Congestive Heart Failure Lecture
Transcript of Congestive Heart Failure Lecture
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CONGESTIVE HEARTCONGESTIVE HEARTFAILUREFAILURE
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IS CHF AN ACTUAL MEDICALIS CHF AN ACTUAL MEDICALDIAGNOSIS?DIAGNOSIS?
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CHF is the common end point fo m!n"CHF is the common end point fo m!n"
foms of c!di!c dise!se !nd t"pic!##"foms of c!di!c dise!se !nd t"pic!##"
is ! po$essi%e condition th!t c!iesis ! po$essi%e condition th!t c!ies
!n e&teme#" poo po$nosis!n e&teme#" poo po$nosis
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Con$esti%e He!t F!i#'eCon$esti%e He!t F!i#'e
The in!(i#it" of the he!t to s'pp#"The in!(i#it" of the he!t to s'pp#"
eno'$h (#ood cic'#!tion to meet theeno'$h (#ood cic'#!tion to meet the
(od")s needs*(od")s needs*
Res'#ts in !cc'm'#!tion ofRes'#ts in !cc'm'#!tion of
e&t!%!sc'#! f#'idse&t!%!sc'#! f#'ids
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C!di!c c!thetei+!tion is 'sed to st'd" the %!io's
f'nctions of the he!t*
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Con$esti%e He!t F!i#'eCon$esti%e He!t F!i#'e
, mi##ion c!ses in the US, mi##ion c!ses in the US
,,-.--- ne/ conditions0"e!,,-.--- ne/ conditions0"e!
1--.-- de!ths pe "e!1--.-- de!ths pe "e!In !## !$e $o'ps CHF is the fo'thIn !## !$e $o'ps CHF is the fo'th
most common medic!# conditionmost common medic!# condition
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Con$esti%e He!t F!i#'eCon$esti%e He!t F!i#'e
2oo po$nosis2oo po$nosis
,-3 de!th !te (" "e! ,,-3 de!th !te (" "e! ,,- 4 5-3 de!th !te /ithin one "e! if,- 4 5-3 de!th !te /ithin one "e! if
s"mptoms !e se%ees"mptoms !e se%ee
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6ho Gets CHF?6ho Gets CHF?
He!t f!i#'e c!n h!ppen toHe!t f!i#'e c!n h!ppen to
!n"one. ('t it is moe common!n"one. ('t it is moe common
in7in72eop#e 5, "e!s of !$e !nd o#de2eop#e 5, "e!s of !$e !nd o#de
Afic!n Ameic!nsAfic!n Ameic!ns
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CHF in Afic!n Ameic!nsCHF in Afic!n Ameic!ns
Afic!n Ameic!ns !e moe #i8e#" toAfic!n Ameic!ns !e moe #i8e#" to
h!%e he!t f!i#'e !nd s'ffe moeh!%e he!t f!i#'e !nd s'ffe moe
se%ee#" fom it7se%ee#" fom it7
De%e#op s"mptoms !t !n e!#ie !$eDe%e#op s"mptoms !t !n e!#ie !$e
H!%e thei he!t f!i#'e $et /ose f!steH!%e thei he!t f!i#'e $et /ose f!ste
H!%e moe hospit!# %isitsH!%e moe hospit!# %isitsDie fom he!t f!i#'eDie fom he!t f!i#'e
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Gende diffeences in CHFGende diffeences in CHF
Men !#so h!%e ! hi$he !te of he!tMen !#so h!%e ! hi$he !te of he!t
f!i#'e th!n /omen*f!i#'e th!n /omen*9't in !ct'!# n'm(es. moe /omen9't in !ct'!# n'm(es. moe /omen
h!%e he!t f!i#'e (ec!'se m!n"h!%e he!t f!i#'e (ec!'se m!n"
moe /omen #i%e into thei :-s !ndmoe /omen #i%e into thei :-s !nd
;-s /hen he!t f!i#'e is common*;-s /hen he!t f!i#'e is common*
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Con$esti%e He!t Dise!seCon$esti%e He!t Dise!se
C!'sed (" the in!(i#it" of the he!t toC!'sed (" the in!(i#it" of the he!t to
f'nction efficient#" !s ! p'mpf'nction efficient#" !s ! p'mp
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Physiology Terms You MUSTPhysiology Terms You MUST
UnderstandUnderstand
PreloadPreload
AfterloadAfterload
Stroke VolumeStroke VolumeCardiac OutputCardiac Output
aroreceptor !efle"aroreceptor !efle"
!enin#Angiotensin System!enin#Angiotensin System
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rief O$er$ie%rief O$er$ie%
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2oo p'mpin$2oo p'mpin$
mech!nism #e!ds to7mech!nism #e!ds to7
Incomp#ete fi##in$ of theIncomp#ete fi##in$ of the
%entic#es d'in$ di!sto#e%entic#es d'in$ di!sto#e
Dece!se in c!di!c o'tp'tDece!se in c!di!c o'tp'tIn!de
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2oo p'mpin$2oo p'mpin$
mech!nism #e!ds to7mech!nism #e!ds to7
In!deNom!#>,,>:-3,,>:-3
CHFCHF>,>,-3 !nd (e#o/>,>,-3 !nd (e#o/
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C!din!# M!nifest!tions of CHF7C!din!# M!nifest!tions of CHF7
F!ti$'eF!ti$'e
D"spne!D"spne!
