بسم الله الرحمن الرحيم
✳Heart failure
♻CLINICAL
MANIFESTATIONS♻
⚜SYMPTOMS⚜
the cardinal symptoms of HF are fatigue and shortness of breathing
طبعاً ال fatigue اكثره يكون بسبب low COP in HF
بس هو مايعتبر specific for HF
بمعنى ممكن يحصل لأسباب ثانيه من ضمنه
Skeletal muscle abnormalitits
and anemia
Dyspnea
في المراحل الأولى من الHF
تحصل فقط during exertion
ولكن مع تتطور مراحل المرض لمراحل متقدمه
dyspnea occur ē less sternuous activity and even at rest
طيب يجي سؤال ليش تحصل ال dyspnea in HF
تعتبر Multifactorial
but the most mechanism is
pulmonary congestion
with accumlation of interstitial or intra alveolar fluid
واللي بدوره تعمل تنشيط لل
juxtacapillary J receptor
ايش تعمل هذه ال receptor
🔻
stimulate
rapid
shallow breathing
which is characteristic of cardiac dyspnea
⏺orthopnea
is dyspnea occuring in the recumbent postion
وتعبر late manifestation of HF
كيف تحصل........؟
occur redistribution of fluid from splanchnic circulation and lower extermities into central circulation during recumbency with a resultant increase on pul. capillary pressure
وبنفس الشي ممكن تحصل nocturnal cough
كيف ممكن نخفف الorthopnea
by sitting upright or by sleeping with additional pillows.
⏺paroxysmal nocturnal dyspnea
is acute episode of severe shortness of breath and coughing that generally occur at night and awaken the patient from sleep
Due to increased pressure in the bronchial arteries leading to airway compression along with interstitial pul. edemal leading to increased airway resistance
⏺cheyne stroke respiration
is periodic respiration or cyclic respiration
is comman in advanced HF
caused by diminished sensitivty of resp. center to arterial p co2
🔴GIT symptoms
anorexia
nausea
early satiety associated with abdominal pain and fullness
related to edema of the bowel wall and congested liver. congested liver and stretch of hepatic capsule cause right upper quadrant pain
🔴cerebral symptoms
confusion
disorientation
sleep and mood disturbances
especially in severe HF
🔴 oliguria ,
Nocturia
is comman in HF and may contribute to insomnia
🔴symptoms of pul. edema
🔴peripheral edema
in feet in ambulatory
in sacral in bed bound patient
more common in right HF
💠physical examination💠
careful PE is always warraned in the evaluation of patients of HF
ايش السبب؟"
b/c
to help determmine the cause of HF
asses the severityvof the HF
⛔Genaral appearance and vital signs
في حاله لمن يكون الHF
mild or mordetely severe
المريض مايكون distress at rest
فقط يحس ب uncomfortable
لمن يكون lying flat
لبعض دقائق
لكن في حاله كان more severe HF
هنا المريض دائما يكون sit upright and may have labored breathing
ويكون مش قادر يكمل جمله ع بعضها بسبب الdyspnea
بالنسبة للvtial signs
ال systolic BP
يكون يااما طبيعي او مرتفع قليل في المراحل الاولى من الHF
لكن لمن يوصل المرض لمراحل متقدمة يكون reduced
due to severe LV dysfunction
pulse pressure may diminshed
sinus tachycardia
but is non specific
cool peripheral extermititis and due to peripheral vasoconstriction.
cynosis of lips and nail beds
⛔JUGULAR VEINS⛔
in early stage of HF may normal at rest
but become abnormally elevated with sustained pressure on the abdomen
وهذا مايسمى
(positive abdominojugular reflux)
⛔pul. examination
ممكن نسمع
pul. crepitation
بسبب تجمع السوائل في الalveoli
في حالة وجود ال pul. edema
بنسمع bilateral crepitation
ووممكن يجي معه
expiratory wheezing
لمن نسمع ال crepitation في مريض مافي عنده اي lung disease بيكون specific for HF
حاجة مهمه!!
في حاله ال chronic HF
مابنسمع Crepitation
في المريض
بسببب؟؟
increased of lymphatic drainage of alveolar fluid
🔆pleural effusion
most commonly in biventricula
⛔Cardiac examination
صح هو يكون مهم وضروري لاي مريض HF
بس مابيعطينا معلومات عن severity of HF
ايش اللي ممكن نشوفه ب HF patient
لو كان المريض عنده cardiomegaly
ممكن نشوف
point of maximal impulse (PMI) is displaced below 5th intercostal space
or lateral to miclavicular line
in some patient s3 is audible and palpable at the apex
S4 in not specific for HF
but present in patient with diastolic dysfunction
Murmurs of mitral and tricuspid regurgitation are frequently present in patients with advanced HF
🔲Abdomen and extermitis
Heptaomegaly
frequently tender
Ascites is late sign
Jaundice also late sign
ليش ممكن يحصلjaundice ..؟
Due to impairment of hepatic function sec.to hepatic congestion and hepatocellular hypoxia.
