1. 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

2. 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

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

4. PATHOGENESIS OF PULMONARY EDEMA

5. Scheme of the sequence of
events in heart failure

6. INVESTIGATIONS IN HEART FAILUREde hy

7. INVESTIGATIONS IN HEART FAILURE

8. 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

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

10. 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 +

11. 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 +

13. 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

14. 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

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

16. CHRONIC HEART FAILURE____CHOICE OF PHARMACOLOGIC THERAPY

17. THANK YOU