PROF. DR. MUHAMMAD AKBAR CHAUDHRY HEART FAILURE 2 PROF. DR. MUHAMMAD AKBAR CHAUDHRY M.R.C.P.(U.K) F.R.C.P.(E) F.R.C.P.(LONDON) F.A.C.C. DESIGNED AT A.V. DEPTT F.J.M.C. BY RABIA KAZMI

COMPENSATORY MECHANISMS IN HEART FAILURE : Arginine vasopressin (increased preload and afterload) Atrial Natriuretic peptides (decreased afterload) Prostaglandins Peptides Frank-starling law of the heart hypertrophy

COMPENSATORY MECHANISMS IN HEART FAILURE : Peripheral oxygen delivery Redistribution of cardiac output Altered oxygen-haemoglobin dissociation Increased oxygen- extraction by tissues Anaerobic metabolism

PATHOGENESIS OF PULMONARY EDEMA

Scheme of the sequence of events in heart failure

INVESTIGATIONS IN HEART FAILURE de hy

INVESTIGATIONS IN HEART FAILURE

THERAPY OF HEART FAILURE Salt restriction , diuretics Venous vasodilators Arterial vasodilators Angiotensin-converting enzyme inhibitors , angiotensin ii –receptor blockers Inotropic agents Beta blockers(??) Pacemaker Antiarrhythmic agents, Devices , beta blockers Abnormality Preload Afterload Contractility Heart rate and rhythm

HEART FAILURE Management A. MILD HEART FAILURE: Search for curable cause Decrease physical activity slightly Omit salt Diuretics; thiazide (with k) digitalis

HEART FAILURE Management B. Moderately severe heart failure Search for curable cause Decrease physical activity moderately Thiazide / frusemide diuretics with k Digitalis Vasodilators A.C.E. Inhibitors +

MANAGEMENT OF SEVERE CHRONIC HEART FAILURE C. Severe chronic heart failure Search for curable etiology Strict bed rest Loop diuretics with potassium supplement Digitalis If no response – add k sparing Diuretics Add Thiazide diuretics Vasodilators A.C.E. inhibitors Nitroglycerine locally at night +

ACUTE HEART FAILURE , PULMONARY OEDEMA Prop- up position O therapy Morphine 5-10 mg (if no contra -indication) If Bronchospasm –Aminophylline Loop diuretics I/V Vasodilators Treatment of Arrhythmias Treat underlying cause 2

VASODILATOR Rx IN HEART FAILURE Venous tone Peripheral resistance BP SV T PR Peripheral perfusion Stroke volume End diastolic volume MR BP Pulm congestion Wall tension LEVDP Collar CBF MVo 2 SCHEMATIC DIAGRAM OF THE MAJOR ACTION OF VASODILATOR THERAPY IN HEART FAILURE

POSSIBLE MECHANISIMS BY WHICH BETA- ADRENERGIC BLOCKERS IMPROVE VENTRICULAR FUNCTION IN CHRINIC CONGESTIVE HEART FAILURE

CHRONIC HEART FAILURE____CHOICE OF PHARMACOLOGIC THERAPY

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