By

Ali Alalawi

Content of this lecture:

What is Congestive Heart Failure?

Epidemiology

Causes of Congestive heart Failure. Causes of Congestive heart Failure.

Signs and Symptoms.

Treatment.

What is Congestive Heart Failure?

Congestive heart failure (CHF), or heart failure, is a condition in which the heart can't pump enough blood to the body's other organs.other organs.

Epidemiology

US Health and Human Services. 5 million Americans suffer from CHF.

$17.8 billion spent annually.

400,000 new cases reported each year.

0.3/1000 < 45

3/1000 45-65

10/1000 >65

Causes of Congestive heart Failure:

This can result from:

Narrowed arteries that supply blood to the heart

muscle — coronary artery disease

Past heart attack, or myocardial infarction, with scar Past heart attack, or myocardial infarction, with scar

tissue that interferes with the heart muscle's normal work

Heart defects present at birth — congenital heart

defects.

Causes of Congestive heart Failure:This can result from:

High blood pressure

Heart valve disease due to past rheumatic fever

or other causes

Primary disease of the heart muscle itself, called Primary disease of the heart muscle itself, called

cardiomyopathy.

Infection of the heart valves and/or heart muscle

itself — endocarditis and/or myocarditis

Signs and Symptoms:

The most common signs of congestive heart

failure are :

Swollen legs or ankles

Difficulty breathing.

Weight gain when fluid builds up

Pulmonary edema.

Treatment:

When a specific cause of congestive heart failure is discovered, it should be treated or, if possible,

corrected for example:1. Some cases of congestive heart failure can be

treated by treating high blood pressure. treated by treating high blood pressure.

2. If the heart failure is caused by an abnormal heart valve, the valve can be surgically replaced.

Treatment:

The therapeutics goal for CHF is to increase cardiac

output.

CHF usually requires a treatment program which

help to reduce symptoms and prolonging life:○ Rest. ○ Proper diet. ○ Modified daily activities. ○ Drugs.

DRUGS AND DRUG CLASSES USED TO TREAT CHF

Vasodilators - Drugs that decrease either preload or afterload;

a) Arterial selective vasodilators decrease peripheral vascular resistance and

afterload on the failing myocardium. The reduction in afterload leads to an

increased cardiac output and improved tissue perfusion.

b) Venous selective vasodilators increase venous capacitance, thus decreasing b) Venous selective vasodilators increase venous capacitance, thus decreasing

preload. A small reduction in venous tone can result in a pooling of large

amounts of blood. This would decrease left ventricular filling pressure and

pulmonary congestion.

The major vasodilators used are ACE inhibitors and angiotensin II receptor

antagonists. Other agents include organic nitrates, hydralazine and nitroprusside.

DRUGS AND DRUG CLASSES USED TO TREAT CHF

Positive Inotropic Agents.Drugs that increase contractile force

Beta blockers.

Diuretics. Diuretics.diuretics promote the elimination of edematous fluid, improving tissue

perfusion and pulmonary function.