Con$estion ofCon$estion of
p'#mon!" %esse#sp'#mon!" %esse#s
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Con$esti%e He!t Dise!seCon$esti%e He!t Dise!se
The He!tThe He!t
t/o p'mps in !t/o p'mps in !
seiesseies
connected %i!connected %i!p'#mon!" !ndp'#mon!" !nd
s"stemic cic'#!tions"stemic cic'#!tion
e!ch side of he!te!ch side of he!t
h!s @ %!#%es /hichh!s @ %!#%es /hich
m!int!in one sidedm!int!in one sided
(#ood f#o/(#ood f#o/
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Con$esti%e He!t Dise!seCon$esti%e He!t Dise!se
Ri$ht %entic#eRi$ht %entic#ep'mps #!$e %o#'mes ofp'mps #!$e %o#'mes of
(#ood !t #o/ pess'e tho'$h the(#ood !t #o/ pess'e tho'$h thep'#mon!" cic'#!tionp'#mon!" cic'#!tion
Left %entic#eLeft %entic#eis ! thic8 /!##ed !ndis ! thic8 /!##ed !nd
p'mps !t hi$he pess'e !nd is moep'mps !t hi$he pess'e !nd is moeeffected (" dise!se pocesseseffected (" dise!se pocesses
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NHA CHF C#!ssific!tionNHA CHF C#!ssific!tion
C#!ss IC#!ss I B!s"mptom!ticB!s"mptom!tic No #imit!tion of ph"sic!# !cti%it"No #imit!tion of ph"sic!# !cti%it"
C#!ss IIC#!ss II S#i$ht #imit!tion of ph"sic!# !cti%it"S#i$ht #imit!tion of ph"sic!# !cti%it"
C#!ss IIIC#!ss III
M!8ed #imit!tion of !cti%it"M!8ed #imit!tion of !cti%it"C#!ss IVC#!ss IV S"mptoms !t estS"mptoms !t est
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Ameic!n He!t Associ!tion0Ameic!n He!t Associ!tion0
Ameic!n Co##e$e of C!dio#o$"Ameic!n Co##e$e of C!dio#o$"Stage AStage A
Patients ha$e risk factors predisposing to &' (ut noPatients ha$e risk factors predisposing to &' (ut no
symptomssymptoms
CA)* &T+* )MCA)* &T+* )M
Stage Stage
!isk factors plus ,V& and-or dysfunction!isk factors plus ,V& and-or dysfunction
Stage CStage C
Past or present symptoms of &' %ith heart damagePast or present symptoms of &' %ith heart damage
Stage )Stage )
Patients ha$e se$ere &' needing ad$anced treatment orPatients ha$e se$ere &' needing ad$anced treatment or
end of life careend of life care
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CAUSES OF CHFCAUSES OF CHF
Most commonMost common
'nde#"in$ c!'se'nde#"in$ c!'se
Coon!" Ate"Coon!" Ate"
Dise!se BCADDise!se BCADInce!sed %!sc'#!Ince!sed %!sc'#!
