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Approach to HEART FAILURE Dr. Subroto Mandal, MD, DM Assistant Professor, Cardiology NRI Heart Centre & Research Institute
Definition of Heart Failure <ul><ul><li>HF is a complex clinical syndrome that can </li></ul></ul><ul><ul><li>result from ...
“ Heart Failure” vs. “Congestive Heart Failure” <ul><ul><li>Because not all patients have volume overload at </li></ul></u...
<ul><li>Relatively common disorder </li></ul><ul><li>The incidence of HF approaches 10 per 1000 population after age 65 </...
CLASSIFICATION <ul><li>Forward Vs Backward </li></ul><ul><li>Rt. Vs Lt. sided HF  </li></ul><ul><li>Acute Vs Chronic HF </...
NYHA Classification
Stages of Heart Failure <ul><ul><li>At Risk for Heart Failure: </li></ul></ul><ul><ul><li>STAGE A   High risk for developi...
Stages of Heart Failure <ul><li>Designed to emphasize  preventability  of HF </li></ul><ul><li>Designed to recognize the  ...
Stages of Heart Failure <ul><li>COMPLEMENT, DO  NOT  REPLACE NYHA CLASSES </li></ul><ul><li>NYHA Classes - shift back/fort...
 
Rapid classification of hemodynamic states
PRECIPITATING FACTORS <ul><li>INAPPROPRIATE  THERAPY </li></ul><ul><li>HIGH SALT INTAKE  </li></ul><ul><li>ARRYTHMIAS </li...
 
Evaluation of HF patient
 
 
RIGHT SIDED <ul><li>SYMPTOMS </li></ul><ul><ul><li>Abdominal Pain </li></ul></ul><ul><ul><li>Nausea </li></ul></ul><ul><ul...
COUGH <ul><li>Caused by pulmonary congestion </li></ul><ul><li>Nonproductive cough in LVF (Dyspnea equivalent) </li></ul><...
JVP Normal upper limit of JVP are 4 cm from sternal angle TR  V wave  and Y descend are prominent Kussumal sign  in constr...
 
Right heart failure
INVESTIGATIONS <ul><li>BNP </li></ul><ul><li>ECG </li></ul><ul><li>CXR </li></ul><ul><li>ECHOCARDIOGRAPHY ( TTE, TEE) </li...
Atrial fibrillation
Myocarditis
Cardiomegaly
Dextrocardia – Acute pulmonary edema
CCF
Mitral stenosis
Pericardial effusion
Mitral Stenosis
Mitral Stenosis Pre PBMV Post PBMV
MVP - MR
Aortic Stenosis
LA Myxoma
Post MI-VSD
DCM
DCM
DCM
MR Coronary Angiogram
CT Coronary Angiogram
HCM
Framingham Criteria for Congestive Heart Failure Major criteria:           Paroxysmal nocturnal dyspnea           Neck vei...
 
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Powerpoint presentation of Heart Failure
LVF
management of Heart failure

