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What is Congestive Heart Failure? - NEET PG Medicine

Feb 3, 2023

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Clinical features

On examination

FRAMINGHAM CRITERIA: FOR DIAGNOSIS OF CHF

Minor Criteria

Framingham heart risk calculator

Congestive Heart Failure Stages

WORKUP

TREATMENT

congestive heart failure neet pg

If you’re having trouble understanding congestive heart failure, then you have landed on the right page. Here we will discuss everything you need to know about congestive heart failure stages, symptoms, and its treatment in detail.
Read further to upgrade your NEET PG preparation.
So, let’s get started with what is Cardiac Output?

Cardiac output = Heart rate X stroke volume 

  • ↑HR →↑Sympathetic drive

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Clinical features

Let’s learn about the Clinical features of Congestive Heart Failure here:

1. Palpitations

2. Diaphoresis

3. Dyspnea on exertion/rest

4. Nocturnal cough

5. Paroxysmal nocturnal dyspnea (Orthopnea)

6. Pink frothy sputum

7. Effort intolerance

On examination

  • Tachycardia
    • Maximum HR = 220 – Age

Left Ventricular failure 

Right Ventricular failure 

  • SBP leads to oliguria 
  • S3 present: Ventricular gallop rhythm 
  • B/L fine crepitation 
  • air entry B/L
  • Vital capacity 

[m/c/c of RVF is LVF]

  • JVP
  • Kussmaul signs JVP on Inspiration 
  • Abdomino – jugular reflux 
  • Tender hepatomegaly 
  • B/L pitting pedal edema 

[Chronic CCF] 

 


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FRAMINGHAM CRITERIA: FOR DIAGNOSIS OF CHF

Minor Criteria

  1. Dyspnea On exertion
  2. Nocturnal cough
  3. Tachycardia
  4. Pleural effusion
  5. Vital capacity 1/3rd
  6. Tender hepatomegaly
  7. Pitting pedal edema
  8. Oliguria

Major Criteria = Rest all are major criteria.

 

Important Information

For Diagnosis

  • 2 major criteria should be present or
  • 1 major + 2 minor

Also Read: Myocardial Infarction - Neet PG Medicine

Framingham heart risk calculator

  • To determine chances of coronary events in next 10 yrs (risks)

Congestive Heart Failure Stages

Now that you have learned about the criteria for diagnosis of CHF, let’s take a look at the stages of CHF:

(ACCORDING TO ACC)

Stage A → No structural damage, high risk of developing symptoms (risk factors present)

Stage B→ Structural heart disease + No symptoms of CHF

Stage C → Structural heart disease + Symptoms of CHF

Stage D → Refractory heart failure

Before reading further, refer to this video and boost your knowledge related to The Abnormal Heart Sounds Auscultated In Various Heart Pathologies

The Abnormal Heart Sounds Auscultated In Various Heart Pathologies

WORKUP

1. BNP levels / N - terminal Pro BN

  • Released from ventricles of heart
  • If >100 pg/ml - It differentiate from non-cardiogenic pulmonary edema

2. Chest X-ray

Chest X-ray for congestive heart failure
Chest X-ray

a. Earliest radiological finding: Prominent upper lobe veins/ Antler sign or Reverse moustache sign

b. CT ratio increased > 0.5

c. Bat wing pulmonary edema

d. Costophrenic angle blunting

e. B/L pleural effusion

f. Kerley B lines → Perpendicular to pleural surface. Due to thickened interlobular septa

  • Also seen in lymphangitis carcinomatosis (Kerley A lines: Present in the periphery of hila
  • Due to distension of anastomotic channels between central and peripheral lymphatics Kerley C lines: Reticular opacities at lung base.)

