1. As.prof. N.Z. Yarema The syndrome of heart failure and vascular insufficiency in diseases of cardiovascular system

2. Methods of examination of a heart Inquiry Inspection Palpation Percussion Auscultation Laboratory and instrumental studies

3. Patient’s complaints typical for heart diseases Dyspnea Pain in the heart area Oedema Cough Palpitation Heart intermissions

5. Points of auscultation

8. Causes of heart failure Causes of heart failure (H F): Caused by diseases which affect primary the myocardium and its metabolism:infections, intoxycations,insufficient of blood supply to the myocardium and its metabolism

9. HF due to overloading or overstrain of the myocardium: heart defects, arterial hypertension LV is overloading in presence of obstacles to blood ejection from the ventricle ( narrowing of the aortic orifice, persistent increase in the arterial hypertension) in diastolic overfilling of the LV (aortic incompetence or mitral insufficiency)

10. Right ventrical may be overloaded in difficult blood outflow from ventrical due to narrowing of the pulmonary trunk orifice or increase pressure in the lesser circulation In diastolic overfilling associated with tricuspid or pulmonary valve incompetence

11. Compensatory mechanism The force of heart contractions increased by the actions of the vagus nerve Heart rate increases becauses elevated pressure in the orifice of vena cava Decreases diastolic pressure due to dilatation of arterioles and capillaries Increases of oxygen utilisation

12. Clinical symptoms of HF Dyspnoea (cardiac astma) Cyanosis( acrocyanosis) oedema

18. Aortal heart configuration

19. Mitral heart configuration

22. Classification of the HF 1 st. (initial) – signs of HF due to with physical exercise 2 st. – haemodynamic disorders( congestion in lesser or graeter circulation ) and dysfunction of organs at rest. The work capasity of patients is markedly decreased A – initial period with mild haemodynamic disorders B – final period with grave haemodynamic disorder 3 st.- terminal dystrophic stage

23. Classification of HF ( New York) 1 - initial (latent) stage due to with physical exercises 2 – significant stage, congestion in lesser and greater circulation at rest and physical exercises, usual physical exercises causes signs of HF 3 – considerable limitation of physical activity, satisfactory condition at rest 4 - satisfactory condition only at rest

24. Treatment patients with HF general recommendation ( diet, habits, limitation of physical activity ) diuretics (furosemide, hypothiaside, inhibitors of ACF (captopril, enalapril, lisinopril) b- blocers (bisoprolol, carvedilol antagonists of aldosteronum: verospironum digoxynum

30. Thank you