نارسایی احتقانی قلب، CHF

نارسایی احتقانی قلب، CHF

اسلاید 1: Congestive Heart Failure

اسلاید 2: Heart FailureResults from any structural or functional abnormality that impairs the ability of the ventricle to eject blood (Systolic Heart Failure) or to fill with blood (Diastolic Heart Failure).

اسلاید 3: The Vicious Cycle of Congestive Heart Failure

اسلاید 4: Types of Heart FailureLow-Output Heart FailureSystolic Heart Failure: decreased cardiac outputDecreased Left ventricular ejection fractionDiastolic Heart Failure: Elevated Left and Right ventricular end-diastolic pressuresMay have normal LVEFHigh-Output Heart FailureSeen with peripheral shunting, low-systemic vascular resistance, hyperthryoidism, beri-beri, carcinoid, anemiaOften have normal cardiac outputRight-Ventricular FailureSeen with pulmonary hypertension, large RV infarctions.

اسلاید 5: Causes of Low-Output Heart FailureSystolic DysfunctionCoronary Artery DiseaseIdiopathic dilated cardiomyopathy (DCM)50% idiopathic (at least 25% familial)9 % mycoarditis (viral)Ischemic heart disease, perpartum, hypertension, HIV, connective tissue disease, substance abuse, doxorubicinHypertensionValvular Heart DiseaseDiastolic DysfunctionHypertensionCoronary artery diseaseHypertrophic obstructive cardiomyopathy (HCM)Restrictive cardiomyopathy

اسلاید 6: Clinical Presentation of Heart FailureDue to excess fluid accumulation:Dyspnea (most sensitive symptom)EdemaHepatic congestionAscitesOrthopnea, Paroxysmal Nocturnal Dyspnea (PND)Due to reduction in cardiac ouput:Fatigue (especially with exertion(Weakness

اسلاید 7: Physical Examination in Heart FailureS3 gallop Low sensitivity, but highly specificCool, pale, cyanotic extremitiesHave sinus tachycardia, diaphoresis and peripheral vasoconstrictionCrackles or decreased breath sounds at bases (effusions) on lung examElevated jugular venous pressureLower extremity edemaAscitesHepatomegalySplenomegalyDisplaced PMIApical impulse that is laterally displaced past the midclavicular line is usually indicative of left ventricular enlargement>

اسلاید 8: Measuring Jugular Venous Pressure

اسلاید 9: Lab Analysis in Heart FailureCBCSince anemia can exacerbate heart failureSerum electrolytes and creatinine before starting high dose diureticsFasting Blood glucoseTo evaluate for possible diabetes mellitusThyroid function testsSince thyrotoxicosis can result in A. Fib, and hypothyroidism can results in HF.Iron studiesTo screen for hereditary hemochromatosis as cause of heart failure.ANATo evaluate for possible lupusViral studies If viral mycocarditis suspected

اسلاید 10: Laboratory Analysis (cont.)BNPWith chronic heart failure, atrial mycotes secrete increase amounts of atrial natriuretic peptide (ANP) and brain natriuretic pepetide (BNP) in response to high atrial and ventricular filling pressuresUsually is > 400 pg/mL in patients with dyspnea due to heart failure.

اسلاید 11: Chest X-ray in Heart FailureCardiomegalyCephalization of the pulmonary vesselsKerley B-linesPleural effusions

اسلاید 12: Cardiomegaly