Medico- Surgerical lecturer Dr. - PowerPoint Presentation

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Medico- Surgerical lecturer Dr. Faraj . Hato Joni -AlBidhaniInstitute of Medical Technology/Baghdad

Institute of Medical Technology/Baghdad

Scientific Degree:

lecturer Dr.

Thikra Mahmood AliOfficial Email: mahmoodthikra@gmail .comEmail@mtu.edu.iq

Middle Technical University - Iraq

الجامعة التقنية الوسـطى - العراق

Scientific Degree: lecturer Dr. Thikra Mahmood AliOfficial Email: mahmoodthikra@gmail .comMiddle Technical University - Iraq

الجامعة التقنية الوسـطى - العراق

26 أيلول، 18

Congestive heart failure

Causes heart failure

: heart failure is most often related to another disease or illness. The most common cause of heart failure is coronary artery disease, which is a disorder that causes narrowing of the arteries that supply blood and oxygen to the heart. Other conditions that may increase the risk for developing heart failure include: (1) cardiomyopathy, which is a disorder of the heart muscle that causes the heart to become weak (2) congenital heart defect (3) heart attack (4) heart valve disease (5) certain types of arrythmias

or irregular heart rhythms (6) blood pressure (7) emphysems, a disease of the lung (8) diabetes (9) an overactive or underactive thyroid (10) HIV (11) AIDS (12) severe forms of anemia, which is a deficiency of red blood cells (13) certain cancer treatment such as chemotherapy (14) drug or alcohol abuse.

Symptoms of heart failure : the symptoms of heart failure may include : (1) excessive fatigue (2) sudden weight gain (3) loss of appetite (4) persistent coughing (5) persistent coughing (6) irregular pulse (7) heart palpitations (8) abdominal swelling (9) shortness of breath (10) leg and ankle swelling (11) protruding neck veins. Types of heart failure : heart failure canoccure in either the left or right side of heart, also possible for both sides of heart to fail at the fame time.

(a) left –sided heart failure : is the most common type of heart failure. The left heart ventricle is located in the bottom left side of heart, this area pumps oxygen rich blood to the rest of the body, left sided heart failure occurs when the left ventricle doesn't pump efficiency, this prevents body from getting enough oxygen –rich blood. The blood back up into the lungs, which causes shortness of breath and a build up of fluid.

(b) Right-sided heart failure. The right heart ventricle is responsible for pumping blood to lungs to collect oxygen, right sided heart failure occurs when the right side of heart can't perform its job effectively. Its usually triggered by left –sided heart failure, the accumulation of blood in lungs (due to left –sided heart failure) makes the right ventricle work harder, lead to rightside failure of heart , other condition like lung disease lead to right sided of heartReferences:_

(c) Diastolic heart failure : this occurs when the heart muscle become stiffer than normal, due to heart disease and the heart doesn't fill with blood easily, lead to lack of blood flow to the rest of the organs in body and this type of heart failure more common in women than in men. (d) Systolic failure : occurs when the heart muscle loses ability to contract, and occur when the heart is weak and enlarged.

Risk factors of heart failure : certain factors that may increase the risk of developing heart such as (1) Anemia (2) hyperthyroidism (3) hypothyroidism (4) emphysems (5) certain behaviors such as smoking , eating foods with high fat orcholesterol, over weight. Diagnosis : (1) Echocardiogram (2) chest X-rays (3) ECG (4) MRI (5) Nuclear scan (6) catheterization or coronary angiogram (7) Electrode patches which placed on chest and attached to small machine called (Holter monitor)

Treatment of heart failure :Medication : certain medication treated the heart failure such as (1) improve heart to pump blood (2) reduce blood cloths (3) reduce heart rate and cholesterol level. These medication include: (1) betablockers (2) digoxin (3) diuretics Surgery : some people with heart failure need surgery such as coronary by pass surgery , angioplasty and using in other people with heart failure by pacemakers or using heart transplants in the final stage of heart failure. Preventing heart failure : (1) don't smoke (2) eat heart healthy foods (3) regular exercise (4) stay at healthy weight (5) management of other health problem such as high blood pressure , high cholesterol, diabetes. Complication: complication of heart failure include (1) kidney damage or failure (2) liver damage (3) heart valve problem (4) heartrhythm problems.

HypertensionHypertension defines as a blood pressure higher than 140 over 90 millimeters of mercury (mmHg), the systolic reading of 140 mmHg refers to the pressure as the heart pumps blood around the body, the diastolic reading of 90 mmHg refers to the pressure as the heart relaxes and refills with blood. Symptoms of hypertension: hypertension is generally a silent condition, many people will not experience any symptoms, it may take years or even decades for the condition to reach levels severe enough that symptoms become obvious, these symptoms may be attributed to other issues, the symptoms which include: (1) headaches (2) shortness of breath (3) nose bleeds (4) flushing (5) dizziness (6) chest pain (7) visual changes (8) blood in urine

Risk factors: a number of risk factor increase the chances of having hypertension : (1) age, the hypertension is more common in people aged with over 60 years. (2) Ethnicity, some ethnic groups are more prone to hypertension (3) size and weight, over weight or obsese is a key risk factor (4) sex, the risk is the same for males and females, but men are more prone to hypertension at a younger age, but hugher rate in women at older ages. (5) existing health condition : cardiovascular disease, chronic kidney disease and high cholesterol levels, other contributing factors include, the physical inactivity , salt-rich diet, low potassium in the diet, alcohol and tobacco use, and certain diseases and medications. Types: (1) primary hypertension: this occur due to multifactors which include blood plasma volume and activity of the hormones that regulate of blood volume and pressure and also environmental factors, such as stress and lack of exercise (2) secondary hypertension which has specific causes and as result of complication such as diabetes, kidney disease , pheochromocytoma which can caused by cancer of an adrenal gland, cushing syndrome , hyperthyroidism , hyperparathyroidism, pregnancy , obesity and chronic kidney disease. Diagnosis: diagnosis of hypertension is made by measuring blood pressure over at least 3 clinic visits using the upper –arm cuff device called phygmomanometer, some tests can help identify the cause of high blood pressure, the tests may include: (1) urinary tests (2) kidney ultrasound imaging (3) blood tests (4) electro cardio gram (ECG).

