Download MBBS (Bachelor of Medicine, Bachelor of Surgery) Cardiology PPT 2 Heart Failure Lecture Notes
HEART FAILURE
1
RULES
40 MINUTES
2
Are we missing the point?
Despite timely PPCI with STEMI
mortality decreased to 7%
but heart failure increased to 22%
(1 year after event)
3
WHAT IS EXPECTED TO KNOW?
? Definitions
? HEMODYNAMICS
? Etiology
? CLINICAL RECOGNITON &
? Types
DIFFERENTIATION
? Symptoms
? ASSESSING SEVERITY
? Signs
? ORDERING TESTS
? Medical Tx
? IMMEDIATE MANAGEMENT
? Surgical Tx
? LONG TERM MANAGAMENT
4
WHAT HAPPENS IN HEART FAILURE?
SVC 5
PV 10
SVC 8
PV 25 PCWP 25
RA 5
LA 10
RA 8
LA 25
RV 25/0-5
LV 120/0-10
RV 40/0-8 LV 100/0-25
PA 25/10
AO 120/80
PA 40/25 AO 100/60
NORMAL
AHF: LVEDP 25
LVEDP=mLAP=mPCWP CPP=DBP-LVEDP
SVC 5
PV 12 PCWP 12
SVC 5
PV 20 PCWP 20
RA 5
LA 12
RA 5
LA 20
RV 30/0-5
LV 10/0-12
RV 40/0-5
LV 10/0-20
PA 30/12
AO 100/70
PA 40/20
AO 80/60
COMPENSATED HF
DECOMPENSATED HF
LVEF reduced: Perfusion Low 5
CLINICAL RECOGNITION
LEFT HEART FAILURE
RIGHT HEART FAILURE
? DOE
? SWELLING
? ORTHOPNEA (LAP>24)
? ABDOMINAL PAIN
? BENDOPNEA*
? JVP ELEVATED
? PND (LAP>18)
? PINK FROTHY SPUTUM
? HJR+ (PCWP> 18)
? RAPID THREADY PULSE
? PEDAL EDEMA
? SBP LOW
ALSO
? CARDIOMEGALY
? S3 (LVEDP>18)
? LOW URINE OUTPUT
? BILATERAL BASAL CREPS
? CONFUSION
? COLD EXTREMITIES
? FATIGUE
6
NYHA
MODIFIED ROSS SCALE
LAP<12
LAP 12-18
LAP 18-24
LAP>24
Outdoor Work
SUCK REST SUCK
Household Choirs
DIAPHORESIS
Personal Activities
FEEDING DIFFICULTY
PND
FTT
Orhtopnea
7
ACC/ AHA
8
FRAMINGHAM CRITERIA
2 MJ/ 1MJ+2MN
FOR CHILDREN
NADAS CRITERIA
1 MJ/ 2MN
9
VOLUME STATUS
PERFUSION STATUS
BENDOPNEA
10
HOW GOOD
ARE THE CLINICAL SIGNS?
11
12
FORRESTER
n
2
>
2
.
2
L
/
mi
CI
n
2
<
2
.
2
L
/
mi
CI
PCWP<18mmHg
PCWP>18mmHg
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STEVENSON
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ELLIS
NYHA 2
NYHA 3
PND
NYHA 4
Orthopnea
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TYPES!!
? ACUTE/ CHRONIC
? COMPENSATED/
DECOMPENSATED
? SYSTOLIC/ DIASTOLIC/ both
? HFREF/ HFPEF/ both
? LHF/ RHF/ CHF
? Mild/mod/severe
? A/B/C/L
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GROSS, OKAY &
SUBTLE
Batwing?HF?
Cephalization
Pulm Venous
Congestion
Kerley B
Batwing
Interstitial
edema
Alveolar edema 17
ARDS VS HF
18
ACUTE ONSET SOB
ASTHMA
RONCHI+
Pneumothx
PCO2
Absent BS
high
Pulmonary
Pneumonia
Embolism
DKA
Metabolic
acidosis
19
ECG in HF
Goldberger's triad
LBBB+ Wide QRS
LAE
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VALSALVA IN HF
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COPD VS HF
VENTILLATED:
`'VALSALVA'
Pulse oxymetry
Biomarkers:
Diagnosis/ prognosis
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WHAT LIES BENEATH?
LOW SALT
B1 blockers
LOW FLUID
DIURETICS
SNS
Ivabradine
RAAS
NP
ACEI
NEPRILYSIN
ARB
INHIBITOR
MRA
PNEUMOVAC
(ARNI)
INFLUVAC
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ESC
GUIDELINE
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ARNI: SACUBITRIL VALSARTAN
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CARDIAC RESYNCHRONISATION THERAPY
NYHA II-IVa + LVEF< 35%
NYHA I + LVEF <30%
LBBB + QRS>150 ms (>120ms)
NSR (AF)
Life expectancy> 1 yr
26
Ionotrops & more
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Treatment Summary
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MECHANICAL CIRCULATORY DEVICE
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MECHANICAL CIRCULATORY DEVICE
TANDEM HEART
IMPELLA
HEARTMATE
ECMO
30
HEART TRANSPLANT
31
Stem cell therapy
32
What causes Acute heart failure?
? <5 years: CHD (PDA>VSD)
? 5-15 years: Rheumatic carditis (h/o joint pain)
viral (h/o fever) (MC Coxsackie)
? 15-35 years: Myocarditis (h/o fever)
arrythmias (palpitation) (SVT>VT)
HTN
? >35 years: Ischemic (Chest pain ? ACS)
arrhythmia (palpitation) (AF>VT>SVT)
myocarditis (fever)
CKD
ALWAYS RULE OUT HTN CRISIS AND AF
33
What causes Chronic heart failure?
? <5 years: CHD (PDA>VSD)
? 5-15 years: Rheumatic heart dis (h/o joint pain)
viral (h/o fever) (MC Coxsackie)
? 15-35 years: RHD
CHD
? >35 years: Ischemic
CMP (r/o alcohol CMP)
ALWAYS RULE OUT ANAEMIA, hypoThy
34
Treat the underlying cause!
? Myocarditis: supportive therapy only
? Arrhythmia: DC shock (SVT 50-100J, VT 200J)
? ACS: PTCA+S
? Anemia: keep Hb around 10
? DO NOT GIVE IV FLUID (NS) TO HF PATIENTS
? Old MI EF 35%: No role of PTCA w/o viability
? Rule out Cardiomyopathies by Echo/ Imaging
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ACUTE CHEST PAIN + SOB + NORMAL CAG
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50 yr old+ HTN + Obese Lady+ DOE
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10 year child CHF no murmer
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? HEMODYNAMICS
Increased LVEDP ? LAP - PCWP
? CLINICAL RECOGNITON & DIFFERENTIATION
Volume status/ perfusion status/ HTN/ anemia/ AF
? ASSESSING SEVERITY
AHA/ ACC, Killip, NYHA, CPK level
So,
? ORDERING TESTS
Pallor/ Hb (r/o Anemia)
very little Murmer (r/o structural heart dis)
to learn ECG and trop I (r/o ACS)
CXR (r/o pneumothx)
actual y.. CPK (confirming HF)
ABG (r/o Asthma/ COPD)
Echo (r/o CMP, structural heart dis)
? IMMEDIATE MANAGEMENT
O2/ IV Diuretics/ NIV (BIPAP, CPAP)/ ionotrops
? LONG TERM MANAGAMENT
Pharmacotherapy/ CRT/ low salt + fluid/ vaccines
39
LVAD ? HTX ? Stem Cell therapy
This post was last modified on 07 April 2022