Ch-2 | L-5 | Congestive heart failure | Pharmacotherapeutics | D.Pharm second year

#congestiveheartfailure #CHF #pharmacotherapeutics #dpharma #exitexam Notes, PYQ, MCQ, EXIT Exam Preparation, Pharmacist exam prepartion availbale in "MIND NURTURE" app Link for app: https://play.google.com/store/apps/de... Congestive Heart Failure (CHF) Congestive Heart Failure (CHF) is a clinical condition in which the heart becomes weak or stiff and cannot pump blood efficiently, causing fluid to accumulate in the lungs, legs and other body tissues. “Failure” does not mean complete stoppage of the heart; it means the heart cannot meet the body’s workload effectively. Types 1. Left-sided heart failure o Systolic (HFrEF): Left ventricle cannot contract normally, so insufficient blood is pumped into circulation. o Diastolic (HFpEF): Left ventricle becomes stiff and cannot relax and fill properly. o Both increase cardiac pressure and may cause edema in lungs, liver, abdomen and legs. 2. Right-sided heart failure: Usually develops secondary to left-sided failure. Blood backs up in veins, causing leg/ankle swelling and abdominal congestion or ascites. Classification ACC/AHA stages: • A: High risk, but no structural disease or symptoms. • B: Structural heart disease without symptoms. • C: Structural heart disease with symptoms such as dyspnea, fatigue and edema. • D: Advanced/refractory heart failure with severe symptoms despite treatment. NYHA classes: Class I: No activity limitation. Class II: Slight limitation. Class III: Marked limitation. Class IV: Symptoms occur even at rest. Etiology Major causes include coronary artery disease and myocardial infarction, hypertension, cardiomyopathy and valvular heart disease. Other causes include arrhythmias, congenital heart disease, myocarditis, excessive alcohol, cardiotoxic drugs, endocrine disorders, diabetes, obesity and sleep apnea. Clinical Manifestations Left-sided: Dyspnea, orthopnea, nocturnal breathlessness, fatigue, cough with frothy sputum and nocturnal wheezing. Right-sided: Foot/ankle edema, abdominal discomfort, loss of appetite, nausea, fatigue and weakness. Low cardiac output: Cold extremities, weak pulse, reduced urine output, increased night-time urination, confusion, irritability and weight gain. Severe CHF: Pulmonary edema, cachexia, arrhythmias, syncope and sudden cardiac death. Management Non-pharmacological: Restrict salt and, when indicated, fluids; monitor daily weight; take a balanced diet; stop smoking and avoid alcohol; use appropriate physical activity; recognize worsening symptoms; maintain medication adherence; receive recommended vaccinations; avoid precipitating factors such as excessive fluid intake and certain medicines; control hypertension, diabetes and hyperlipidemia. Pharmacological: • Diuretics: Furosemide, bumetanide, hydrochlorothiazide, spironolactone — reduce congestion and edema. • ACE inhibitors/ARBs/ARNI: Enalapril, captopril, ramipril, losartan, valsartan, candesartan, sacubitril + valsartan — reduce cardiac workload and remodeling. • Beta-blockers: Carvedilol, metoprolol succinate, bisoprolol — reduce sympathetic overactivity and improve outcomes. • Aldosterone antagonists: Spironolactone, eplerenone. • SGLT2 inhibitors: Dapagliflozin, empagliflozin — improve symptoms and survival in HFrEF. • Digoxin: Increases contractility and may improve symptoms, but does not provide a survival benefit. #CongestiveHeartFailure #HeartFailure #CHF #HFrEF #HFpEF #LeftSidedHeartFailure #RightSidedHeartFailure #CardiacFailure #HeartFailureSymptoms #HeartFailureManagement #HeartFailureTreatment #HeartFailurePathogenesis #HeartFailureEtiology #CardiacOutput #PulmonaryEdema #PeripheralEdema #Dyspnea #Diuretics #CardiacGlycosides #Pharmacotherapeutics