esist!nceesist!nce
H"petension in :,3H"petension in :,3
of CHF p!tientsof CHF p!tients HTN is not ! pim!"HTN is not ! pim!"
c!'se ho/e%ec!'se ho/e%e
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C!'ses of CHFC!'ses of CHF
Di#!ted o h"petophicDi#!ted o h"petophic
c!diom"op!th"c!diom"op!th"
Idiop!thicIdiop!thic
A#coho# !('seA#coho# !('se
Heedit!"Heedit!"
c!diom"op!th"c!diom"op!th"
Vi!# infectionVi!# infection
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& t i & t )i& t i & t )i
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&ypertensi$e &eart )isease.&ypertensi$e &eart )isease.Myocardial &ypertrophyMyocardial &ypertrophy
Left %entic'#! h"petoph"7Left %entic'#! h"petoph"7 ,V outflo% o(struction or,V outflo% o(struction orincreased peripheral $ascular resistanceincreased peripheral $ascular resistance4thic8ened LV4thic8ened LV /!##/!##
Ri$ht %entic'#! h"petoph" Bco p'#mon!#e7Ri$ht %entic'#! h"petoph" Bco p'#mon!#e7!V load increased due to pulmonary resistance !V load increased due to pulmonary resistance di#!ted RVdi#!ted RV ch!m(ech!m(e
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Othe C!'ses of CHFOthe C!'ses of CHF
V!#%'#! he!tV!#%'#! he!t
dise!sedise!se
M"oc!di!#M"oc!di!#
Inf!ctionInf!ctionM"oc!ditisM"oc!ditis
Infecti%eInfecti%e
Endoc!ditisEndoc!ditis
Con$enit!# he!tCon$enit!# he!t
dise!sedise!se
2'#mon!"2'#mon!"
h"petensionh"petension2'#mon!"2'#mon!"
em(o#ismem(o#ism
Endocine dise!seEndocine dise!se
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CardiomyopathiesCardiomyopathies
Di#!ted7Di#!ted7 symmetricallysymmetricallyenlargedenlarged /0#1" normal2 %ith/0#1" normal2 %ith
dilation in all cham(ersdilation in all cham(ers
H"petophic7H"petophic7 $entricular$entricular
hypertrophy %ithout dilationhypertrophy %ithout dilation**oftenoften asymmetricalasymmetricalseptalseptal
hypertrophyhypertrophy
Resticti%e7Resticti%e7 oftenoften (ilateral(ilateral
$entricular hypertrophy %ithout$entricular hypertrophy %ithoutdilationdilation/(ut atria are often/(ut atria are often
dilateddilated (ilaterally2#Ventricular(ilaterally2#Ventricular
%all is stiffer%all is stiffer
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Con$esti%e He!t Dise!seCon$esti%e He!t Dise!se
Left sided he!t f!i#'eLeft sided he!t f!i#'e
HTNHTNAotic dise!seAotic dise!se
Mit!# dise!seMit!# dise!se
Coon!" he!t dise!seCoon!" he!t dise!se
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Con$esti%e He!t Dise!seCon$esti%e He!t Dise!se
Ri$ht sidedRi$ht sidedhe!t dise!sehe!t dise!se
Most commonMost commonc!'se isc!'se is
left sided failureleft sided failure
Co p'#mon!#eCo p'#mon!#e
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S G S S O S OSIGNS d SM2TOMS OF
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SIGNS !nd SM2TOMS OFSIGNS !nd SM2TOMS OF
CHFCHF
LHF>2'#mon!"LHF>2'#mon!"
D"spne!D"spne!
Othopne!Othopne!
2!o&"sm!#2!o&"sm!#
noct'n!# d"spne!noct'n!# d"spne!
2'#mon!"2'#mon!"
h"petensionh"petension
RHF>S"stemicRHF>S"stemic
Distended ='$'#!Distended ='$'#!
%eins%eins
2eiphe!# edem!2eiphe!# edem!
Li%e p!inLi%e p!in
6ei$ht $!in6ei$ht $!in
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2ND2ND
2!o&"sm!# noct'n!# d"spne!2!o&"sm!# noct'n!# d"spne!
