Congestive Heart Failure

Congestive Heart Failure

1. definition

   • heart is unable to provide adequate perfusion

2. types

   • Left-sided heart failure
     • causes
       • ischemic heart disease
       • systemic hypertension
       • valve disease
         • mitral
         • aortic
     • general symptoms
       • pulmonary congestion
       • renal & cerebral dysfunction
   • Right-sided heart failure
     • symptoms
       • peripheral edema
         • Mechanism of edema
           • Increased capillary hydrostatic pressure
           • Reduced plasma oncotic pressure
           • Lymphatic obstruction
           • Sodium water retention
           • Inflammation
           • Increased capillary permeability
       • visceral congestion
     • causes
       • primary pulmonary disorders
       • left heart failure

3. Risk Factors

   • Coronary artery disease
   • HBP
   • Heart attack
   • Diabetes
   • Sleep apnea
   • Congenital heart defects
   • Viruses
   • Alcohol use
   • Tobacco use
   • Obesity
   • Irregular heartbeats

4. mechanism of compensation

5. Complication

   • Arrhythmias
   • Heart Valve Problems
   • Lung Congestion
   • Cardiac Cachexia
   • Anemia
   • Liver Damage

6. Investigation

   • ECG
   • Echocardiogram
   • x-ray

7. Management

   • Non-pharmacological
     • diet
     • excercise
   • pharmacological
     • intropics
       • Digoxin
         • MOA
           • inhibits Na+/K+ ATPase
           • (-)ve chronotropic effect
           • increase parasympathetic activity
         • Pharmacokinetic
           • Oral availability 70%
           • Protein-binding 20-40%
           • Medium lipid solubility
           • large VD
             • crosses the placenta
             • high concentrations
               • myocardium
               • brain
               • liver
               • skeletal muscle
           • 20% metabolized
           • Half-life 36-40 hours
         • Therapeutic Uses of Digoxin
           • Management of HF
           • atrial flutter
           • atrial flutter
         • contraindicated
           • myocarditis
           • Ventricular tachycardia
           • ventricular fibrillation
           • Heart block
           • Wolff-Parkinson-White syndrome
           • Electrolyte imbalances
             • hypokalemia
             • hypomagnesemia
             • hypercalcemia
         • Digoxin Toxicity
           • GI
             • anorexia
             • nausea
             • vomiting
             • diarrhoea
             • abdominal cramps
           • CNS
       • Phosphodiesterase Inhibitors
         • members
           • Inamrinone
           • milrinone
     • Adrenergics
       • Dopamine
       • dobutamine
     • Nesiritide
       • MOA
         • Reducing preload and afterload
         • Increasing diuresis
         • Suppressing the renin–angiotensin–aldosterone

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