Systolic Heart Failure.ppt

1、/home/eyevstratov,Systolic Heart Failure,Eugene Yevstratov MD,/home/eyevstratov,Definition,Inability to pump an adequate volume of blood and/or to do so only from an abnormally elevated filling pressure,is that heart failure, can be caused by an abnormality in

2、 systolic function leading to a defect in the expulsion of blood i.e. Systolic Heart Failure,/home/eyevstratov,Causes,Coronary artery disease Valvular heart disease Hypertension and aging Diabetes Dilated cardiomyopathy,/home/eyevstratov,NYHA classification of

3、 heart failure symptoms,Class 1: No limitations, ordinary physical activity does not cause undue fatige, dyspnoea or palpitation (asymptomatic LVD) Class 2: Slight limitation of physical activity, such patients are comfortable at rest (symptomatically mildheart failure) Class 3: Marked limitation od

4、 physical activity, less then ordinary physical activity will lead to symptoms (symptomatilcally moderadeheart failure),/home/eyevstratov,Echo Morphological Classification,Segmental dysfunction Focal scarring/dyskinesis most likely ischemic origin,but significant regional asymmet

5、ry (even without LBBB) often seen in DCM Global dysfunction May be due to any of the causes of systolic dysfunction, including CAD,/home/eyevstratov,SHF vs Normal Heart Value,End diastolic volume 135 mVm2 (N80) End Systolic volume 105 ml/m2 (N40) Stroke volume 30 ml/m2 (N40) Ejec

6、tion fraction 20 % (N50) End diastolic pressure 25 mmHg (N10),/home/eyevstratov,Left ventricular systolic dysfunction is defined as an ejection fraction of less than 40%,/home/eyevstratov,Clinical Symptoms,Dyspnoea Fatigue Periferal oedema Orthopnoea Paroxysma

7、l nocturnal dyspnoea,Hallmark symptoms,Spesific symptoms,/home/eyevstratov,Nearly 50% of patients with heart failure die within five years of the onest of symptoms,/home/eyevstratov,Identification of SHF,/home/eyevstratov,CAD producing isch

8、emic cardiomyopathy is the most common cause of left ventricular systolic dysfunction,/home/eyevstratov,/home/eyevstratov,Physiology,/home/eyevstratov,/home/eyevstratov,Preload,/home/eyevstratov,After

9、load,/home/eyevstratov,Pressure overload,Volume overload,Increased SP,Increased DP,Icreased S,Icreased D,Parallel addition of new myofibrils,Series addition of new safcomeres,Wall thickening,Chamber enlargement,Concentric hypertrophy,Eccentric hypertophy,+,normal,LV remodeling,ht

10、tp://home/eyevstratov,Ventricular Hypertrophy,3,/home/eyevstratov,Systolic vs Diastolic Dysfunction,/home/eyevstratov,Diuretics Positive Inotropics Drugs Direct-Acting Vasodilators Neurohormonal Antagonists,Treatment of SHF,/h

11、ome/eyevstratov,Treatment of SHF,/home/eyevstratov,Tailored Therapy for Advanced Heart Failure,IV nitroprusside and diuretics tailored to hemodynamics goals PCW 80 mmHg,/home/eyevstratov,Definition of optional hemodynamics by 23 48 hours Titration of high-dose oral vasodilators as nitroprusside weaned (combination of captopril, ISDN, hydralazine as needed as alternative or addition) M