An !tt!c8 of s'dden !nd se%eeAn !tt!c8 of s'dden !nd se%eeshotness of (e!th th!t !/!8ens theshotness of (e!th th!t !/!8ens the
p!tient fom s#eep. 's'!##" /ithin top!tient fom s#eep. 's'!##" /ithin to
1 ho's !fte the p!tient $oes to (ed1 ho's !fte the p!tient $oes to (ed
!nd eso#%es /ithin 1- min'tes !fte!nd eso#%es /ithin 1- min'tes !fte
the p!tient !ises often $!spin$ fo !i*the p!tient !ises often $!spin$ fo !i*
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Othopne!Othopne!
2osition!#2osition!#
d"spne!d"spne!
/osened (" !/osened (" !
ec'm(ent oec'm(ent osemiec'm(entsemiec'm(ent
positionposition
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2ND 0 Othopne!2ND 0 Othopne!
)ue to increased $enous return)ue to increased $enous return
encouraged (y the semi#reclined positionencouraged (y the semi#reclined position
resulting in increases in pulmonaryresulting in increases in pulmonary
$enous pressure and al$eolar edema$enous pressure and al$eolar edema
Cheyne#Stokes reathingCheyne#Stokes reathing
Alternating cycles of hyper$entilation andAlternating cycles of hyper$entilation and
apneaapnea
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Side Effects of He!t F!i#'eSide Effects of He!t F!i#'e
Renin>An$iotensin s"stem stim'#!tedRenin>An$iotensin s"stem stim'#!ted
S"mp!thetic Ne%o's s"stem stim'#!tionS"mp!thetic Ne%o's s"stem stim'#!tion
Res'#ts in7Res'#ts in7
Ince!sed he!t !te0cont!cti#it" of he!tInce!sed he!t !te0cont!cti#it" of he!t
Ince!sed peiphe!# esist!nceInce!sed peiphe!# esist!nce
Sodi'm 0 6!te etention BSodi'm 0 6!te etention BR!#es0C!c8#esR!#es0C!c8#es
9#ood edisti('tion to he!t !nd (!in9#ood edisti('tion to he!t !nd (!in
Ince!sed efficienc" of o&"$en 'se ("Ince!sed efficienc" of o&"$en 'se ("
tiss'estiss'es
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3hat is the difference43hat is the difference4
Compens!tedCompens!ted
Decompens!tedDecompens!ted
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Pitting 5demaPitting 5dema
@ 1
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Symptoms of &eart 'ailure
)
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6 )yspnea
6 'atigue and %eakness
6 Orthopnea
6 Paro"ysmal nocturnal dyspnea6 Acute pulmonary edema
6 5"ercise intolerance
6 )ependent edema /after standing or
%alking26 !eport of %eight gain or increased
a(dominal girth /fluid accumulation7 ascites2
6 !ight upper 8uadrant pain /li$er congestion2
6 Anore"ia* nausea* $omiting* constipation
/(o%el edema26 &yper$entilation follo%ed (y apnea during
sleep /Cheyne#Stokes respiration2
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Signs of C&'Signs of C&'
)isplaced Apical pulse)isplaced Apical pulse
Mitral regurgitationMitral regurgitation
S1 - S9 :allopS1 - S9 :allop
Pulsus AlternansPulsus Alternans
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Pulsus AlternansPulsus Alternans
Arterial (lood pressureArterial (lood pressure%a$e form%a$e form
Most accurate measureMost accurate measureof (lood pressure perof (lood pressure perheart (eatheart (eat
Pulsus Alternans ;Pulsus Alternans ;alternating strong andalternating strong and
%eak (eats%eak (eats
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,a(oratory 'indings,a(oratory 'indings
Tests for )iagnosis.Tests for )iagnosis.
Chest
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INCREASED VASCULARINCREASED VASCULAR
RESISTANCERESISTANCE2RIMAR CAUSE2RIMAR CAUSE
H"petensionH"petension :,3 of c!ses:,3 of c!ses
Aotic StenosisAotic Stenosis
Co!ct!tion of the Aot!Co!ct!tion of the Aot!
