Heart Failure Tutorial

Topics: Myocardial infarction, Hypertension, Cardiology Pages: 6 (544 words) Published: September 30, 2013
TUTORIAL 5

HEART FAILURE

Pathophysiology

B. Left-sided HF SOB

A. Right-sided HF

Orthopnea
Edema in the feet, ankles, legs, liver,
& abdomen.
If the amount of fluid is

fluid

accumulates in the abdomen.
Fluid accumulation in the liver or
stomach

nausea & loss of appetite.

Eventually, food is not absorbed well
loss of weight & muscle.
This condition is called Cardiac Cachexia

Paroxysmal nocturnal dyspnea
Tiredness & weakness
A sudden accumulation of a high amount of fluid
in the lungs (acute pulmonary edema)
extreme difficulty in breathing, tachypnea,
cyanosis, & feelings of restlessness & anxiety.
Bronchospasms & wheezing.
Cheyne-Stokes respiration
Stroke
Depression & decline in mental function

Tests & diagnosis
1. Medical history & physical examination.
2. Check for the presence of risk factors such
as HTN.
3. Blood tests
1. kidney & thyroid function
2. BNP
4. Chest X-ray
In HF:1. The heart may appear enlarged.
2. Fluid buildup may be visible in lungs.
5. ECG heart rhythm problems & damage to
the heart from a heart attack that may be
underlying HF.
6. Echocardiogram.
7. Ejection fraction (EF).

Prevention
1.The key to preventing HF is to

risk factors.

2.Control or elimination of many risk factors for heart disease (HTN, CAD) by making lifestyle changes along with the help of any needed medications.
1.Stop smoking
2.Weigh loss for obese patients
3. dietary sodium
4. alcohol & fluids
5. fat & cholesterol
6. stress
7.Exercise
8.Sleep easy

Values of therapeutic intervention
Therapy

Value

ACE inhibitors

Decrease afterload an Preload

Aldosterone antagonists

Oppose Aldosterone mediated
effects:
Renal Na+ retention
Cardiac and vascular remodeling

Inotropes (Digoxin, PDE inh., Dobutamine)

Increase myocardial cell contractility

Beta blockers
(Carvedilol, Bisoprolol, Metoprolol)

Lower deleterious sympathetic
nervous system effects:
Slow Heart rate
Decrease blood pressure
Promote adaptive remodeling
(reverse remodeling)

Vasodilator therapy
(Hydralazine + Nitrates)

Decrease afterload and preload

Neseritide (ANP analogue)

Decrease preload

Stages of HF and DOC

Case 2
History
W.N. is a 60 year old hypertensive man with a history of
heart failure. He is a heavy smoker and consumes high
sodium in his diet. He was admitted to the hospital after
experiencing SOB , fatigue, Confusion and disorientation.
His HF symptoms also appeared at rest. He is suffering
from Pulmonary edema , bronchospasm and chyenestrokes respiration.

Questions
What stage is his HF?
Stage IV
Which side is his HF?
Left sided

What drug therapy do you recommend?
ACEI or ARB and diuretic and inotropic
digoxin and spironolactone
What is the beneficial triad of ACEI and
what is its beneficial and non beneficial
effect on kidney?

Effects of ACEIs & ARBs on Kidney
function of HF Patients
1. Beneficial Effect:
ACEI/ARB
pre- & afterload

CO

renal blood flow.

2. Non-beneficial Effect:
Initial therapy
rapid BP fall
slow CO response
worsening
of renal function.
Prediction of which event to occur is impossible
ACEI/ARB therapy:Initiated with dose.
Slow in dose.
Careful BP & renal function monitor.
Diuretic dose is adjusted to avoid volume depletion & hypotension.

ACEIs
Vasodilation, DIURESIS & REMODELING REGRESSION
These are the beneficial triad for ACEI

Vasodilation:
Decreased Angiotensin II & NE & increased Bradykinin (BK) & substance P BK stimulates B1 receptors

increased PGI2, NO & EDRF

VD.

BK increases natriuresis via direct tubular effect

Mild diuresis:
renal blood flow, via increased CO & locally through efferent arteriolar VD. aldosterone & vasopressin secretion.

Cardiac & Vascular Remodeling inhibition:
by lowering Angiotensin II type I Receptor- hypertrophic effects.

What are the side effects of ACEI?

What life style modification should he
adopt?...
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