Cardiomyopathy case based presentation ppt
- 1. 02/24/2025 CASE BASED PRESENTATION BY TUGAINE ANSELM TUTOR: DR TEBAJANGA JOHN
- 2. 02/24/2025 History Name: NAKASITA AGNES Age/sex: 32/F Address: Mbarara Occupation: Peasant NOK: Burinda John Tribe: Munyankore Religion: Born again Date of Admission: 23, October 2024
- 3. 02/24/2025 PC: Difficulty in breathing for 3/7 Lower limb swelling for 1/52 HPC 32/F NYY on TLD for 1 year, good adherence, unknown CD4+ count and viral load, non diabetic, non hypertensive, non alcoholic, non smoker, known heart failure patient for 4 months on dapzine 10mg od and carvedilol 6.25mg poor adherence, discharged 2/52 PTA has been readmitted presenting with difficulty in breathing for 3/7 and a dry cough with a dull aching lower sternal pain, radiating to the right upper quadrant, worse on coughing and exertion scored 4/10,she reported orthopnea, PND, palpitations and easy fatigability on exertion.
- 4. 02/24/2025 HPC cont... Alongside lower limb swelling for 1/52 with abdominal distention but no yellowing of eyes, no vomiting, no diarrhea, no melena stools. She reported reduced urine output to about less than a full cup(400ml) a day, with facial puffiness however no hematuria, dysuria, urethral or PV discharge or incontinence.
- 5. 02/24/2025 REVIEW OF OTHER SYSTEMS • CNS: No headaches, No loss of consciousness, no convulsions, no altered mental state, no tremors • ENT: No dysphagia, no odynophagia, proper hearing and balance • Musculoskeletal: No joint pains, swellings or stiffness, no muscle pains or weakness. • Integumentary: No rashes, no itching or any lesions.
- 6. 02/24/2025 • PMHx: Known NYY patient on TLD for 1 year, known heart failure patient for 4/12 on dapzin 10mg od, carvedilol 6.25mg bd poor adherence, non hypertensive, non diabetic. 3rd admission, first being 4 months ago when they presented with similar symptoms and were diagnosed with heart failure which was managed and she was well on discharge. Second admission was 3 weeks ago when she presented with similar symptoms and a CAP as well. No known chronic illnesses, food or drug allergies. • PSHx: No blood transfusions, no major trauma, no surgical procedures done. • Family Social Hx: Non alcoholic, non smoker, a mother of 3 all well, unmarried and stays with the children. No known familial chronic illnesses.
- 7. 02/24/2025 Summary • 32/F NYY on TLD for 1 year, good adherence, unknown CD4+ count and viral load, non diabetic, non hypertensive, non alcoholic, non smoker, known heart failure patient for 4 months on dapzine 10mg od and carvedilol 6.25mg poor adherence presented with difficulty in breathing for 3/7 and a dry cough with a dull aching lower sternal pain, orthopnea, PND, palpitations and easy fatigability on exertion, with abdominal distention, reduced urine output, with facial puffiness. Differentials?
- 8. 02/24/2025 O/E: Sick looking middle aged female in mild respiratory distress with use of accessory muscles for breathing and tachypneic with 31cpm with a dry cough in an improvised cardiac bed, no peripheral cyanosis, no palmar or conjunctival pallor, radial pulse present, no lymphadenopathy, no jaundice, no central cyanosis, lower limb edema grade 2. Vitals BP: 102/92mmHg, PR:141bpm, SaO2: 97% CVS: No splinter hemorrhages, no Jane way lesions, no Osler’s nodes, no palmar pallor, pulse full volume, regular, no radial radial, radial brachial delay, no collapsing pulse, no conjunctival pallor, no central cyanosis, distended neck veins, diffuse PMI, no heaves, S1 and S2 heard with a pan systolic murmur at both mitral and tricuspid area grade 4/6, Basal lung crepitations, tender hepatomegaly 10 cm below costal margin and positive hepato-jugular reflux, bilateral lower limb edema grade 2.
- 9. 02/24/2025 P/A: symmetrical moving with respiration, mildly distended, tenderness in the right upper quadrant, tender hepatomegaly of 10cm below costal margin, no splenomegaly or any masses, positive shifting dullness and bowel sounds heard. Respiratory: bilateral equal chest expansion, resonant percussion notes, fine crackles at the lung bases and normal vesicular breath sounds in all other regions. CNS: Alert with GCS 15/15, pupils equal and reactive to light, cranial nerves intact, normal tone, power, reflexes, coordination and sensation in all limbs.