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DECREASED MOCARDIALDECREASED MOCARDIAL
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DECREASED MOCARDIALDECREASED MOCARDIAL
FUNCTIONFUNCTION
Ischemic he!t dise!seIschemic he!t dise!se
Infi#t!ti%e dise!sesInfi#t!ti%e dise!ses
Am"#oidosisAm"#oidosis
Met!(o#ic disodesMet!(o#ic disodes
H"poth"oidismH"poth"oidism
2h!m!co#o$ic s'ppession2h!m!co#o$ic s'ppession
2op!no#o#2op!no#o#
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INCREASED 9LOODINCREASED 9LOOD
VOLUMEVOLUME
V!#%'#! ins'fficienc"V!#%'#! ins'fficienc" Aotic o mit!# %!#%e ins'fficienc"Aotic o mit!# %!#%e ins'fficienc"
Ati!# o Ventic'#! sept!# defectAti!# o Ventic'#! sept!# defect
Chonic en!# f!i#'e /ith f#'idChonic en!# f!i#'e /ith f#'id
etentionetention
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ECESSIVE META9OLICECESSIVE META9OLICDEMANDDEMAND
Se%ee !nemi!Se%ee !nemi!
Th"oto&icosisTh"oto&icosis
MEDICAL MANAGEMENT OFMEDICAL MANAGEMENT OF
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MEDICAL MANAGEMENT OFMEDICAL MANAGEMENT OF
THE CHF 2ATIENTTHE CHF 2ATIENTSt!$e A7 2!tients !t Hi$h Ris8 fo HF. ('tSt!$e A7 2!tients !t Hi$h Ris8 fo HF. ('t
/itho't St'ct'!# He!t Dise!se o/itho't St'ct'!# He!t Dise!se o
S"mptoms of HFS"mptoms of HF
Treatment of hypertension* encourage smokingTreatment of hypertension* encourage smokingcessation* treatment of lipid disorders*cessation* treatment of lipid disorders*
encouragement of regular e"ercise* discourageencouragement of regular e"ercise* discourage
alcohol intake* illicit drug use* and control ofalcohol intake* illicit drug use* and control of
meta(olic syndromemeta(olic syndrome
AC5 inhi(itors or A!s as appropriate for treatmentAC5 inhi(itors or A!s as appropriate for treatment
of $ascular disease or dia(etesof $ascular disease or dia(etes
MEDICAL MANAGEMENT OFMEDICAL MANAGEMENT OF
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MEDICAL MANAGEMENT OFMEDICAL MANAGEMENT OF
THE CHF 2ATIENTTHE CHF 2ATIENTSt!$e 97 2!tients /ith St'ct'!# He!tSt!$e 97 2!tients /ith St'ct'!# He!t
Dise!se. ('t /itho't Si$ns o S"mptoms ofDise!se. ('t /itho't Si$ns o S"mptoms of
HFHF
All measures for stage A* plusAll measures for stage A* plusAC5 inhi(itors /or A!s2 as appropriateAC5 inhi(itors /or A!s2 as appropriate
eta (lockers as appropriateeta (lockers as appropriate
MEDICAL MANAGEMENT OFMEDICAL MANAGEMENT OF
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MEDICAL MANAGEMENT OFMEDICAL MANAGEMENT OF
THE CHF 2ATIENTTHE CHF 2ATIENTSt!$e C7 2!tients /ith St'ct'!# He!tSt!$e C7 2!tients /ith St'ct'!# He!t
Dise!se /ith 2e%io's o C'ent S"mptomsDise!se /ith 2e%io's o C'ent S"mptoms
of HFof HF
All measures for stages A and * dietary saltAll measures for stages A and * dietary salt
restriction*restriction* plusplus
)rugs for routine use. diuretics* AC5 inhi(itors* (eta)rugs for routine use. diuretics* AC5 inhi(itors* (eta
(lockers(lockers
)rugs in selected patients. aldosterone antagonists*)rugs in selected patients. aldosterone antagonists*
A!s* digitalis* hydrala=ine#nitratesA!s* digitalis* hydrala=ine#nitrates
)e$ices in selected patients. (i$entricular pacing)e$ices in selected patients. (i$entricular pacing
de$ice* implanta(le defi(rillatorde$ice* implanta(le defi(rillator
MEDICAL MANAGEMENT OFMEDICAL MANAGEMENT OF
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MEDICAL MANAGEMENT OFMEDICAL MANAGEMENT OF
THE CHF 2ATIENTTHE CHF 2ATIENTSt!$e D7 2!tients /ith Ref!cto" HFSt!$e D7 2!tients /ith Ref!cto" HF
Re
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DRUGS USED IN THEDRUGS USED IN THE
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DRUGS USED IN THEDRUGS USED IN THE
TREATMENT OF CHFTREATMENT OF CHF
Di'eticsDi'etics
Ch#oothi!+ide. F'osemide. 2ot!ssi'm>Ch#oothi!+ide. F'osemide. 2ot!ssi'm>
sp!in$sp!in$
C!di!c G#"cosidesC!di!c G#"cosides Di$o&in. Di$it!#isDi$o&in. Di$it!#is
Afte#o!d Red'cin$ A$entsAfte#o!d Red'cin$ A$ents
ACE>inhi(itos. V!sodi#!tosACE>inhi(itos. V!sodi#!tosMost Common Side effect>Most Common Side effect> &eostomi!&eostomi!
