Chronic Heart failure By Camila Narkulova Group nd pediatric faculty

Heart Failure – is a chronic, progressive condition in which the heart muscle is unable to pump enough blood through the heart to meet the body's needs for blood and oxygen. Heart failure usually results in an enlarged heart.

Causes – Viral infections of the heart can lead to inflammation of the muscular layer of the heartinflammation of the muscular layer of the heart – Heart damage Heart damage – abuse of drugs such as alcohol and methamphetamine abusealcoholmethamphetamine

Left-sided failure – The left side of the heart is responsible for receiving oxygen-rich blood from the lungs and pumping it forward to the systemic circulation (the rest of the body except for the pulmonary circulation). Failure of the left side of the heart causes blood to back up (be congested) into the lungs, causing respiratory symptoms as well as fatigue due to insufficient supply of oxygenated blood aortic stenosissystemic circulationpulmonary circulationaortic stenosis – Increase of rate breathe – Rales – PulmONARY EDEMA (FLUID IN ALVEOLY) – CYANOSIS – Apex beat – Gallop rhythm – Heart murmurs

Right-sided failure – Right-sided heart failure is often caused by pulmonary heart disease (cor pulmonale), which is usually caused by difficulties of the pulmonary circulation, such as pulmonary hypertension or pulmonic stenosis.pulmonary heart diseasepulmonary circulationpulmonary hypertensionpulmonic stenosis – Physical examination may reveal pitting peripheral edema, ascites, and liver enlargementedemaascitesliver enlargement – Nocturia Nocturia – coagulopathycoagulopathy

Biventricular failure – Dullness of the lung fields to finger percussion and reduced breath sounds at the bases of the lung may suggest the development of a pleural effusion (fluid collection between the lung and the chest wall). Though it can occur in isolated left- or right- sided heart failure, it is more common in biventricular failure because pleural veins drain into both the systemic and pulmonary venous systems. When unilateral, effusions are often right sided.finger percussionpleural effusionbetween the lung and the chest wall

Shortness of breathe(dyspnea) Breathlessness during activity (most commonly), at rest, or while sleeping, which may come on suddenly and wake you up. You often have difficulty breathing while lying flat and may need to prop up the upper body and head on two pillows. You often complain of waking up tired or feeling anxious and restless. Blood "backs up" in the pulmonary veins (the vessels that return blood from the lungs to the heart) because the heart can't keep up with the supply. This causes fluid to leak into the lungs.

Persistent coughing or wheezin – coughing that produces white or pink blood-tinged mucus.

fluid in body tissues (edema) –.swelling in the feet, ankles, legs or abdomen or weight gain. You may find that your shoes feel tight. – As blood flow out of the heart slows, blood returning to the heart through the veins backs up, causing fluid to build up in the tissues. The kidneys are less able to dispose of sodium and water, also causing fluid retention in the tissues.

Chest pain

Diagnosis – echocardiogram – electrocardiogram (ECG) – coronary angiogram – chest X-ray. – Blood test

Algorithms – There are various algorithms for the diagnosis of heart failure. For example, the algorithm used by the Framingham Heart Study adds together criteria mainly from physical examination. In contrast, the more extensive algorithmalgorithmsFramingham Heart Study – by the European Society of Cardiology (ESC) weights the difference between supporting and opposing parameters from the medical history, physical examination, further medical tests as well as response to therapyEuropean Society of Cardiologymedical historyphysical examination

Framingham criteria Major criteria : – enlarged heartenlarged heart – an S3 gallop (a third heart sound)third heart sound – acute pulmonary edemaacute pulmonary edema – episodes of waking up from sleep gasping for airepisodes of waking up from sleep gasping for air – central venous pressure of more than 16 cm H 2O at the right atriumcentral venous pressure – jugular vein distensionjugular vein distension – positive abdominojugular testabdominojugular test – weight loss of more than 4.5 kg in 5 days weight loss

Framingham criteria – Minor criteria: – abnormally fast heart rate of more than 120 beats per minuteabnormally fast heart rate – nocturnal coughnocturnal cough – difficulty breathing with physical activitydifficulty breathing – pleural effusionpleural effusion – a decrease in the vital capacityvital capacity – liver enlargementliver enlargement – bilateral ankle swellingankle swelling

Differential diagnosis – Cardiac arrestCardiac arrest – Myocardial infarction ("Heart attack")Myocardial infarction – Cardiomyopathy Cardiomyopathy – Dilated cardiomyopathy Dilated cardiomyopathy – Hypertrophic cardiomyopathyHypertrophic cardiomyopathy

Medication – angiotensin-converting enzyme (ACE) inhibitors (ACE-I) angiotensin-converting enzyme (ACE) inhibitors – angiotensin receptor blockers (ARBs) angiotensin receptor blockers – Beta-adrenergic blocking agents (beta blockers) Beta-adrenergic blocking agents – Diuretics – DigoxinDigoxin – parenteral iron if anemia is foundparenteral iron

Surgical therapies – People with the most severe heart failure may be candidates for ventricular assist devices (VAD). VADs have commonly been used as a bridge to heart transplantation, but have been used more recently as a destination treatment for advanced heart failureventricular assist devices – n select cases, heart transplantation can be considered. While this may resolve the problems associated with heart failure, the person must generally remain on an immunosuppressive regimen to prevent rejection, which has its own significant downsidesheart transplantation

Thank you for attention!