chf hosp. san lucas interno new
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jul /11 /16
Congestive Heart FailureManuel Fonseca Crescioni Medical internHospital San Lucas Guayama P.R
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✤ IN USA CHF is the MCC of being admitted to the hospital
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Heart Failure
✤Dysfunction of the heart as a pump
✤Results in insufficient 02 delivery to tissues acompanied by the accumulation of fluid in the lungs
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Pathophysiology
✤ Activation of renin-angiotensin system
✤ Angiotensin II( TPR, Aldosterone)
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✤Can be either from systolic dysfunction( decreased EF and heart dilatation) or from diastolic dysfunction ( inability to relax and recieve blood, EF is preserved sometimes even above normal)
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Causes of Systolic Heart Failure✤ HTN (MC)
✤ MI
✤ Valvular heart dz of all types
✤ All 3 account for the vast majority of cases (over 95%)
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Systolic Heart Failure✤ Less common causes of systolic dysfunction are;
✤ Etoh
✤ Postviral (idiodpathic) myocarditis = Often due to coxsackie B virus
✤ Radiation
✤ Adriamycin(doxorubicin)
✤ Chagas
✤ Hemochromatosis
✤ Thyroid dz
✤ Peripartum cardiomyopathy
✤ Thiamine deficiency
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Presentation✤ Dyspnea (SOB)
✤ Orthopnea(worse when lying flat, relieved when sitting up or standing)
✤ Rales , Wheezing on lung examination Bibasilar crakles, decreased breath sounds at the bases due to pleura effusion
✤ JVD
✤ S3, S4
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Diagnostic Test
✤ Echocardiography (To distinguish systolic from diastolic dusfunction) every pt must get echo to evaluate EF
✤ Best initial test= Transthoracic echo
✤ Most accurate test= MUGA Scan , Nuclear Ventriculogram,
✤ BNP
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Systolic Dysfunction (low EF) Tx.✤ ACE inhibitors , ARB*
✤ B-blockers*
✤ Spirinolactone/eplerenone*
✤ Hydralazine/ nitrates*
✤ Diuretics
✤ Digoxin (does not lower mortality in CHF, controls sx.)
✤ Implantable defibrillator*/ Biventricular pacemaker*( EF below 35%)
✤ Transplantation when all else fails
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Distolic Dysfunction (CHF w/ Preserved EF ) Tx.
✤ Nothing we know lowers mortality in diastolic dysfunction
✤ Clearly beneficial= B-Blockers and Diuretics
✤ Clearly not Beneficial Digoxin and Spirinolactone
✤ Uncertain = ACE inhib, ARB’s & hydralazine
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References✤ Harrisons Principles of Internal Medicine
15th Eugene Braunwald
✤ Medscape
✤ New York Heart Association
✤ Fundamental of Pathology Husain A. Sattar
✤ Master The Boards Step 2 CK Conrad Fischer, MD
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