Treatment : (A) lifestyle changes, (1) like losing weight , (2) quitting smoking (3) eating a healthy diet (4) reducing the amount of sodium in diet less than 1.500 milligrams (5) getting regular aerobic exercise (6) limiting alcohol to two drinks for men, one drink for women. (B) drugs: there are several types of drugs used to treat high blood pressure, including (1) angiotension –converting enzyme (ACE) inhibitors (2) Angiotension 11 receptor blockers (ARBs) (3) Diuretics (4) Betablockers (5) calcium channel blockers (6) Alpha-blockers (7) Alpha-agonists (8) Renininhibitors  Complication of hypertension : (1) heart attacks, heart attacks are one of the worst diseases associated with uncontrolled high blood pressure, this condition can be deadly. Heart attacks occur because the arteries harden and narrow. (2) stroke, the strokes can happen when blood flows restricted on one of the blood vessels that gives blood to brain (3) heart failure , also called congestive heart failure, this happens because the heart has to pump blood through hard , narrow arteries, this condition is one of the main causes of death for those with hypertension (4) diabetes , diabetes ids different than other diseases caused by high blood pressure, this is because it can either be the cause or the result of uncontrolled high blood pressure, some time, diabetes can get worse in hypertension patients, this is due to the fact that blood pressure affects on the metabolism, the function of the pan crease, and kidneys (5) atherosclerosis, atherosclerosis is a condition that show when the blood pressure is constant, there is not any significant kind of treatment for this disease, (6) kidney disease, these organs located at both sides of back, hypertension directly affects on the function of kidney, (7) eye disease, most people can not imagine how much damage high blood pressure to the eye health, restricted blood flow in any part of body can cause damage to the blood vessels in the retina.

AnginaAngina is not a disease but rather a likely symptoms of coronary artery disease, the most common type of heart disease, angina may manifest itself in the form of an angina attack, pain or discomfort in the chest that typically lasts from 1-15 minutes, the condition is classified by the pattern of attack into stable, unstable and variant angina . (A) stable (chronic ) angina, it occurs when the heart is working harder than usual, for instance, during exercise, can be predicted to happen over months or even years, rest or medication relieves symptoms. (B) unstable angina, it occurs when at rest and is considered less common and more serious because rest and medication does not relieve it, this can give signal a future heart attack within a short time-hour or weeks. (C) variant angina, it rare and can occur at rest without any underlying coronary artery disease, it occurs due to abnormal narrowing or relaxation of the blood vessels reducing blood flow to the heart.

Causes of Angina : angina is most frequently the result of underlying coronary artery disease, when cholesterol aggregates on the artery wall and hard plaques form, the artery narrows the actual angina attacks are result of this reduced oxygen supply to the heart, common triggers include : (1) physical exertion, is a common trigger because the heart needs more oxygen than it receives in order to work harder (2) severe emotional stress (3) a heavy meal (4) exposure to extreme temperature (5) smoking may trigger angina attacks.  Unstable angina , is often caused by blood clots that partially or totally block an artery, larger blockage may lead to heart attacks. Variant angina occurs when an artery experiences as pasm that causes it to tighten and narrow.  

Symptoms of angina : angina is usually felt in the chest region as (1) squeezing (2) pressure (3) heaviness (4) tightening (5) burning or aching across the chest. Patients may also complain of symptoms including, indigestion, heart burn, weakness, sweating, nausea, cramping and shortness of breath. Stable angina usually lasts a short period, and may feel like gas or indigestion, unstable angina lasts longer, variant angina occurs at rest and is usually severe.  Risk factors: (1) unhealthy cholesterol levels (2) hypertension (3) tobacco smoking (4) diabetes (5) obese (6) metabolic syndrome (7) sedentary life style (8) over 45 for men and over 55 for women (9) family history.

Treatment of angina : angina treatment aim to reduce pain, prevent symptoms and prevent or lower the risk of heart attack, medicines, lifestyle changes and medical procedures may all be employed. The lifestyle changes recommended to heart angina include, (1) stopping smoking (2) controlling weight (3) regularly checking cholesterol levels (4) resting and slowing down (5) avoiding large meals (6) learning how to handle or avoid stress (7) eating fruits, vegetables, whole grains, low fat or not fat dairy products and lean meat and fish, the medicines used in treatment of angina include, betablockers ACE (angiotensin-convering enzyme) inhibitors, oral antiplatelet, anticoagulants in some cases surgical medical procedures are necessary to treat angina a heart specialist may recommend angioplasty, coronary artery by pass grafting is another standard procedure.

Diagnosis of Angina: diagnosis for chest pain is important because it can predict the like hood of having a heart attack. The process will start with a physical exam as well as discussion of symptoms, risk factors, and family medical history other test like (1) Electro cardio graph (2) stress test-blood pressure reading and ECG while the patient is increasing physical activity (3) chest X –ray to see the structure inside the chest (4) coronary angiography, dye and special X rays to show the inside of coronary arteries (dye is inserted using cardiac catheterization (5) blood test, to check levels of fats , cholesterol , sugar and proteins.