Peripheral edema
Cardinal manifestationof HF
but nonspecific
CH.CH of edemal
Symmetric
Dependent
Occur predominantly in ankle and pretibial in ambulatory patient
In sacral and scrotal in bedridden patients
🔲Cardiac cachexia
Severe chronic HF
associated with
Weight loss
Cachexia
ليش ممكن يحصل هذا الشي عند مريض الHF
Due to
◼Anorexia
◼Impaired absorpation due to G.T congestion
◼Poor tissue perfusion due to low C.O.P
◼skeletal muscle atrophy due to immobility
Cachexia when present is poor overall prognosis
🔬DIAGNOSIS🔬
♦History
♦Physical examination
♦Investigation
Diagnosis of HF is relatively straightforword
وهذا اذا جاء المريض ب
Classical signs and symptoms of HF
ومع ذلك
S/S of HF
neither specific or sensitive
وعشان كذا مفتاح تشخيص ال HF
هو ال high index of suspencion
وخاصه لمن يكون المريض high risk
بالاضافه بنعمل lab. testing
📄INVISTIGATIONS📄
🔅routine lab.testing
CBC
electrolytes
Blood urea/creatinine
Hepatic enzymes
Urinalysis
وبعض المرضى ممكن نعمل لهم
Assesment of D.M
Lipid profiles
Thyroid function test
📉ECG📈
to asses
Cardiac rhythm
Determine Presence of LV hypertrophy
Prior Mi
➰Chest x ray
Give us information about
🔅Cardiac size
🔅Shape
🔅State of pul.vasculature
🔅May identify noncardiac cause of patient's symptoms.
♦ECHOCARDIOGRAPHY♦
very useful and considered in ALL patients with HF to
🔅 determine the etiology
🔅 unsuspected valular heart
🔅diseaseibdentify the patient who benefit from long standing therapy
📄biomarker
Like circulating level of natriuretic peptides
Troponin
CRP
Uric acid
✳Heart failure
♻CLINICAL
MANIFESTATIONS♻
⚜SYMPTOMS⚜
the cardinal symptoms of HF are fatigue and shortness of breathing
طبعاً ال fatigue اكثره يكون بسبب low COP in HF
بس هو مايعتبر specific for HF
بمعنى ممكن يحصل لأسباب ثانيه من ضمنه
Skeletal muscle abnormalitits
and anemia
Dyspnea
في المراحل الأولى من الHF
تحصل فقط during exertion
ولكن مع تتطور مراحل المرض لمراحل متقدمه
dyspnea occur ē less sternuous activity and even at rest
طيب يجي سؤال ليش تحصل ال dyspnea in HF
تعتبر Multifactorial
but the most mechanism is
pulmonary congestion
with accumlation of interstitial or intra alveolar fluid
واللي بدوره تعمل تنشيط لل
juxtacapillary J receptor
ايش تعمل هذه ال receptor
🔻
stimulate
rapid
shallow breathing
which is characteristic of cardiac dyspnea
⏺orthopnea
is dyspnea occuring in the recumbent postion
وتعبر late manifestation of HF
كيف تحصل........؟
occur redistribution of fluid from splanchnic circulation and lower extermities into central circulation during recumbency with a resultant increase on pul. capillary pressure
وبنفس الشي ممكن تحصل nocturnal cough
كيف ممكن نخفف الorthopnea
by sitting upright or by sleeping with additional pillows.
