1. CIRCULATORY HEART FAILURE (CHF)‏
Katedra Kardiologii i Chorób Wewnętrznych
Collegium Medicum im. Ludwika Rydygiera w Bydgoszczy
Uniwersytet Mikołaja Kopernika w Toruniu
CIRCULATORY HEART FAILURE (CHF)‏
Maria Bogdan

2. Congestive Heart Failure

3. HEART FAILURE
The most common reason for hospitalization in adults >65 years old.
1 in 100 adults has HF

4. HEART FAILURE Normal heart function
04/11/2009

5. Pathophysiological mechanisms of CHF
CARDIAC ABNORMALITIES
Frank-Starling Mechanism
Compensatory hypertrophy
Ventricular remodeling
Coronary arteries
Mitral regurgitation
Arrhythmias
OTHER MECHANISMS
Redistribution of cardiac output
NEUROHORMONAL
Renin-angiotensin- aldosterone system
Sympathetic nervous system
Natriuretic peptides
Vasodilator peptides
Cytokines
Matrix Metalloproteinases

7. 90/140= 64% EF: normal

8. Congestive Heart Failure

12. Congestive Heart Failure Common Causes
Chronic
Acute
CAD
Hypertensive HD
Rheumatic Heart Dis
Congenital Heart Dis
Cor pulmonale
Cardiomyopathy
Anemia
Bacterial endocarditis
Valvular disorders
Acute MI
Dysrhythmias
Pulmonary emboli
Thyrotixicosis
Hypertensive crisis
Rupture of papillary muscle
VSD
Myocarditis

13. The most common causes of CHF
Remember that CHF is a syndrome, so always look for an underlying cause!
Ischemic heart disease ~ 40 percent
Dilated cardiomyopathy ~ 30 percent
Primary valvular heart disease ~ 15 percent
Hypertensive heart disease ~ 10 percent
Other ~ 5 percent

16. Zawał serca ściany dolnej

17. Zawał serca ściany przedniej

18. Zawał serca ściany dolnej i prawej komory

20. Clinical Manifestations of CHF
SYMPTOMS
Fluid overload
Dyspnea
Orthopnea
Paroxysmal nocturnal dyspnea
Cardiac asthma
Cheyne-Stokes Respiration
Fatigue, weakness
Exercise intolerance
Decreased urine output
Confusion
Lethargy
Nocturia
Anorexia
PHYSICAL SIGNS
Rales
Tachycardia
Displaced PMI
S3 (ventricular gallop)
S4 (atrial gallop)
Pulmonary HTN (loud P2)
Neck vein distention
Hepatic enlargement
Peripheral edema
Ascites
Pleural effusion
Cardiac Cachexia
Jaundice
Skin cold and clammy
Pulsus alternans

21. Symptoms

22. Heart Failure Clinical Manifestations
Acute decompensated heart failure (ADHF)
Pulmonary edema, often life-threatening
Early
Increase in the respiratory rate
Decrease in PaO2
Later
Tachypnea
Respiratory acidemia

23. Congestive Heart Failure

24. Congestive Heart Failure Pulmonary Edema

25. CHF/ Pulmonary Edema

26. Right Sided Congestive Heart Failure

31. Congestive Heart Failure Complications
Pleural effusion
Dysrhythmias
Left ventricular thrombus
Hepatomegaly – impaired liver function
Acute Pulmonary Edema

32. Transesophageal echocardiogram TEE

34. PATIENT TEACHING Joint Commission has mandated 6 areas of discharge teaching

35. Discharge Teaching 6 areas
Weight Monitoring
Medications
Activity
Diet
What to do if symptoms worsen
Follow-up

36. Thank you for your attention