekiMentor: A. mega Horvat

Elementary notionsCardiac output

Peripheral circulation

Preload

Afterload

Definition of CHFComplex syndrome

Impaired function of the heart

Compromised peripheral perfusion

EpidemiologyPrevalence in Europe: 2 %

Prevalence > 65 yrs: 10 %

1st year mortality: 30 40 %

5 year mortality: 60 70 %

Clinical characteristicsAcute heart failure

Chronic heart failure

Clinical characteristicsLeft heart failure

Right heart failure

Biventricular (congestive) heart failure

AetiologyCardiac pathology

Ischaemic heart disease

Hypertensive heart disease

Cardiomyopathy

Valvular heart disease

Congenital heart disease

Pericardial disease

AetiologyExtracardiac pathology

Pulmonary disease: pulmonary embolism

Endocrine and metabolic disease

Infective disease

Toxic substances: alcohol

PathophysiologySympathetic activation

Increased heart rate

Increased myocardial contractility

Venous vasoconstriction

Arteriolar vasoconstriction

PathophysiologyRAAS system

Arteriolar vasoconstriction

Fluid retention

PathophysiologyNatriuretic peptides

Diuretic effect

Natriuretic effect

Hypotensive effect

PathophysiologyVentricular dilatation

Increase in metabolic requirements

Clinical featuresCommon symptoms

Fatigue

Dyspnoea

Palpitations

Weight gain

Clinical featuresLeft heart failure

Paroxysmal nocturnal dyspnoea

Orthopnoea

Basal lung crackles

Presence of the third heart sound

Clinical featuresRight heart failure

Jugular venous distension

Hepatomegaly

Peripheral oedema

DiagnosticsChest X-ray

ECG

Blood tests

Echocardiography

Natriuretic peptide

TreatmentVasodilator therapy

ACE inhibitors

Angiotensin II receptor antagonists

Nitrates

Hydralazine

Treatment blockers

Metoprolol

Bisoprolol

Carvedilol

TreatmentDiuretics

Loop diuretics

Thiazide diuretics

Potassiumsparing diuretics

TreatmentDigoxin

Dopamine

Dobutamine

Antiarrhythmic drugs

TreatmentRevascularization

Biventricular pacemaker

Cardiac transplantation

ReferencesVrhovac B et al: Interna medicina, Naklada Ljevak, 2008Ballinger A, Patchett S: Pocket Essentials of Clinical Medicine, Elsevier Saunders, 2007United States National Library of Medicine (nlm.nih.gov)Wikipedia (wikipedia.org)

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