⏺paroxysmal nocturnal dyspnea
is acute episode of severe shortness of breath and coughing that generally occur at night and awaken the patient from sleep
Due to increased pressure in the bronchial arteries leading to airway compression along with interstitial pul. edemal leading to increased airway resistance
⏺cheyne stroke respiration
is periodic respiration or cyclic respiration
is comman in advanced HF
caused by diminished sensitivty of resp. center to arterial p co2
🔴GIT symptoms
anorexia
nausea
early satiety associated with abdominal pain and fullness
related to edema of the bowel wall and congested liver. congested liver and stretch of hepatic capsule cause right upper quadrant pain
🔴cerebral symptoms
confusion
disorientation
sleep and mood disturbances
especially in severe HF
🔴 oliguria ,
Nocturia
is comman in HF and may contribute to insomnia
🔴symptoms of pul. edema
🔴peripheral edema
in feet in ambulatory
in sacral in bed bound patient
more common in right HF
💠physical examination💠
careful PE is always warraned in the evaluation of patients of HF
ايش السبب؟"
b/c
to help determmine the cause of HF
asses the severityvof the HF
⛔Genaral appearance and vital signs
في حاله لمن يكون الHF
mild or mordetely severe
المريض مايكون distress at rest
فقط يحس ب uncomfortable
لمن يكون lying flat
لبعض دقائق
لكن في حاله كان more severe HF
هنا المريض دائما يكون sit upright and may have labored breathing
ويكون مش قادر يكمل جمله ع بعضها بسبب الdyspnea
بالنسبة للvtial signs
ال systolic BP
يكون يااما طبيعي او مرتفع قليل في المراحل الاولى من الHF
لكن لمن يوصل المرض لمراحل متقدمة يكون reduced
due to severe LV dysfunction
pulse pressure may diminshed
sinus tachycardia
but is non specific
cool peripheral extermititis and due to peripheral vasoconstriction.
cynosis of lips and nail beds
⛔JUGULAR VEINS⛔
in early stage of HF may normal at rest
but become abnormally elevated with sustained pressure on the abdomen
وهذا مايسمى
(positive abdominojugular reflux)
⛔pul. examination
ممكن نسمع
pul. crepitation
بسبب تجمع السوائل في الalveoli
في حالة وجود ال pul. edema
بنسمع bilateral crepitation
ووممكن يجي معه
expiratory wheezing
لمن نسمع ال crepitation في مريض مافي عنده اي lung disease بيكون specific for HF
حاجة مهمه!!
في حاله ال chronic HF
مابنسمع Crepitation
في المريض
بسببب؟؟
increased of lymphatic drainage of alveolar fluid
🔆pleural effusion
most commonly in biventricula
⛔Cardiac examination
صح هو يكون مهم وضروري لاي مريض HF
بس مابيعطينا معلومات عن severity of HF
ايش اللي ممكن نشوفه ب HF patient
لو كان المريض عنده cardiomegaly
ممكن نشوف
point of maximal impulse (PMI) is displaced below 5th intercostal space
or lateral to miclavicular line
in some patient s3 is audible and palpable at the apex
S4 in not specific for HF
but present in patient with diastolic dysfunction
Murmurs of mitral and tricuspid regurgitation are frequently present in patients with advanced HF
🔲Abdomen and extermitis
Heptaomegaly
frequently tender
Ascites is late sign
Jaundice also late sign
ليش ممكن يحصلjaundice ..؟
Due to impairment of hepatic function sec.to hepatic congestion and hepatocellular hypoxia.
Peripheral edema
Cardinal manifestationof HF
but nonspecific
CH.CH of edemal
Symmetric
Dependent
Occur predominantly in ankle and pretibial in ambulatory patient
In sacral and scrotal in bedridden patients
🔲Cardiac cachexia
Severe chronic HF
associated with
Weight loss
Cachexia
ليش ممكن يحصل هذا الشي عند مريض الHF
Due to
◼Anorexia
◼Impaired absorpation due to G.T congestion
◼Poor tissue perfusion due to low C.O.P
◼skeletal muscle atrophy due to immobility
Cachexia when present is poor overall prognosis
🔬DIAGNOSIS🔬
♦History
♦Physical examination
♦Investigation
Diagnosis of HF is relatively straightforword
وهذا اذا جاء المريض ب
Classical signs and symptoms of HF
ومع ذلك
S/S of HF
neither specific or sensitive
وعشان كذا مفتاح تشخيص ال HF
هو ال high index of suspencion
وخاصه لمن يكون المريض high risk
بالاضافه بنعمل lab. testing
📄INVISTIGATIONS📄
🔅routine lab.testing
CBC
electrolytes
Blood urea/creatinine
Hepatic enzymes
Urinalysis
وبعض المرضى ممكن نعمل لهم
Assesment of D.M
Lipid profiles
Thyroid function test
📉ECG📈
to asses
Cardiac rhythm
Determine Presence of LV hypertrophy
Prior Mi
➰Chest x ray
Give us information about
🔅Cardiac size
🔅Shape
🔅State of pul.vasculature
🔅May identify noncardiac cause of patient's symptoms.
♦ECHOCARDIOGRAPHY♦
very useful and considered in ALL patients with HF to
🔅 determine the etiology
🔅 unsuspected valular heart
🔅diseaseibdentify the patient who benefit from long standing therapy
📄biomarker
Like circulating level of natriuretic peptides
Troponin
CRP
Uric acid