Transcript Heart-Failurex

Heart Failure
• Heart failure (HF) is a common clinical
syndrome.
• Heart failure (HF) is a complex clinical
syndrome that can result from any structural
or functional cardiovascular disorder;
• It causes systemic perfusion deficiency
inadequate to meet the body’s metabolic
demands Causes increasing left ventricular
filling pressures
The Incidence of Congestive Heart
Failure in Type 2 Diabetes
• As the leading cause of hospitalization for individuals
aged 65 years and older (1), congestive heart failure
(CHF) is emerging as a major public health concern.
• The CHF problem is magnified in individuals with
diabetes, in whom incidence rates are two to five times
greater than those in the general population.
• The U.K. Prospective Diabetes Study (UKPDS) reported
heart failure incidence rates of 2.3–11.9 per 1,000
patient-years over 10 years.
• CHF in diabetes is 3–15 times greater than the
previously reported 2–10 cases per 1,000 subjects.
Diabetic Cardiomyopathy-Etiology
• Diabetic cardiomyopathy has been defined as
ventricular dysfunction that occurs in diabetic patients
independent of a recognized cause (eg, coronary heart
disease, hypertension
• Autonomic neuropathy
• Abnormal epicardial vessel tone and microvascular
dysfunction
• Abnormal glycation end product deposition may
increase LV diastolic stiffness
• Decreased insulin availability or responsiveness can
impair energy-independent transport of glucose across
the cell membrane.
Heart Failure (Classifications)
Systolic versus
diastolic
• Systolic- loss of
contractility get dec.
CO
• Diastolic- decreased
filling or preload
High outputhypermetabolic
state
Left-sided
versus right –
sided
• Left- lungs
• Right-peripheral
Acute versus
chronic
• Acute- MI
• Chroniccardiomyopathy
Symptoms
Making the diagnosis - Symptoms
LVF (back pressure into pulmonary
system)
RVF (back pressure into peripheral
circulation)
SOB on exertion
Ankle oedema
Nocturnal cough
Nausea and anorexia
PND
Fatigue and wasting
Orthopnoea
Abdo pain due to
hepatomegaly
Wheeze
Increased weight
CCF (failure of both ventricles)
Lethargy
(Remember to ask about chest pain and palpitations)
Reduced exercise tolerance
Making the diagnosis - Signs
Cachexia and muscle wasting
Tachypnoeic +/- cyanosis
Tachycardia +/- gallop rhythm
Cardiomegaly and displaced apex
Right ventricular heave
Raised JVP
Basal creps +/- effusions +/- wheeze
Ankle oedema
Hepatomegaly
Ascites
What does this
show?
What is present in this extremity,
common to right sided HF?