1. Signs and Symptoms
1.1. Left sided HF
1.1.1. Dyspnea, orthopnea, PND
1.1.2. Fatigue
1.1.3. Pulmonary edema (crackles and cough)
1.2. Right sided HF
1.2.1. Peripheral edema
1.2.2. JVD( jugular venous distention
1.2.3. Ascites and hepatomegaly
1.3. Systemic signs
1.3.1. Weight gain
1.3.2. Decrease urine output
1.3.3. Cold extremities
1.3.4. Cognitive changes
2. Body System Impacts
2.1. Respiratory System
2.1.1. Pulmonary edema leading to SOB and Hypoxia
2.2. Renal System
2.2.1. Perfusion
2.2.1.1. RAAS activation leading to fluid overload
2.3. Neurological System
2.3.1. Cerebral perfusion (leading to confusion and syncope)
2.4. Hepatic System
2.4.1. Congestion leading to hepatomegaly and increase liver enzymes
3. Complications
3.1. Acute kidney Injury
3.2. Hyperkalemia from RAAS inhibitors
3.3. Cardiac arrhythmias (AF, VT)
3.4. Thromboembolism (Stroke risk)
3.5. Volume depletion/ hypotension
3.6. Genital / urinary infection (SGLT2 inhibitors)
4. Diagnostic test
4.1. BNP/ NT_proBNP ( Indicates myocardial wall stress)
4.2. Echocardiography (Assess LVEF (HFrEF vs HFpEF))
4.3. Chest X-ray ( pulmonary congestion and cardiomegaly)
4.4. ECG ( identify ischemia or arrhythmia)
5. Treatment Options
5.1. Pharmacological
5.1.1. First line
5.1.1.1. ACE inhibitors/ARBs
5.1.1.2. Beta Blockers
5.1.1.3. Diuretics
5.1.1.4. Mineralocorticoid receptor antagonists (MRAs)
5.1.2. Newer therapies
5.1.2.1. ARNIs ( Sacubitril/ Valsartan- PARADIGM-HF
5.1.2.2. SGLT2 inhibitors (Empagliflozin - EMPEROR-Reduced, DAPA-HF)
5.2. Non pharmacological
5.2.1. Sodium’ and fluid restriction
5.2.2. Daily weight monitoring
5.2.3. Smoking and Alcohol cessation
5.2.4. Regular supervised exercise
5.2.5. Patient education and self care
5.3. Advanced therapies
5.3.1. ICDs: Implantable Cardioverter defibrillators
5.3.2. CRT: Cardiac resynchronization therapy
5.3.3. Heart transplantation for End stage HF
6. DEFINITION AND PATHOPHYSIOLOGY
6.1. sudden interruption of blood supply to the brain, leading to brain cell damage due to lack of oxygen and nutrients.
6.2. Ischemic stroke (most common, 87%)
6.2.1. (a) Caused by interruption of cerebral blood flow due to
6.2.1.1. Thrombosis (blood clot forms in the brain)
6.2.1.2. Embolism (clot travels from another part of the body, often the heart) lead to
6.2.2. (b) Decreased oxygen/glucose delivery
6.2.3. (C) Cellular hypoxia and death - Infarction
6.2.4. (d) Penumbra zone: area of potentially salvageable brain tissue
6.2.5. (d) Inflammatory cascade- further damage
6.3. CONSEQUENCE OF CHRONIC ACTIVATION:
6.3.1. (a) Vasoconstriction and fluid retention
6.3.2. (b) Cardiac remodelling
6.3.3. (c) Decrease effectiveness of natriuretic peptides
6.3.4. (d) Oxidative strees and mitrochondrial dysfuntion
6.3.5. (e) Neurohormonal Imbalance.