B. Left-sided HF SOB
A. Right-sided HF
Edema in the feet, ankles, legs, liver,
If the amount of fluid is
accumulates in the abdomen.
Fluid accumulation in the liver or
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.
Depression & decline in mental function
Tests & diagnosis
1. Medical history & physical examination.
2. Check for the presence of risk factors such
3. Blood tests
1. kidney & thyroid function
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
7. Ejection fraction (EF).
1.The key to preventing HF is to
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.
2.Weigh loss for obese patients
3. dietary sodium
4. alcohol & fluids
5. fat & cholesterol
Values of therapeutic intervention
Decrease afterload an Preload
Oppose Aldosterone mediated
Renal Na+ retention
Cardiac and vascular remodeling
Inotropes (Digoxin, PDE inh., Dobutamine)
Increase myocardial cell contractility
(Carvedilol, Bisoprolol, Metoprolol)
Lower deleterious sympathetic
nervous system effects:
Slow Heart rate
Decrease blood pressure
Promote adaptive remodeling
(Hydralazine + Nitrates)
Decrease afterload and preload
Neseritide (ANP analogue)
Stages of HF and DOC
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.
What stage is his HF?
Which side is his HF?
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:
pre- & afterload
renal blood flow.
2. Non-beneficial Effect:
rapid BP fall
slow CO response
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.
Vasodilation, DIURESIS & REMODELING REGRESSION
These are the beneficial triad for ACEI
Decreased Angiotensin II & NE & increased Bradykinin (BK) & substance P BK stimulates B1 receptors
increased PGI2, NO & EDRF
BK increases natriuresis via direct tubular effect
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
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