C!di!c G#"cosides 'sed inC!di!c G#"cosides 'sed in
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C!di!c G#"cosides 'sed inC!di!c G#"cosides 'sed in
CHFCHF
Di$o&in BDi$it!#is. L!no&in.Di$o&in BDi$it!#is. L!no&in.
L!no&ic!pL!no&ic!p Ince!ses foce !nd %e#ocit" of c!di!cInce!ses foce !nd %e#ocit" of c!di!c
cont!ctioncont!ction Dece!ses cond'ction !te of A>V nodeDece!ses cond'ction !te of A>V node
O!# M!nifest!tionsO!# M!nifest!tions
Ince!sed $!$ ef#e& BimpessionsInce!sed $!$ ef#e& Bimpessionseostomi!eostomi!
Ince!sed c!iesInce!sed c!ies
Di it #i T i itDi it #i T i it
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Di$it!#is To&icit"Di$it!#is To&icit"
Di$it!#is To&icit"Di$it!#is To&icit"S"mptoms Si$nsS"mptoms Si$ns
Visual changesVisual changes/unusual2/unusual2
&alos or rings of light&alos or rings of light
around o(>ectsaround o(>ects Seeing lights or (rightSeeing lights or (right
spotsspots
Changes in colorChanges in color
perceptionperception
lind spots inlind spots in $ision$ision
lurred $isionlurred $ision
ConfusionConfusion
,oss of appetite,oss of appetite
+ausea+ausea** $omiting$omiting**
diarrheadiarrhea
PalpitationsPalpitations
?rregular?rregular pulsepulse
ACE I hi(it d i CHF
http://health.allrefer.com/health/vision-abnormalities-info.htmlhttp://health.allrefer.com/health/vision-abnormalities-info.htmlhttp://health.allrefer.com/health/vision-abnormalities-info.htmlhttp://health.allrefer.com/health/vision-abnormalities-info.htmlhttp://health.allrefer.com/health/vision-abnormalities-info.htmlhttp://health.allrefer.com/health/vision-abnormalities-info.htmlhttp://health.allrefer.com/health/appetite-decreased-info.htmlhttp://health.allrefer.com/health/appetite-decreased-info.htmlhttp://health.allrefer.com/health/nausea-and-vomiting-info.htmlhttp://health.allrefer.com/health/nausea-and-vomiting-info.htmlhttp://health.allrefer.com/health/nausea-and-vomiting-info.htmlhttp://health.allrefer.com/health/nausea-and-vomiting-info.htmlhttp://health.allrefer.com/health/pulse-info.htmlhttp://health.allrefer.com/health/pulse-info.htmlhttp://health.allrefer.com/health/heartbeat-sensations-info.htmlhttp://health.allrefer.com/health/heartbeat-sensations-info.htmlhttp://health.allrefer.com/health/pulse-info.htmlhttp://health.allrefer.com/health/pulse-info.htmlhttp://health.allrefer.com/health/pulse-info.htmlhttp://health.allrefer.com/health/heartbeat-sensations-info.htmlhttp://health.allrefer.com/health/pulse-info.htmlhttp://health.allrefer.com/health/nausea-and-vomiting-info.htmlhttp://health.allrefer.com/health/nausea-and-vomiting-info.htmlhttp://health.allrefer.com/health/appetite-decreased-info.htmlhttp://health.allrefer.com/health/vision-abnormalities-info.htmlhttp://health.allrefer.com/health/vision-abnormalities-info.htmlhttp://health.allrefer.com/health/vision-abnormalities-info.html -
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ACE>Inhi(itos 'sed in CHFACE>Inhi(itos 'sed in CHF
Sho/n to ince!se #ife e&pect!nc"Sho/n to ince!se #ife e&pect!nc"
En!#opi# > V!sotecEn!#opi# > V!sotec
C!ptopi# > C!potenC!ptopi# > C!potenLisinopi# > 2ini%i#. Jesti#Lisinopi# > 2ini%i#. Jesti#
K'in!pi# > Acc'pi#K'in!pi# > Acc'pi#
O!# M!nifest!tionsO!# M!nifest!tions
Co'$hCo'$h
O!# '#ce!tion. ('nin$ p!in of m'cos!O!# '#ce!tion. ('nin$ p!in of m'cos!
