CHF in brief

1. Dr.T SANDEEP PATIL
Chronic Heart Failure

2. Definition of chronic heart failure
• Heart failure is a complex clinical syndrome
of symptoms and signs that suggest
impairment of the heart as a pump supporting
physiological circulation.
• It is caused by structural or functional
abnormalities of the heart.
• The demonstration of objective evidence of
these cardiac abnormalities is necessary for
the diagnosis of heart failure to be made.

3. Causes
• Heart attack (Most common cause),which
causes damage to the muscle of the left
ventricle

4. Other possible causes
• Coronary Artery Disease
• Previous heart attack (which has left scar
tissue that stops the heart muscle working
normally)
• Hypertension
• Diseased or Damaged heart valves (can
affect the flow of blood in the heart)

5. Other possible causes
• Cardiomyopathy
• Congenital heart defects
• Endocarditis
• Myocarditis
• Unknown

6. Main Symptoms
• Severe tiredness or fatigue
• Dyspnoea
• Swelling of the ankles
These symptoms can also be caused by
other conditions
Tests to find out if you have heart failure or
not
Symptoms to classify the severity of heart
failure

9. INVESTIGATIONS
• BP
• PR
• ECG
• BNP
• EchoCardioGram

12. • X-ray Chest
• Blood tests
(S.electrolytes,Bl.Urea,S.Creatinine,eGFR,Thyroid
Function Tests,Fasting Lipids,Fasing Glucose,Full
Blood Count)
• Urinalysis
• Peak flow or spirometry

13. Treatment
• Lifestyle modification
• Drug treatment
• Other treatments &Interventional
Procedures
• Monitoring

15. Drug Treatment
• ACE inhibitors
• Beta blockers
• ARBs
• Hydralazine
• Nitrates
• Aldosterone antagonists
• Digoxin
• Ivabradine
• Diuretics

17. Other treatments
• CPAP
• Exercise training programme
• Immunisation (Flu & Pneumococcal)

18. Interventional procedures
• CRT
• Cardiac transplantation
• Preoperative(CABG) intra-aortic balloon
counterpulsion
• Sutureless aortic valve replacement for AS
• Transcatheter aortic valve implantation for AS
• Percutaneous mitral valve annuloplasty
• Percutaneous mitral valve leaflet repair for MR
• Short term circulatory support with left
ventricular assist devices as a bridge to cardiac
transplantation or recovery

19. Monitoring
• Clinical review
• Serum natriuretic peptides
• Serum digoxin
• Pulmonary artery pressure monitors

20. Lifestyle modification
• Drink less alcohol
• Stop smoking
• Be physically more active
• Cut down salt
• Reduce your fluid intake
• Watch your weight
• Vaccination
• Air Travel,Sexual activity & Driving
• Avoid St.John wart,Cranberry juice &
Grape juice

21. Long term care
• Prognosis
Discuss prognosis with patients and carers in a sensitive,
open and honest manner
• Anxiety and depression
Consider a diagnosis of depression in patients with heart
failure
Carefully consider the risks and benefits of drug treatment
for depression

22. Long term care
• End of life
Ensure that patients and carers have the opportunity at all
stages of care to discuss issues of sudden death and living
with uncertainty.
Identify and manage palliative care needs as soon as
possible

23. Palliative Care
• Emotional support
• Symptom management
• Opportunity to discuss stop treatments
If breathlessness is becoming very difficult low dose
opioids may help
Medication should be reviewed regularly and the decision
to adjust or stop any treatments should be based on how
effective the treatments are and how the pt. feels
Pt.s have the right to refuse any medical treatment or
request withdrawl of treatment including pacemakers and
other ICDs

24. THANK YOU