This document defines and discusses the causes, symptoms, diagnosis, and treatment of congestive heart failure (CHF). It notes that CHF occurs when the heart cannot meet the body's needs due to various causes such as congenital heart disease, viral infection, hypertension, or myocardial infarction. Symptoms vary depending on whether the left or right side of the heart is affected, but may include fatigue, shortness of breath, leg swelling, and liver enlargement. Diagnostic tests include chest x-rays, ECGs, echocardiograms, and bloodwork. Treatment involves managing symptoms, addressing the underlying cause, and medications like diuretics, digoxin, and ACE inhibitors.

1. Congestive Heart Failure
Dr. Noura Noreddin

2. Definition:
The heart fail to maintain body needs

3. Causes of heart failure:
•Congenital heart disease at infancy
•Viral myocarditis at any age
•Rheumatic heart disease
•Dilated cardiomyopathy
•Cor-pulmonale
•Fluid overload
•Hypertension
•Arrhythmia
•Metabolic
•Anemia
•SAM
•SBE
•HIE

4. Causes of heart failure:
HEART MAY DIE
 Hypertension
 Embolism
 Anemia
 Rheumatic
 Thyrotoxicosis
 Myocardial infarction
 Arrhythmia
 Y
 Diet& lifestyle
 Infection/ Ischemia
 Endocarditis

5. Causes of heart failure:
FAILURE
 Forgot medications
 Anemia/Arrhythmia/Anomalies
 Infection/Infarction/Ischemia
 Lifestyle
 Up regulation
 Rheumatic/Renal failure
 Embolism/Endocarditis

6. Clinical picture of CHF:
•Tachypnea
•Tachycardia
•Tender hepatomegaly
•Cardiomegaly in Chest-X-ray

7. Types of CHF:
Acute& chronic
Left side& right side

8. Right side heart failure:
Raised JVP
Hepatomegaly
Lower limb edema
Left side heart failure:
Orthopnea
Shortness of breath
Paroxysmal nocturnal dyspnea

9. CHF signs& symptoms:
Left side FORCED Right side BACONED
Fatigue Bloating
Orthopnea Anorexia
Restless/Rales Cool legs
Confusion/Cyanosis Oliguria
Extreme weakness Nausea
Dyspnea Edema (bipedal)
Distended neck veins

10. CHF signs& symptoms:
Left side FORCED Right side AW HEAD
Fatigue Anorexia
Orthopnea Weight gain
Restless/Rales Hepatomegaly
Confusion/Cyanosis Edema (bipedal)
Extreme weakness Ascites
Dyspnea Distended neck veins

11. Investigations:
CXR: cardiomegaly
ECG: arrhythmia
Echo: CHD, RHD, SBE, CMP
CBC, S.E, KFT, LFT, CPK, LDH& Digoxin level

12. Stages of heart failure
1 Cardiac disease but no symptoms
No limitation in ordinary activity
2 Mild symptoms
Slight limitation of ordinary activity
3 Symptoms disappear at rest
Significant limitation of activity
4 Symptoms even at rest
Severe limitation of daily activity

14. Daily living activities:
ADL assessment
BATTED
 Bathing
 Ambulation
 Transfers
 Toileting
 Eating
 Dressing

15. Stages of heart failure in CXR
1
Redistribution
Cardiomegaly
Broad vascular pedicle
2
Interstitial edema
Kerley lines
Peribronchial cuffing
Hazy vessels contour
Thickened interlobar fissure
3
Alveolar edema
Consolidation
Air bronchogram
Cottonwood appearance
Pleural effusion

16. Stages of heart failure in CXR
A B C D E
A Alveolar edema
B Kerley B lines
C Cardiomegaly
D Dilated upper lobe BV
E Effusion (pleural)

18. Supportive treatment:
 Oxygen
 Salt restriction
 Fluid restriction
 Semi-sitting position
Management:

19. Specific treatment:
 Detect the cause
 Diuretics
 Digoxin
 Dilator
Management:

20. Management:
UNLOAD FAST
 Upright position
 Nitrates
 Lasix
 Oxygen
 ACE inhibitor
 Digoxin
 Fluid 
 Afterload 
 Sodium 
 Test digoxin level

21. Management of CHF+Pulmonary edema:
MAD DOG
 Morphine
 Aminophyline
 Dopamine
 Diuretics
 Oxygen
 Gases ABG

22. Management of CHF+ Pulmonary edema:
DOLMA
Dopamine
Oxygen
Lasix
Morphine
Aminophylline

24. Thank you