HEART FAILURE by T.V. SUBBA RAO B.Pharm

INDEX

1. Introduction 2. Epidemiology3. Etiology4. Signs and symptoms 5. Diagnosis6. Treatment 7. References

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BASIC TERMINOLIGIES

1. Stroke volume ( blood pumped each beat )

2. Cardiac output ( blood pumped each minute )

3. Preload ( end diastolic volume )

4. Afterload ( resistance against which ventricles has to pump blood )

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CO = HR >< SV

HEART FAILURE

Def :- it is defined as condition in which heart looses its ability to pump sufficient amount of blood to all parts of body .

ÞHeart failure involves left ventricular or right ventricular or both .

ÞIt may be acute or chronic .

ÞCongestive heart failure .

CONGESTIVE HEART FAILURE

Def :-heart failure resulting in accumulation of fluid in lungs and other tissues .

ÞWhen heart is not able to pump fluid through aorta , the blood remains in heart.

ÞIt result in dilation of chambers and accumulation of blood in veins .

ÞFluid retention and pulmonary edema also occur in this condition .

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EPIDEMIOLOGY

Heart failure is most common disease .

In US 6.6 million in 2010 .

World wide 23 million .

CAUSES OF HEART FAILURE ( ETIOLOGY )

1. Coronary artery disease 2. Defective heart valves ( aortic stenosis )3. Arrhythmias 4. Cardiac muscle disease ( cardiomyopathy )5. Hypertension 6. Congenital heart diseases7. Cigarette smoking 8. Obesity 9. Alcohol drinking

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PATHOPHYSIOLOGY

1. Decrease stroke volume 2. Decrease cardiac output3. Increase preload4. Increase after load 5. Increase heart rate ( less filling time )6. Coronary artery disease 7. Cardio myopathy ( thin / thick walled ventricle )8. Kidney ( unhappy )

SIGNS AND SYMPTOMS

1. Fatigue and weakness 2. Rapid and irregular heart beat3. Shortness of breathing 4. Fluid retention and weight gain5. Cough6. Chest pain

Left side of heart failure – pulmonary edema right side of heart failure – peripheral edema

CLINICAL FEATURES OF LEFT SIDE HEART FAILURE

1. Pulmonary edema

i. Dyspneaii. Paroxysmal nocturnal dyspnea iii. Orthopnea

2. Decreased forward perfusion ( RAAS activation )

CLINICAL FEATURES OF RIGHT SIDE HEART FAILURE

ÞCommon causes of right side heart failure is left side heart failure .

1. Peripheral edema

i. Jugular venous distention ii. Pitting edema

JEGULAR VEIN DISTENTION

PITTING EDEMA

DIAGNOSIS

1. Echocardiogram

2. B – type natriuretic peptide ( BNP )

3. Chest X – rays

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Chest x - ray

TREATMENT

1. Life style changes

2. Pharmacological ( desired outcome )

3. Surgical

LIFE STYLE CHANGES

Weight lossSmoking cessation Exercise Limiting alcohol intake Dietary changes Managing stress

=> The above are effective in preventing diastolic and systolic heart failure .

DESIREDOUTCOME

1. Decrease preload ( venodilators )2. Decrease afterload ( arteriolardilators )3. Increase calcium4. Increase cAMP5. Increase water elimination6. Improved pumping action7. Reduce heart work load

1.Decrease preload ( venodilators )

i.Glyceryl trinitrateii. Isosorbide dinitrate

2.Decrease afterload ( arteriolardilators )

i. Hydralazine ii. Minoxidil iii.Ca+2 channel blockers ( nefidipine )iv. K + channel openers ( nicorandil )

3.Increase calcium

i.Digitalis ( +ve ionotropic effect and –ve chronotropic effect )

4. Increase CAMP levels

i. Dobutamine ii. PDE Inhibitors – amrinone , milrinone .

5. Increase water elimination

i. Diuretics

ACC / AHA AND AYHA CLASSIFICATION

SYSTOLIC DYSFUNCTION TREATMENT

1. ACE inhibitors ( if cough occurs use ARB’s )

2. Beta blockers

3. Spiranolactone

4. Diuretics

5. Digoxin

DIASTOLIC DYSFUNCTION TREATMENT

1. Beta blockers ( 1st line therapy )

2. Calcium channel blockers

3. ACE inhibitors

4. Diuretics

SURGICAL TREATMENT

1. Surgical procedure without devicesi. Angioplastyii. Coronary artery bypassiii. Heart transplant

2. Implantable medical devices iv. Valve replacementv. ventricular assist device (VAD)

REFERENCES

1.KD Tripathi

2.Katzung

3. NET

Happy holi

PHARMACOLOGICAL THERAPY ( DRUGS )

1. DIURETICS ÞLoop diuretics :- furosemide , bumetanide . ÞK + sparing diuretics :- amiloride , triamterene . ÞAldosterone antagonist :- spironolactone .

2. VASODILATORS ÞHydralazine - isosorbide dinitrate combination ÞACE inhibitors - prills ( rami , anala , lisinoprill )ÞARB’S – sartans ÞNitrovasodilators – nitroglycerine , nitroprosside .

ÞOrganic nitrates - isosorbide dinitrate .ÞHydralazine ÞCa +2 channel blockers – verapamil , diltiazem , nefedipine .

3. Beta blockers Ex- carvedilol , bisoprolol , metoprolol .

4.Cardiac glycosides Ex – digoxin .

Chronic + ve inotropic therapy – ex - PDE inhibitor – milrinone , amrinone .

anticoagulation and antiplatelet drugs – ex - warfarin antiarrhythmic drugs ex - amiodarone

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CONGESTIVE HEART FAILURE

Divided into :- left side heart failure right side heart failure

Can be either from :- systolic dysfunction diastolic dysfunction

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Echocardiogram An echocardiogram (also called an echo) is a type of ultrasound test that uses

high-pitched sound waves that are sent through a device called a transducer. The device picks up echoes of the sound waves as they bounce off the different parts of your heart. These echoes are turned into moving pictures of your heart that can be seen on a video screen.