An$ioedem!An$ioedem!
V di# t d i CHFV di# t d i CHF
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V!sodi#!tos 'sed in CHFV!sodi#!tos 'sed in CHF
H"d!#!+ine > Apeso#ineH"d!#!+ine > Apeso#ine
2!+osin 4 Minipes B!>(#oc8e2!+osin 4 Minipes B!>(#oc8e O!# m!nifest!tionsO!# m!nifest!tions
D" mo'thD" mo'th
L'p's>#i8e #esionsL'p's>#i8e #esions
9e s'e to e!d T!(#e 5>9e s'e to e!d T!(#e 5>
COM2LICATIONS OF DRUGSCOM2LICATIONS OF DRUGS
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COM2LICATIONS OF DRUGSCOM2LICATIONS OF DRUGS
USED TO TREAT CHFUSED TO TREAT CHF
Di'eticsDi'etics
H"po8!#emi!. deh"d!tion. &eostomi!H"po8!#emi!. deh"d!tion. &eostomi!
C!di!c G#"coside O%edoseC!di!c G#"coside O%edose Life the!tenin$ !h"thmi!Life the!tenin$ !h"thmi!
V!sodi#!tosV!sodi#!tos
Othost!tic h"potensionOthost!tic h"potension
D Sid Eff t i CHFD Sid Eff t i CHF
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D'$ Side>Effects in CHFD'$ Side>Effects in CHF
Othost!tic h"potensionOthost!tic h"potension
Di'etics !nd %!sodi#!tosDi'etics !nd %!sodi#!tos
A"thmi!sA"thmi!s
Di$o&inDi$o&in
N!'se!. %omitin$N!'se!. %omitin$
Di$o&in !nd %!sodi#!tosDi$o&in !nd %!sodi#!tos
2!#pit!tions2!#pit!tions Di$o&in !nd %!sodi#!tosDi$o&in !nd %!sodi#!tos
Ri 8 f D t # T t tRi 8 f D t # T t t
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Ris8s of Dent!# Te!tmentRis8s of Dent!# Te!tment
Untreated or Poorly Managed C&'Untreated or Poorly Managed C&'
C!di!c Aest BAh"thmi!C!di!c Aest BAh"thmi!
CVACVA
MIMI
M di # C id tiM di # C id ti
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Medic!# Conside!tionsMedic!# Conside!tions
Thoo'$h Medic!# Histo" Thoo'$h Medic!# Histo"
Re%ie/ of s"stems BC!diop'#mon!"Re%ie/ of s"stems BC!diop'#mon!"
