CASE STUDY (2009) A 56 years old patient complain of difficulty in breathing on less than ordinary activity.

He awoke many times about 2 hours after sleeping with severe dyspnea that was relieved by sitting. Pericardial examination revealed an apex in the 6th space outside the midclavicular line, a gallop on the apex and fine basal crepitations on the back.

What type of heart failure this patient has? Left sided heart failure

Enumerate the causes of this heart failure: Increased afterload hypertension Aortic stenosis Dilated cardiomyopathy cardiomyopathies Valvular regurgitation Excessive preload Mitral regurge Fluid overload

1. Systolic dysfunction Decreased contractility Myocardial infarction Valvular heart diseases eg. MR hypertension

2. Diastolic dysfunction

stiffness of the myocardium caused by hypertension of infiltration eg. Amyloidosis

How to stage heart failure?what is the stage of this heart failure?

Newyork classification of heart failure (NYHA) Heart disease present, but no dyspnea from ordinary activity Comfortable at rest: dyspnea on ordinary activity Less than ordinary activity causes dyspnea, which is limiting Dyspnea at rest; all activity causes discomfort

Stage 1 Stage 2 Stage 3 Stage 4

This patient has dyspnea on less than ordinary activity, so he is in stage 3

Enumerate the factors that precipitate heart failure in patients with preexisting heart disease:

Myocardial ischaemia/ infarction Intercurrent illness eg. Infection Specific infections eg.rheumatic activity/ infective endocarditis Arrhythmia eg. Atrial fibrillation

Inappropriate reduction of therapy Administration of drugs B-blockers NSAIDS Corticosteroid Pulmonary embolism Condition associated with increased metabolic demand Pregnancy Thyrotoxicosis Anaemia

IV fluid overload