Important Information

  • Reverse Bat Wing Edema- Chronic Eosinophilic Pneumonia
  • Moustache sign - Pneumoperitoneum (gas under diaphragm)

3. Echocardiography

  • Ejection fraction = Stroke volume/End diastolic volume 
  • In systolic malfunction = EF↓
  • In diastolic malfunction = EF can be normal
  • In HTN patient → Left ventricular end diastolic pressure increase
  • Pooling of blood in lungs

4. Cardiac MRI

  • Preferred imaging
  • Type of malfunction: Systolic Vs Diastolic
  • Etiology: Fibrosis/ischemic/Hypokinesia/DCM
  • Prognosis

5. BORG scale - Tells functional assessment of the patients

Refer the table below:

RPE Scale Rate of perceived Exertion 
10Max effort Activity It Feels almost impossible to keep going. Completely out of breath, unable to talk. Cannot maintain for more than a very short time. 
9Very hard Activity Very difficult to maintain exercise intensity. Can barely breathe and speak only a few words
7-8Vigorous Activity Borderline uncomfortable. Short of breath, can speak a sentence. 
4-6Moderate Activity Breathing heavily, can hold short conversation, still somewhat comfortable, but becoming noticeably more challenging  
2-3Light Activity Feel like you can maintain it for hours. Easy to breathe and carry a conversation 
1Very Light Activity Hardly any exertion, but more than sleeping, watching TC, etc. 

Also Read: Infective Endocarditis- NEET PG Medicine

EPILEPSY AND Electroencephalography (EEG) : NEET PG Medicine

TREATMENT

Learn about the Congestive Heart Failure Treatment below:

Heart failure with preserved EF (HFpEF)

  • Preserved EF 50%

Seen in:

  • HTN, RCM, Radiation
  • CTD, aging
  • Endocardial fibroelastosis
  • Hemochromatosis

Rx

  1. Aldosterone antagonist
  2. ARNI → Valsartan (ARB) + sacubitril (neprilysin → inhibitors degradation of BNP)

Digoxin

  • Ineffective
  • ↑O2 demand of heart
  • Can be detrimental

Heart failure with reduced EF (HFrEF) Seen in:

  • CAD: Ischemic cardiomyopathy
  • HTN: recent onset
  • Valvular Lesion
  • L → R shunt
  • Cor Pulmonale
  • Chagas diseases/Ch.Arrhythmias

Management

Congestive heart failure Treatment of acute pulmonary edema

L → Lasix (Furosemide)

M → Morphine (↓Pulmonary edema)

N → Nitroglycerine

O → Oxygen (NIV)

P → Positioning

How to remember

  • LMNOP

Vasodilators

  • Nitroglycerine
  • Nesiritide
  • Nitroprusside

Diuretics

  • Furosemide

Nesiritide

  • BNP Analogue

Treatment of Acute decompensation with cardiogenic shock

1. Vasopressors

  • Nor-epinephrine → DBP ↑→ CBF ↑
  • Dopamine: improves GFR also
  • Dobutamine:  β1 →↑ HR→↑O2 consumption

2. Inodilators: Milrinone \& Amrinone

3. Levosimendan

Omecamtiv → ↑ production of stronger actin-myosin complex

Acute CHF/HFrEF: <40% of EF
Cardiogenic Shock Volume Overload 
Vasopressors L → Lasix (Furosemide)M → Morphine (↓Pulmonary edema )N → NitroglycerineO → Oxygen (NIV)P → Positioning 

CHRONIC CHF

  • ↓Post discharge
  • Initiate with ARNI: Valsartan. Sacubitril
  • ACE +  Blockers
  • Spironolactone
Heart Failure
HF with preserved ejection fraction EF ≥ 50%HF with reduced ejection fraction EF < 40%
Causes Causes
Long standing HTNARNIAldosterone antagonist ACE inhibitors Acute pulmonary edema S. anemia with CHF T3 pregnancy→ LMNOP→ ARNI→ ACEI + βblockers IVABRADINE Cardiogenic Shock        → vasopressors 

Medically Refractory Cardiogenic Shock

1. LVAD:LV assist device: heart-mate

2. CRT: Cardiac resynchronization therapy

3. Cardiac transplantation

Digoxin toxicity

  • V. Bigeminy (MC arrhythmia)
  • Non paroxysmal atrial tachycardia with AV block

Rx

  • Lignocaine

We hope that now you’ve a better understanding of what Congestive Heart Failure is along with its stages, symptoms and treatment. To study more about such important topics, download the PrepLadder App and enhance your knowledge with NEET PG Medicine Notes.


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