Vit!# Si$nsVit!# Si$ns
2'#se. !te. h"thm. 92. esi!tions2'#se. !te. h"thm. 92. esi!tions
Identific!tion of !## medicines t!8enIdentific!tion of !## medicines t!8en
DENTAL EVALUATION OFDENTAL EVALUATION OF
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THE CHF 2ATIENT BROSTHE CHF 2ATIENT BROS
A(i#it" to /!#8 'p st!isA(i#it" to /!#8 'p st!is
S#eepin$ on ince!sed n'm(e ofS#eepin$ on ince!sed n'm(e of
pi##o/spi##o/sShotness of (e!thShotness of (e!th
9e!th#essness /hen f#!t9e!th#essness /hen f#!t
S/o##en !n8#esS/o##en !n8#es
As8 if di!$nosed /ith ! m'm'As8 if di!$nosed /ith ! m'm'
DENTAL EVALUATION OFDENTAL EVALUATION OF
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THE CHF 2ATIENTTHE CHF 2ATIENT
Mot!#it" R!te > ,-3 !t fi%e "e!sMot!#it" R!te > ,-3 !t fi%e "e!s
2!tient !t #o/ is82!tient !t #o/ is8
Histo" of mi#d con$esti%e he!t f!i#'eHisto" of mi#d con$esti%e he!t f!i#'e
As"mptom!tic on the!p"As"mptom!tic on the!p"
Us'!##" on di'etics. /ith o /itho'tUs'!##" on di'etics. /ith o /itho't
c!di!c $#"cosidesc!di!c $#"cosides
DENTAL EVALUATION OFDENTAL EVALUATION OF
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THE CHF 2ATIENTTHE CHF 2ATIENT
2!tient !t Mode!te is82!tient !t Mode!te is8
Histo" of mode!te#" se%ee CHFHisto" of mode!te#" se%ee CHF
As"mptom!tic !t est ('tAs"mptom!tic !t est ('t
s"mptoms on e&etions"mptoms on e&etion
Us'!##" on moe potent di'eticsUs'!##" on moe potent di'etics
!nd c!di!c $#"cosides!nd c!di!c $#"cosides
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DENTAL EVALUATION OFDENTAL EVALUATION OF
THE CHF 2ATIENTTHE CHF 2ATIENT
2!tient !t Hi$h Ris82!tient !t Hi$h Ris8
S"mptom!tic despite the!p" BRef!cto"S"mptom!tic despite the!p" BRef!cto"
he!t f!i#'ehe!t f!i#'e
Often on esc!#!tin$ doses of medic!tions.Often on esc!#!tin$ doses of medic!tions.
inc#'din$ %!sodi#!tosinc#'din$ %!sodi#!tos
Dent!# M!n!$ement of theDent!# M!n!$ement of the
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$$
CHF 2!tientCHF 2!tient
eep p!tient in 'pi$ht o ,eep p!tient in 'pi$ht o ,oopositionposition
Est!(#ish NHA c#!ssific!tionEst!(#ish NHA c#!ssific!tion
Chec8 medic!tionsChec8 medic!tionsC!'tio's 'se of epinephineC!'tio's 'se of epinephine
Chec8 fo di$it!#is to&icit"Chec8 fo di$it!#is to&icit"
6!tch fo othost!tic h"potension6!tch fo othost!tic h"potensionShot monin$ !ppointmentsShot monin$ !ppointments
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9efoe An" Te!tment. M!8e9efoe An" Te!tment. M!8e
S'e The 9enefits O't/ei$hS'e The 9enefits O't/ei$h
The Ris8s In%o#%ed To TheThe Ris8s In%o#%ed To The2!tient2!tient
MANAGEMENT OF CHF AND ACUTEMANAGEMENT OF CHF AND ACUTE
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2ULMONAR EDEMA2ULMONAR EDEMA
Sit p!tient 'pi$htSit p!tient 'pi$ht
Administe o&"$enAdministe o&"$en
N!s!# c!nn'#! pefeedN!s!# c!nn'#! pefeed
Recod %it!# si$nsRecod %it!# si$ns
92. he!t !te !nd h"thm. espi!to" !te92. he!t !te !nd h"thm. espi!to" !te
A##e%i!te !ppehensionA##e%i!te !ppehension
S'mmon medic!# !ssist!nceS'mmon medic!# !ssist!nce
Loc!# An!esthetic in CHFLoc!# An!esthetic in CHF
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2!tients2!tients
C#!ss I !nd II BNHAC#!ss I !nd II BNHA
M!&im'm -*-15 m$ of epinephineM!&im'm -*-15 m$ of epinephine -*@- m$ of #e%onodephine-*@- m$ of #e%onodephine
C#!ss III !nd IV BNHAC#!ss III !nd IV BNHA
A%oid %!soconstictosA%oid %!soconstictos
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