04. Suytim Harvard FINAL sua

Heart Failure Trương Thanh Hương, PhD. Hanoi Medical University Definition • Heart failure is a condition in which the cardiac output is insufficient in meeting the needs of oxygen of the body in any situation. • Heart failure is a complex clinical syndrome that can result from any structural or functional cardiac disorder that impairs the ability of the ventricle to fill with or eject blood. • The term "heart failure" is more accurate than "congestive heart failure" because fluid accumulation may not occur in all patients. Heart failure classification • The side of the heart involved: left-sided heart failure, right-sided heart failure. • Progress of heart failure: acute heart failure, chronic heart failure. • The change in the cardiac output: low-output heart failure, high-output heart failure. • Systolic heart failure and diastolic heart failure Causes Left-sided heart failure • Hypertension • Valvular heart diseases: aortic valve stenosis, aortic regurgitation (pured or combined), mitral regurgitation • Myocardial injury: MI, rheumatic myocarditis, intoxication, bacterial contamination, myocardial diseasesthmias • Congenital heareases: coarctation of the aorta, patent ductus arteriosus • Arrhythmias • Be noticed of mitral stenosis causes Right-sided heart failure • Left-sided heart failure • Pulmoray diseases, deformity of thorax-spine • Cardiovascular causes: – Mitral stenosis is a common cause – Tricupid and aortic valvular diseases – Congenital heart diseases (Pulmonary valve stenosis, tetralogy of Fallot): congenital heart diseases with reversed shunt, ruptured sinus of valsalva into right heart chambers, left atrial myoxoma • Be noticed of pericardial effusions and compressive syndromes causes Two-sided heart failure • Left-sided heart failure often leads to two-sided heart failure in the longer term. • Dilated cardiomyopathy, carditis caused by rheumatic fever, myocarditis • Two-sided heart failure with high cardiac output: severve anaemia, hyperthyroidism, vitamin B1 deficiency, arteriovenous fistula Left-sided heart failure symptoms Clinical symptoms Presenting symptoms • Dyspnea on exertion -> dyspnea at rest, orthopnea, cardiac asthma or acute pulmonary edema • Dry/loose cough or coughing up blood, cough nocturnally/on exertion Left-sided heart failure symptoms Signs • Left-laterally displaced apex, tachypnea, a gallop rhythm. • A faint apical systolic murmur indicates secondary mitral regurgitation (due to the dilatation of the left ventricle). • Signs of left-sided heart failure causes. • Wet rales heard initially in the bottom of the lung bases. Cardiac asthma: wheezing, snoring. Pulmonary edema: rales extend from the base upward. • Decreased systolic blood pressure, normal diastolic blood pressure leading to decreased hypertension difference. Left-sided heart failure symptoms NONCLINICAL SYSTOMS • Chest X-ray: cardiomegaly, bulging and prolonged left heart border caused by dialated left ventricle. Bilateral increased lung markings especially in the centre, Kerley B lines caused by edema in the interstitial of lung lymphatic system, shaped like bats wings in the centre when pulmonary edema presents. • ECG: left heart axis, left atrial hypertrophy, left ventricular hypertrophy. • Echocardiagraphy: dialated left atrium and ventricle, decreased contraction of heart walls, decreased left ventricular systolic funtion, finding out causes of left-sided heart failure. • Haemodynamic study: decreased cardiac index (normal value 2- 3.5l/min/m2), increased left-ventricular end-diastolic pressure, grading the severity of mitral regurgitation, aortic regurgitation right-sided heart failure symptoms Clinical symptoms Presenting symptoms – Dyspnea: increasing dyspnea without paroxysmal nocturnal dyspnea as left-sided heart failure. – Pain in the right upper quadrant caused by painful hepatomegaly. Signs – Hepatomegaly with "accordion effect". – Jugular venous distension, positive hepatojugular reflex [...]... Na/Ca exchange Enhanced Ca storage/release) Enhanced vagal tone (reduce heart rate) Digoxin may attenuate the neuro-hormonal activation associated with HF The serum haft-life of digoxin is 36 h; the usual daily dose is 0.125-0.375mg Therapeutic dose: 0,5-0,8-2,0 ng/ml serum The toxic therapeutic ration is narrow Drug interactions which decrease digoxin release: Quinidin, Verapamil, Spironolacton,... demand Electrolyte abnormalities: K+ và / Mg++ Pharmacologic Therapy Glucoside (Digoxin) Digoxin toxicity Risk factors Clinical signs and symptoms Loss of appetide, nausea/vomiting, diarrhea Visual disturbances, confusion, dizziness, nightmares Increased automaticity and depressed conduction Treatment: Stop the drug, control Electrolyte abnormalitie, kalemia 20-50ml KCl 10%, oral or IV 13-15