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Congestive Heart Failure (Risk Factors (Diabetes, Previous myocardial…
Congestive Heart Failure
Clinical Presentation
Acute pulmonary edema
Chest pain, tachycardia, palpitations
Orthopnea
Fatigue, weakness, confusion
Dyspnea at rest and/or paroxysmal nocturnal dypnea
Rales, wheezing, JVD
Presence of S3 and/or S4 heart sounds
Persistent cough, frothy sputum production
Diagnosis and Treatment
Treatment
Pacemakers, CRT, ICDs, PCI, valvular repair if needed
Lifestyle modifications, sodium/fluid restriction, increased physical activity
Diuretics, vasodilators, Beta blockers, digoxin, ionotropes, anticoagulants
End stage: heart transplant, ventricular assist devices
Diagnosis
Detailed, thorough pt history and exam
EKG, CXR, echo, TEE, sleep studies, holter monitoring
Labs: CBC, UA, CMP, BUN/Creat, fasting BG, LVTs, BNP, lipid panel, TSH
Genetic testing for pts with 1st degree relatives with CHF
Pathophysiology
Decreased CO triggers increased systemic vascular resistance (AFTERLOAD), which leads to further decrease in CO
Cardiac ischemia due to myocardial injury leads to decreased cardiac contractility and ventricular dilation which increases ventricular blood volume (PRELOAD)
Can be right- or left-sided, or both
Vicious cycle
: myocardial damage, hypoxia, and decreased contractility combine to continuously decrease CO which continues the cycle to complete
cardiac failure in the absence of intervention
"Pump Failure"
: Heart unable to produce adequate cardiac output (CO) to maintain proper tissue perfusion
Epidemiology
Greater incidence of CHF in people of color
CHF affects approx. 5.7 million Americans, or 2% of US population
Prevalence increases with age; 1-2% of population < 55 affected; 10% of population > 75 affected
Increasing incidence of death R/T CHF, esp in American men and African Americans
Equal incidence and prevalence in men and women
Risk Factors
Diabetes
Previous myocardial damage (e.g.,MI)
Coronary artery disease
Sleep apnea
Hypertension
Alcohol and/or tobacco use
Obesity
Arrhythmias, valvular disease, congenital heart defects
Viruses