- 12. 02/24/2025 TREATMENT ON ADMISSION • IV lasix 40mg BD • IV ceftriaxone 2G OD • PO Doxycycline 100mg BD
- 14. 02/24/2025 HEART FAILURE Definition Heart Failure is a complex clinical syndrome with symptoms and signs that result from any structural or functional impairment of ventricular filling or ejection of blood. (ACCF/AHA & HFSA)
- 15. 02/24/2025 TYPES OF HEART FAILURE 1. ACUTE VS CHRONIC 2. LEFT VS RIGHT 3. BIVENTRICULAR
- 16. 02/24/2025 ACUTE VS CHRONIC - Chronic heart failure describes patients with longstanding (e.g., months to years) symptoms and/or signs of HF typically treated with medical & device therapy - Acute heart failure, previously termed acute decompensated HF, refers to the rapid onset or worsening of symptoms of HF - Most episodes of acute HF result from worsening of chronic HF, but ~20% are due to new-onset HF that can occur in the setting of acute coronary syndrome, acute valvular dysfunction, hypertensive urgency, or postcardiotomy syndrome
- 17. 02/24/2025 LEFT VS RIGHT VENTRICULAR HEART FAILURE - Left HF is characterized by a reduction in left ventricular output and an increase in left atrial and pulmonary venous pressure - Right HF is characterized by a reduction in right ventricular output and an increase in right atrial and systemic venous pressure - ‘Cor pulmonale’ is right heart failure that is secondary to chronic lung disease
- 18. 02/24/2025 BIVENTRICULAR - In biventricular failure, both sides of the heart are affected. - This may occur because the disease process, such as dilated cardiomyopathy or ischemic heart disease, affects both ventricles. - It can also occur because of the disease of the left heart → chronic elevation of the left atrial pressure, pulmonary HTN & right HF
- 19. 02/24/2025 CLASSIFICATION OF HEART FAILURE 1. NYHA FUNCTIONAL CLASSIFICATION 2. AHA STAGING OF HEART FAILURE 3. BASED ON EJECTION FRACTION Ejection fraction (EF) is a measurement, expressed as a percentage, of how much blood the left ventricle pumps out with each contraction. (AHA)
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- 21. 02/24/2025 AHA STAGING OF HEART FAILURE
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- 23. 02/24/2025 EPIDEMIOLOGY • HF is a major cause of morbidity & mortality worldwide • Globally, >26 million people are affected by HF • The prevalence of HF increases with age (affects the elderly) • Lifetime risk for HF is higher in men • 1-year mortality approaches 40 % in those with severe HF • Re-admission with HF is common, ~ 50% at 6 months • HF in SSA commonly caused by RHD, dilated cardiomyopathy, HTN • In SSA, the reported hospital prevalence studies indicate that HF is responsible for 9.4–42.5% of all medical admissions and 25.6–30.0% of admissions into the cardiac units.
- 24. 02/24/2025 Risk Factors • Old age • Black race • Smoking • Alcoholism • Diabetes • Hypertension • Diet • Obesity
- 26. 02/24/2025 Factors aggravating/precipitating heart failure.
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- 29. 02/24/2025 Symptoms of heart failure • Breathlessness • Orthopnea • Paroxysmal nocturnal dyspnea • Reduced exercise tolerance • Fatigue, tiredness, increased time to recover after exercise • Ankle swelling • Nocturnal cough • Wheezing • Loss of appetite • Palpitation • Dizziness • Syncope • Bendopnea
- 30. 02/24/2025 Signs • Dyspnea at rest • Anxious • Pallor • Cold extremities • Peripheral cyanosis • Cardiac cachexia • Jaundice • Tachycardia • Irregular rhythm • Hepatomegaly • Ascites • Hypotension • Narrow pulse pressure • Tachypnea • Cheyne-Stokes respirations • JVP abnormalities • Pulmonary rales, wheezes • Pleural effusion • S3 gallop • Holosystolic/pansystolic murmurs • Lower extremity edema • Congestive splenomegaly
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- 33. 02/24/2025 Investigations • CBC • RFTs, electrolytes • RBS, HbA1C, lipid profile, TFTs • LFTs, coagulation studies • BNP, NT-proBNP • Chest x-ray • ECG, ECHO • Cardiac MRI (CMR)
- 36. 02/24/2025 Approach to a patient 1. History and Physical Examination 2. Lab tests 3. Chest X-ray 4. ECG and Echo 5. Risk stratification; NYHA functional class, Natriuretic peptide level, cardiopulmonary exercise tolerance test. 6. Determine cause 7. Management
- 37. 02/24/2025 Management Goals of management 1. Reduction in mortality 2. Prevention of recurrent hospitalizations due to worsening HF. 3. Improvement in clinical status, functional capacity and QOL. Treatment includes; • Non pharmacological • Pharmacotherapy • Device therapy
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- 40. 02/24/2025 Non pharmacological management • Restricted salt and fluid intake • Regular physical exercise • Weight regulation • Limit alcohol • Quit smoking • Better stress management
- 41. 02/24/2025 Pharmacotherapy • ACEis like Captopril • ARNI like sacubitril/valsartan • Loop diuretics like Furesemide • ARBs like Valsartan, losartan • MRAs like spironolactone, eplerenone • Beta blockers like Bisoprolol, Carvedilol • SGLT2is like Empagiflozin, Dapagiflozin • Digoxin
- 42. 02/24/2025 Device therapy and Surgical Options 1. Implantable cardioverter defibrillator (ICD) 2. Cardiac Resynchronization Therapy (CRT) 3. Left ventricular assist device (LVAD) Surgically: - Valve replacement -Coronary artery bypass -Heart transplant
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