Heart Failure

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Heart Failure

(Congestive cardiac failure)

Types

• Left Ventricular Failure
  • symptoms mainly due to poor cardiac output and back pressure on lungs
• Right Ventricular Failure
  • symptoms mainly due to back pressure in venous system
• Congestive Cardiac Failure = combination
• High-Output

Aetiology

• Ischaemic heart disease
• Valvular Heart Disease
• Cardiomyopathy
  • Dilated
  • Restricted
  • Hypertrophic Obstructive Cardiomyopathy (HOCM)
• Arrythmias
• Alcohol
• Cardiotoxic drugs
• Idiopathic
• Genetic
• Chaga's disease

Pathophysiology

• complex
• impaired cardiac systolic function
• neuro-hormonal response gives paradoxically worsening condition
• sympathetic system up-regulated
  • fluid retention
  • renin-angiotensin-aldosterone axis activated

Symptoms

• Dyspnoea
• Orthopnoea / PND
• Tiredness / weakness
• fluid retention
  • peripheral oedema
  • ascites
• hepatic congestion
  • pain
  • bloated feeling
  • nausea
  • LFT derangements

Examination

• Dyspnoea
• Oedema
• Hands
  • cool
  • peripheral cyanosis
• Pulse
  • tachycardia
  • poor volume
•  ↓ BP
• Neck
  • JVP raised
• Praecordium
  • displaced apex beat
  • 3rd Heart sound
  • Mitral / Tricuspid Regurgitation murmurs
• Lung Bases
  • Inspiratory Crackles
  • Pleural Effusion
• Sacral Oedema
• Peripheral oedema

Investigation

• ECG
• CXR
• Bloods
• Echocardiogram

Treatment

• educate about diet and exercise
• benefits of smoking cessation
• exacerbating factors
  • hypertension
  • arrhythmias
• Beta blockers
  • bisoprolol / carvedilol / metoprolol MR reduce mortality
• spironolactone
• diuretics
• ACE inhibitors
• Vasodilators
• Inotropic agents
  • digoxin
• anti-arrythmics
  • amiodarone
• surgery (if cause clear and sufficient cardiac output)
  • CABG
  • valve replacement
  • transplant

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