Aisha is not feeling well

Aisha is not feeling well

1. later diagnosed with

   • congestive heart failure
     • occurs when
       • The heart is unable to pump blood at a rate that meets the metabolic requirements of the peripheral tissue; inadequate cardiac output is usually accompanied by increased congestion of the relevant venous circulation.
     • Classification
       • Left-sided versus right-sided failure
         • Left ventricular failure and right ventricular failure can occur independantly or together as congestive cardiac failure
         • RVH
           • LVF
             • Pulmonary stenosis
               • Lung disease
                 • Symptoms
                   • Peripheral edema
                     • Ascites
                       • Nausea
                         • Facial engorgement
                           • Pulsation in neck and face
                             • Epistaxis
         • LVH
           • Dyspnea
             • Poor exercise tolerance
               • fatigue
                 • Orthopnea
                   • PND
                     • Nocturnal cough
                       • Wheeze
                         • Muscle wasting
                           • Weight loss
                             • Cold peripheries
                               • Nocturia
       • Low-output versus high-output failure
         • High-output heart failure
           • Output is normal or increased with increased needs. Failure occurs when cardiac output fails to meet these needs. Occ- urs with a normal heart but ear- lier if there is heart disease.
             • Consequence
               • Initially features of RVF, then LVF becomes evident
             • Causes
               • Anemia
                 • pregnancy
                   • Hyperthyroidism
                     • Paget's disease
         • Low-output heart failure
           • Cardiac output is decreased and fails to increase normally with exertion.
             • Causes
               • Pump failure
                 • Systolic ordistolic
                   • Heart failure
                     • decreased HR
               • Excessive overload
                 • MR
                   • fluid overload
               • Chronic excessive after load
                 • AS
                   • Hypertension
       • Systolic versus diastolic failure
         • Systolic failure
           • Inability of the ventricle to contract normally, resulting in decreased cardiac output. Ejection fraction is <40%.
             • Causes
               • IHD
                 • MI
                   • DCM
                     • myocarditis
         • Diastolic Failure
           • Inability of the ventricle to relax and fill normally causing increased fillinf pressures. Ejection fraction > 50%.
             • Causes
               • Constrictive pericarditiS
                 • Tamponade
                   • Restrictive cardiomyopathy
                     • Hypertension
       • Acute versus chronic heart failure
         • Acute heart failure
           • Is often used exclusively to mean new onset acute or decompensation of chronic heart failure characterised by pulmonary and/or peripheral edema with or without signs of peripheral hypoperfusion.
         • Chronic Heart failure
           • Develops or progresses slowly, venous congestion is common but arterial pressure is well maintained until very late.
     • prognosis
       • Poor with 25 - 50% of patients dying within 5 years of diagnosis.
     • Diagnosis
       • Routine laboratory Test
         • biomarkers
           • Echocardiography
             • ECG
               • Recommended test in all heart failure patients.
               • CXR
                 • Cardiomegaly
                   • Dilated prominent upper lobe vessels
                     • pleural effusion
                       • Kerley B lines
                         • Alveolar Edema
                           • Bat wisngs
                         • Interstitial edema
               • ECG in CHF can show abnormalities as arrhythmias, ischemia, MI, LVH, conduction abnormalities such as PVCs, LBBB.
     • Symptoms
     • Risk factors
       • Tobacco use
         • Hyperlipidemia
           • Hypercholestremia
             • Diabetes
     • Management
       • Non-pharmacological
         • Limiting salt intake for all HF patients
           • Limiting fluid intake for those with hyponatremia, high diuretics intake and severe HF
             • Exercise for those with stable heart and stable volume levels
               • Monitoring all HF patients
       • Pharmacological
         • Drugs used
           • Decreased load on the heart
             • Diuretics
               • ACE inhibitors
                 • ARBs
                   • Vasodilators
           • Increase the function of the heart
             • Beta-blockers
               • Adrenergics
                 • Inotropic-cardiotonic drugs
                   • Digoxin
                     • Phosphodiestrase inhibitors
                       • Dobutamine
                         • Adrenaline
     • Manifestations upon physical examinatio
       • complications
         • Stages
         • Cardiac cachexia
           • Arrhythmia
             • Kidney problems
               • Anemia, stroke
                 • Leg venous stasis
                   • liver problems
                     • Hyponatremia
       • of
         • RHF
           • JVD
             • Hepatosplenomegaly
               • Pitting Edema
         • LVH
           • Pulmonary congestion
             • Decreased forward perfusion
               • Cardiomegaly
                 • Tachycardia
                   • S3
                     • Ventricular Dilation
                       • Arrhythmia

2. presented with

   • Orthopnea
     • definition
       • Difficulty in breathing that occurs when lying down and is relieved upon changing to an upright position.
         • Causes
           • LFH
             • Bronchial Asthma
               • Mitral stenosis
                 • MarkedAscites
                   • Anxiety & hyperventilation
                     • Bilateral diaphragmatic paralysis
                       • pericardial diesease
   • Oedema
     • definition
       • Is the accumelation of excessive fluid in the subcutaneous tissue.
         • Causes
           • Impairment of lymphatic drainage
             • Generalized
               • Congenital deiciency of lymphatics
             • Localized
               • Local infection
                 • Trauma
                   • Burns
                     • Animal bites / stings
           • Increased plasma hydrostatic pressure:
             • Generalized
               • CHF
                 • Vasodialatory drugs
             • Localized
               • Venous obstruction
           • Decreased plasma oncotic pressure
             • Generalized
               • Liver disease
                 • Renal disease
                   • Malnutrition/ malabsorption
             • localized
               • Milroy's disease
                 • Lymphoedema praecox
                   • Malignant infiltration
   • Dyspnea
     • definiton
       • Is the uncomfortable awareness of breathing
         • Causes
           • sudden
             • Pneumothorax, Pulmonary embolism, Aspiration, Anaphylaxis , Anxiety, Chest trauma
               • Acute
                 • Asthma, Respiratory tract infection, Lung tumors, Pleural effusion, Metabolic acidosis
                   • Chronic
                     • COPD, Cardiac failure, Fibrosing alveoli's, Anaemia, Arrhythmia, Vavular heart disease, Chest wall deformities, Pulmonary hypertension
   • Fatigue
     • definition
       • A subjective symptom of malaise and aversion to activity or to objectively impaired performance.

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