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HEART FAILURE
Definition
A clinical picture resulting from decreased cardiac performance with cardiac output lower in comparison with peripheral necessities.Etiology
Cardiomyopathies (primary myocardial disease )Ischemic heart diseaseHaemodynamic overloadArrhythmiasIn fact any severe heart disease is possible to evolute towards heart failure syndromePathology
myocardial cells performance of existing myocitesPathophysiology
systolic performance (LV, RV or both) diastolic performance (LV, RV or both)forward heart failure ( cardiac output)backward heart failure (congestive syndrome)left side heart failureright side heart failurechronic heart failureacute heart failurePathogenesis
Adaptation mechanisms I
HypertrophyDilatation heart rate (tachycardia) contractility (notfunctionning)Adaptation mechanisms II
peripheral A +V O2 extractionRedistribution of cardiac outputperipheral vasoconstriction
blood volume and of venous return( Na and H2O retention)
Realised through:
CathecolaminesRAA systemThe proposed explanation for the Starling effect, whereby a greater end-diastolic fiber length develops a greater force.
Signs and symptoms
Signs and symptoms
Heart:
- sinus tachycardia
- ventricular gallop (S3)
- regurgitation systolic murmur:
- mitral regurgitation
- tricuspid regurgitation
2. exercise capacity
Congestive syndrom
Lungs: - dyspnea,- rales,
- dullness,
- pleural effusion
Liver: - hepathomegaly- tenderness
Peripheral edemaAscites, pleural effusion, pericardial effusion (rare)Venous distention : jugular hepatojugular refluxCyanosis: - peripheral- central
Low output syndrom
Weakness, fatiguePallor weightOliguria SBP DBPCerebral symptoms*
Investigations
Echocardiography- LV, RV or both
- contractility
- LA, RA or both
- LVEF, RVEF or both
- PAPs
- MR, TR
- diastolic LV dysfunction:
- abnormal relaxation
- pseudonormalisation
- restriction
Rx (chest x ray)
cardiac chambersCardiothoracic ratio >0,55Pulmonary congestionPulmonary arterial hypertensionPleural effusionECG
- always abnormal
Morphologycal abnormalities- of the underlying disease
- necrosis
- hypertrophy
- arrhythmias:
- atrial fibrillation
- ventricular: PVB, VT,
- sinus tachycardia
Exercise stress testing
To establish the exercise capacity (METS) and NYHA class (also possible an a clinical basis)Rare investigations
Cardiac angiographyCoronarographyMyocardial biopsyMRI CT multisliceBiochemical date
BNP, ANPLipidsLiver function tetsGlycemiaIons: Na, KCreatinineHaematocritTREATMENT
TREATMENT
TREATMENT
Pulmonary Edema
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PRECIPITANTS AND CAUSES OF ACUTE HEART FAILURE
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Blood oxygen levels (low)
A chest X-ray may reveal the following:
Fluid in or around the lung space
Enlarged heart
*
An ultrasound of the heart (echocardiogram) may reveal the following:
Weak heart muscle
Leaking or narrow heart valves
Fluid surrounding the heart
*
INTRAVENOUS VASODILATORS USED TO TREAT ACUTE
HEART FAILURE