Congestive Heart Failure CHF.ppt

1、Congestive Heart Failure CHF,SUGAR LAND HEART CENTER,By Nik Nikam, M.D. Interventional Cardiologist Sugar Land Texas May 2010,Congestive Heart Failure CHF,SUGAR LAND HEART CENTER,Epidemiology,Approximately 4.9 million people have CHF More than 550,000 cases detected annually Account for 5 to 10% of

2、all hospitalizations 250,000 deaths per year related to CHF Five year mortality as high as 60% in men SNS, sympathetic nervous system.,Myocardial injury to the heart (CAD, HTN, CMP, Valvular disease),Morbidity and mortality Arrhythmias Pump failure,Peripheral vasoconstriction Hemodynamic alterations

3、,Heart failure symptoms,Remodeling and progressive worsening of LV function,Initial fall in LV performance, wall stress,Activation of RAAS and SNS,Fibrosis, apoptosis,hypertrophy, cellular/molecular alterations,myotoxicity,FatigueActivity altered Chest congestionEdemaShortness of breath,Congestive H

4、eart Failure CHF,SUGAR LAND HEART CENTER,Neurohormonal changes,Congestive Heart Failure CHF,SUGAR LAND HEART CENTER,Cardiovascular physiology,Frank-Starling Length: Tension Ratio Ejection Fraction End diastolic volume/end systolic volume Cardiac Output Stroke volume x heart rate Preload Volume of bl

5、ood delivered to heart during diastole Afterload Peripheral vascular resistance,Congestive Heart Failure CHF,SUGAR LAND HEART CENTER, Volume overload: Regurgitate valve High output status Pressure overload: Systemic hypertension Outflow obstructionAS Loss of muscles: Post MI, Chronic ischemia Connec

6、tive tissue diseases Infection, Poisons (alcohol,cobalt,Doxorubicin) Restricted Filling: Pericardial diseases, Restrictive cardiomyopathy Tachyarrhythmia,Causes of CHF,Congestive Heart Failure CHF,SUGAR LAND HEART CENTER,Types of CHF,Systolic 53:184-192.,Adjusted* hazard ratios (95% CI) for one-year

7、 outcomes, beta blocker therapy vs no beta blocker therapy, by LV functional status,Congestive Heart Failure CHF,SUGAR LAND HEART CENTER,Inotropic agents-Digoxin,The role of digitalis has declined somewhat because of safety concern Recent studies have shown that digitals does not affect mortality in

8、 CHF patients but causes significant Reduction in hospitalization Reduction in symptoms of HF Rate control in At fib.,Congestive Heart Failure CHF,SUGAR LAND HEART CENTER,Inotropic agent-Digoxin action,+ve inotropic effect by intracellular Ca 353:2001-2007.,12%,24%,64%,CHF,Other,Sudden,Death,(N = 10

9、3),NYHA II,26%,15%,59%,CHF,Other,Sudden,Death,(N = 103),NYHA III,56%,11%,33%,CHF,Other,Sudden,Death,(N = 27),NYHA IV,Congestive Heart Failure CHF,SUGAR LAND HEART CENTER,Congestive Heart Failure CHF,SUGAR LAND HEART CENTER,CHF Prognosis based on BUN,Congestive Heart Failure CHF,SUGAR LAND HEART CENT

10、ER,CHF Prognosis based on Serum sodium,Congestive Heart Failure CHF,SUGAR LAND HEART CENTER,Diastolic CHF,Impaired LV relaxation Increase passive LV stiffness Endocardial and pericardial disordersw Microvascular flow Myocardial turgor Neurohormonal regulation,Congestive Heart Failure CHF,SUGAR LAND

11、HEART CENTER,Diagnosis of diastolic CHF,Increased ventricular filling pressure with normal systolic function Incresed ventricular pressure with preserved systolic function and normal ventricular volumes Increased left atrial and pulmonary capillary wedge pressure Clinical symptoms and signs.,Congest

12、ive Heart Failure CHF,SUGAR LAND HEART CENTER,Treatment of diastolic CHF,Diuretics provide the most symptoms relief if fluid retentionn is a future ACE inhibitors and Blockers complement diuretics well Central sympatholytics hypertensive episodes Nitrates preventing ischemia Trimetazidine as a metab

13、olic support,Congestive Heart Failure CHF,SUGAR LAND HEART CENTER,Treatment of diastolic CHF,Benefits of Calcium Channel Blockers Slowing of heart rate Reduction of MVO2 Control of BP Regression of LVH Dilation of coronary microcirculation Amelioration of intracellular calcium overload,Congestive He

14、art Failure CHF,SUGAR LAND HEART CENTER,Congestive Heart Failure CHF,SUGAR LAND HEART CENTER,Congestive Heart Failure CHF,SUGAR LAND HEART CENTER,Congestive Heart Failure CHF,SUGAR LAND HEART CENTER,Pacing,Congestive Heart Failure CHF,SUGAR LAND HEART CENTER,Pacing,Congestive Heart Failure CHF,SUGAR

15、 LAND HEART CENTER,Pacing,Congestive Heart Failure CHF,SUGAR LAND HEART CENTER,Vasodilators,Congestive Heart Failure CHF,SUGAR LAND HEART CENTER,CHF treatment-Nursing Initiates,Recommend smoking cessation counseling Initiate LV function determination Patient education Instructional video, printed ma

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17、LAND HEART CENTER,Pacing,Congestive Heart Failure CHF,SUGAR LAND HEART CENTER,ISDN/HDZ,Congestive Heart Failure CHF,SUGAR LAND HEART CENTER,ARBS,Congestive Heart Failure CHF,SUGAR LAND HEART CENTER,BBs,Congestive Heart Failure CHF,SUGAR LAND HEART CENTER,ARBS,Congestive Heart Failure CHF,SUGAR LAND

18、HEART CENTER,Congestive Heart Failure CHF,SUGAR LAND HEART CENTER,CHF prognosis based on rhythm,SOLVD Investigators: J Am Coll Cardiol. 1998;32:695-703. From: Shivkumar, Weiss, Fonarow, and Narula; eds. Braunwalds Atlas of EP in HF.,Arrhythmias,Congestive Heart Failure CHF,SUGAR LAND HEART CENTER,CHF Management-long term,Congestive Heart Failure CHF,SUGAR LAND HEART CENTER,Congestive Heart Failure CHF,SUGAR LAND HEART CENTER,CHF treatment-7