HEART FAILURE - PDF document

1 HEART FAILURE Study day November 2015
HEART FAILURE Study day November 2015 Overview and Introduction • This course is an introd

2 uction and overview of heart failure.
uction and overview of heart failure. Normal heart function and basic pathophysiology of heart f

3 ailure is explained. This will be then
ailure is explained. This will be then related to the diagnosis of heart failure and to the overall

4 management of patients with heart fail
management of patients with heart failure. Device therapy will be explained, and also finally we w

5 ill have discussion session about palli
ill have discussion session about palliative care and heart failure. Demographics of heart failure

6 • Heart failure is serious • H
• Heart failure is serious • Heart failure is terminal • Heart failure is unpredictabl

7 e • Heart failure causes severe symp
e • Heart failure causes severe symptoms • Heart failure outcomes are directly linked to goo

8 d management and self monitoring. Y
d management and self monitoring. You can make a profound difference to a patient’s life P

9 lan of the Day • The normal heart
lan of the Day • The normal heart • Pathophysiology of heart failure • Clinical present

10 ation: History, assessment and clinical
ation: History, assessment and clinical examination • Differential diagnosis, Investigations an

11 d Diagnosis • Pharmacological Manage
d Diagnosis • Pharmacological Management • Non medical Management • Palliative care

12 • Device therapy 1. The Normal He
• Device therapy 1. The Normal Heart 1. Normal Heart Function • The Cardiac Circulatio

13 n • The Cardiac Valves • The
n • The Cardiac Valves • The Coronary Circulation • The Cardiac Electrical System

14 The Heart = A house! Coronary circula
The Heart = A house! Coronary circulation Coronary circulation The Normal Heart • http

15 s://www.youtube.com/watch?v=H04d3rJCLCE&
s://www.youtube.com/watch?v=H04d3rJCLCE&featur e=player_detailpage • http:// www.cardiachealt

16 h.org/how - does - your - heart - work -
h.org/how - does - your - heart - work - anatomy - heart - coronary - arteries 2. Pathophysiology

17 of Heart Failure 2. Pathophysio
of Heart Failure 2. Pathophysiology of heart failure The two types of heart failure affe

18 cting the left ventricle. • HFrE
cting the left ventricle. • HFrEF – can’t pump • HFPEF – can’t relax 2

19 . Pathophysiology of heart failure Ca
. Pathophysiology of heart failure Causes : Myocardial Infarction Ischaemia 2. Pathophysi

20 ology of heart failure Causes :
ology of heart failure Causes : Hypertension and aortic stenosis Aortic Stenosis

21 Left Ventricular Hypertrophy Othe
Left Ventricular Hypertrophy Other causes include: • Mitral regurgitation • Atri

22 al fibrillation • Cardiomyopathies
al fibrillation • Cardiomyopathies • Chemotherapy ……. 2. Pathophysiology of h

23 eart failure Neurohormonal Activatio
eart failure Neurohormonal Activation 1. Increased Sympathetic activation 1. Reduction in

24 renal perfusion results in activation o
renal perfusion results in activation of the RAAs Heart failure is unpredictable! 3 . History,

25 Assessment and Clinical Examination
Assessment and Clinical Examination History • Presenting Complaint: • History of P

26 resenting Complaint: • Past M e
resenting Complaint: • Past M edical History: Its Systemic • Fatigue • Cool extrem

27 ities • Pallor • Heavy leaden le
ities • Pallor • Heavy leaden legs • Renal dysfunction • Anaemia • Acute/increas

28 ing breathlessness • Presents/punc
ing breathlessness • Presents/punctuated with unpredictable episodes of fluid retention…..

29 3. Clinical Presentation Signs
3. Clinical Presentation Signs of Heart Failure - General Appearance – distress, ga

30 it, mobility, colour, pallor, tachypnoe
it, mobility, colour, pallor, tachypnoea , breathlessness, audible breath sounds,habitus , â€

31 ¢ Tachycardia/irregular • Hypertensi
¢ Tachycardia/irregular • Hypertension/hypotension • Pallor/ mallor flush • Elevated JV

32 P �(5cm) • Heart Sounds –
P �(5cm) • Heart Sounds – third heart sound • Added Breath Sounds – Crepitat

33 ions /wheeze • Abdominal distension
ions /wheeze • Abdominal distension • Oedema – legs/sacral Elevated JVP Crepit

34 ations • https://youtu.be/9C5RFb
ations • https://youtu.be/9C5RFb1qWT8 Pulmonary Oedema Ascites Pitting Oedema The B

35 urden of Heart Failure Warning Signs
urden of Heart Failure Warning Signs Weight Gain!! Lets Talk about it!!....... 5. Differenti

36 al Diagnoses ??? Is it ? • Chest
al Diagnoses ??? Is it ? • Chest infection/pneumonia? • Pulmonary Embolism? • COPD?

37 • N/AFLD? • Obesity? • Reduc
• N/AFLD? • Obesity? • Reduced Venous Return? • Lymphoedema ? Or is it? • Hea

38 rt Failure? 6. Investigation Inves
rt Failure? 6. Investigation Investigations • BNP • ECHO • ECG • CXR • Hol

39 ter monitor • 24hour BP • Also
ter monitor • 24hour BP • Also Cardiac MR, MPS, Angiography 7. Diagnosis Heart Failu

40 re?? Lets review the ECHO………
re?? Lets review the ECHO……… 8. Pharmacological Management Neurohormonal dea

41 ctivation 1. A drenaline • Bet
ctivation 1. A drenaline • Beta Blockers Dose Side Effects Monitoring Neurohorm

42 onal Deactivation 2. A ngiotensin
onal Deactivation 2. A ngiotensin II • ACE Inhibition Dose Side Effects Monitorin

43 g Neurohormonal Deactivation 3
g Neurohormonal Deactivation 3. A ldosterone • MRA Dose Side Effects Monitorin

44 g Symptomatic management • Diu
g Symptomatic management • Diuretics Loop/ thiazide Dose Side Effects Monitoring

45 Other Pharmacological agents and cont
Other Pharmacological agents and contraindications • Digoxin • Oral Anticoagulations â

46 €“ NOACS • Ivabradine • Anti
€“ NOACS • Ivabradine • Antianginals • Antihypertensives • Palliative Medicatio

47 ns • Contraindications 9.
ns • Contraindications 9. Non Pharmacological Management Non Pharmacological Managem

48 ent • Anxiety/stress management â
ent • Anxiety/stress management • Depression/low mood • Support Groups • Telehealth

49 • Salt intake • Fluid intake
• Salt intake • Fluid intake • Dry mouth Non Pharmacological Management • Exer

50 cise • General weight management â
cise • General weight management • Smoking, alcohol • Fatigue management – goal sett

51 ing • Sleep • Caffeine intake
ing • Sleep • Caffeine intake • Vaccinations • Holidays I would like to introduce

52 ………….! 11. Palliative Care
………….! 11. Palliative Care 10. Device Therapy Dr Simon Smith, C