HeartFailure-CroydonGPVTS心力衰竭-克罗伊登GPVTS.pptVIP

Chronic Heart Failure Asma Khalil ST1 27/6/12 Background Heart failure is a complex syndrome in which the ability of the heart to maintain the circulation of blood is impaired 50% assoc LVSD (reduced LVEF) Rest have preserved EF ?caused by diastolic dysfunction (due to decreased LV filling, with abnormal LV relaxation or distensibility during diastole) Normal-abnormal LVEF cut off ranges 40-50% Background 2% of all hospitalized bed-days. 5% of all medical emergency admissions. GP sees 30?people with HF and suspect new diagnosis in 10 annually Conditions that damage heart muscle or limit its ability to function normally: CAD HTN Cardiomyopathies. Drugs Toxins Endocrine conditions Infiltrative conditions Other conditions (Chagas disease, HIV infection, end-stage renal failure). Conditions that reduce cardiac output: Increased vascular resistance with HTN. Abnormal heart rhythm Pericardial disease. OSA. Aortic stenosis (severe). Conditions that result in a high cardiac output: Anaemia. Thyrotoxicosis. Septicaemia. Liver failure. AV shunts. Pagets disease. Thiamine deficiency. When to suspect Symptoms Breathlessness? (orthopnoea/PND) Fatigue (tiredness, exhaustion, decreased ET Fluid retention Signs Laterally displaced apex beat. Raised JVP. Enlarged liver Third or fourth heart sound Tachycardia. Lung crackles Dependent oedema Medical and social history MI, CAD, or angina. AF, DM, HTN, Excessive alcohol. Cardiotoxic chemotherapy in the past. FH of HF or sudden cardiac death from cardiomyopathy at a young age. NYHA classification of heart failure symptoms?[AHA 1994] Class?I:?asymptomatic LVD incl: No limitations. Ordinary physical activity does not cause fatigue, breathlessness, or palpitation. Class?II:?symptomatically mild HF: Slight limitation of physical activity. Comfortable at rest. Ordinary physical activity results in fatigue, palpitation, breathlessness, or angina pectoris. Class?III:? moderate HF: Marked limitation of physical