Download MBBS Cardiology PPT 2 Heart Failure Lecture Notes

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

13

STEVENSON

14


ELLIS

NYHA 2

NYHA 3

PND

NYHA 4

Orthopnea

15

TYPES!!

? ACUTE/ CHRONIC

? COMPENSATED/

DECOMPENSATED

? SYSTOLIC/ DIASTOLIC/ both

? HFREF/ HFPEF/ both

? LHF/ RHF/ CHF

? Mild/mod/severe

? A/B/C/L

16




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

20




VALSALVA IN HF

21

COPD VS HF

VENTILLATED:

`'VALSALVA'

Pulse oxymetry

Biomarkers:

Diagnosis/ prognosis

22


WHAT LIES BENEATH?

LOW SALT

B1 blockers

LOW FLUID

DIURETICS

SNS

Ivabradine

RAAS

NP

ACEI

NEPRILYSIN

ARB

INHIBITOR

MRA

PNEUMOVAC

(ARNI)

INFLUVAC

23

ESC

GUIDELINE

24




ARNI: SACUBITRIL VALSARTAN

25

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

27

Treatment Summary

28






MECHANICAL CIRCULATORY DEVICE

29

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

35

ACUTE CHEST PAIN + SOB + NORMAL CAG

36






50 yr old+ HTN + Obese Lady+ DOE

37

10 year child CHF no murmer

38
? 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