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Heart failure

  1. 1. Approach to HEART FAILURE Dr. Subroto Mandal, MD, DM Assistant Professor, Cardiology NRI Heart Centre & Research Institute
  2. 2. Definition of Heart Failure <ul><ul><li>HF is a complex clinical syndrome that can </li></ul></ul><ul><ul><li>result from any structural or functional </li></ul></ul><ul><ul><li>cardiac disorder that impairs the ability of </li></ul></ul><ul><ul><li>the ventricle to fill with or eject blood. </li></ul></ul><ul><ul><li>ACC/AHA Task force </li></ul></ul>
  3. 3. “ Heart Failure” vs. “Congestive Heart Failure” <ul><ul><li>Because not all patients have volume overload at </li></ul></ul><ul><ul><li>the time of initial or subsequent evaluation, the </li></ul></ul><ul><ul><li>term “heart failure” is preferred over the older </li></ul></ul><ul><ul><li>term “congestive heart failure.” </li></ul></ul>
  4. 4. <ul><li>Relatively common disorder </li></ul><ul><li>The incidence of HF approaches 10 per 1000 population after age 65 </li></ul><ul><li>1-2 % at the age of 45-50yrs </li></ul><ul><li>>10% at the age >75yrs </li></ul><ul><li>At 40yrs age life time risk for HF 21%for men 20.3% for women </li></ul><ul><li>80% admission for HF > 65yrs old </li></ul><ul><li>Cost of hospitalization for heart failure is twice that for all form of cancer and myocardial infarction combined </li></ul>PREVALENCE & INCIDENCE
  5. 5. CLASSIFICATION <ul><li>Forward Vs Backward </li></ul><ul><li>Rt. Vs Lt. sided HF </li></ul><ul><li>Acute Vs Chronic HF </li></ul><ul><li>Low Vs High output HF </li></ul><ul><li>Systolic Vs Diastolic HF </li></ul>
  6. 6. NYHA Classification
  7. 7. Stages of Heart Failure <ul><ul><li>At Risk for Heart Failure: </li></ul></ul><ul><ul><li>STAGE A High risk for developing HF </li></ul></ul><ul><ul><li>STAGE B Asymptomatic LV dysfunction </li></ul></ul><ul><ul><li>Heart Failure: </li></ul></ul><ul><ul><li>STAGE C Past or current symptoms of HF </li></ul></ul><ul><ul><li>STAGE D End-stage HF </li></ul></ul>
  8. 8. Stages of Heart Failure <ul><li>Designed to emphasize preventability of HF </li></ul><ul><li>Designed to recognize the progressive nature of LV dysfunction </li></ul>
  9. 9. Stages of Heart Failure <ul><li>COMPLEMENT, DO NOT REPLACE NYHA CLASSES </li></ul><ul><li>NYHA Classes - shift back/forth in individual patient (in response to Rx and/or progression of disease) </li></ul><ul><li>Stages - progress in one direction due to cardiac remodeling </li></ul>
  10. 11. Rapid classification of hemodynamic states
  11. 12. PRECIPITATING FACTORS <ul><li>INAPPROPRIATE THERAPY </li></ul><ul><li>HIGH SALT INTAKE </li></ul><ul><li>ARRYTHMIAS </li></ul><ul><li>INFARCTION OR ISCHAEMIA </li></ul><ul><li>PULMONARY EMBOLISM </li></ul><ul><li>SYSTEMIC INFECTION </li></ul><ul><li>PHYSICAL & EMOTIONAL STRESS </li></ul><ul><li>INFECTIVE ENDOCARDITIS </li></ul><ul><li>COMORBIDITY ( renal failure, sepsis) </li></ul><ul><li>MYOCARDIAL DEPRESSANT DRUGS </li></ul><ul><li>CARDIAC TOXINS </li></ul><ul><li>HIGH OUTPUT STATES </li></ul>
  12. 14. Evaluation of HF patient
  13. 17. RIGHT SIDED <ul><li>SYMPTOMS </li></ul><ul><ul><li>Abdominal Pain </li></ul></ul><ul><ul><li>Nausea </li></ul></ul><ul><ul><li>Constipation </li></ul></ul><ul><ul><li>Anorexia </li></ul></ul><ul><ul><li>Bloating </li></ul></ul><ul><ul><li>Ascites </li></ul></ul><ul><li>SIGNS </li></ul><ul><ul><li>Peripheral edema </li></ul></ul><ul><ul><li>Hepatomegaly </li></ul></ul><ul><ul><li>JVD or JVP </li></ul></ul><ul><ul><li>HJR </li></ul></ul>LEFT SIDED <ul><ul><li>DOE </li></ul></ul><ul><ul><li>PND </li></ul></ul><ul><ul><li>Orthopnea </li></ul></ul><ul><ul><li>Tachypnea </li></ul></ul><ul><ul><li>Cough </li></ul></ul><ul><ul><li>Hemoptysis </li></ul></ul><ul><ul><li>Bibasilar rales </li></ul></ul><ul><ul><li>Pulmonary edema </li></ul></ul><ul><ul><li>S3 gallop </li></ul></ul><ul><ul><li>Pleural effusion </li></ul></ul><ul><ul><li>Cheyne-Stokes respiration </li></ul></ul>
  14. 18. COUGH <ul><li>Caused by pulmonary congestion </li></ul><ul><li>Nonproductive cough in LVF (Dyspnea equivalent) </li></ul><ul><li>Cough at recumbency (Orthopnea equivalent) </li></ul>
  15. 19. JVP Normal upper limit of JVP are 4 cm from sternal angle TR V wave and Y descend are prominent Kussumal sign in constrictive pericarditis
  16. 21. Right heart failure
  17. 22. INVESTIGATIONS <ul><li>BNP </li></ul><ul><li>ECG </li></ul><ul><li>CXR </li></ul><ul><li>ECHOCARDIOGRAPHY ( TTE, TEE) </li></ul><ul><li>CARDIAC CATHETERIZATION </li></ul><ul><li>MUGA SCAN, CT, MRI ANGIO </li></ul><ul><li>ENDOMYOCARDIAL BIOPSY </li></ul><ul><li>VIABILITY ASSESMENT (DSE, MRI, SPECT, PET scan) </li></ul><ul><li>ARRYTHMIA WORK UP </li></ul>
  18. 23. Atrial fibrillation
  19. 24. Myocarditis
  20. 25. Cardiomegaly
  21. 26. Dextrocardia – Acute pulmonary edema
  22. 27. CCF
  23. 28. Mitral stenosis
  24. 29. Pericardial effusion
  25. 30. Mitral Stenosis
  26. 31. Mitral Stenosis Pre PBMV Post PBMV
  27. 32. MVP - MR
  28. 33. Aortic Stenosis
  29. 34. LA Myxoma
  30. 35. Post MI-VSD
  31. 36. DCM
  32. 37. DCM
  33. 38. DCM
  34. 39. MR Coronary Angiogram
  35. 40. CT Coronary Angiogram
  36. 41. HCM
  37. 42. Framingham Criteria for Congestive Heart Failure Major criteria:        Paroxysmal nocturnal dyspnea         Neck vein distention         Rales         Radiographic cardiomegaly    Acute pulmonary edema         S3 gallop         Increased central venous pressure (>16 cm H2O at right atrium)         Hepatojugular reflux         Weight loss >4.5 kg in 5 days in response to treatment   Minor criteria:         Bilateral ankle edema         Nocturnal cough         Dyspnea on ordinary exertion         Hepatomegaly         Pleural effusion         Decrease in vital capacity by one third from maximum recorded         Tachycardia (heart rate>120 beats/min.)
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treatment of Heart Failure, CCF, Powerpoint presentation of Heart Failure LVF management of Heart failure

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