Download Chronic heart failure

Subject 12 - Chronic heart failure
(4 hours)
Place
Training Room, cardiology department .
Purpose
To know:
• The main causes of heart failure
• Pathogenesis of disorders of the central and peripheral hemodynamics in various forms ( leftand right heart ). Systolic and diastolic dysfunction. The role of the kidneys and endocrine
factors.
• Classification of CHF.
• Features of clinical course and diagnosis of chronic left-and right heart failure of varying
degrees .
• Methods of diagnosis , the value of instrumental methods.
• Differential treatment based on the causes and stages of heart failure.
Be able to:
• Based on survey data of patients with CHF formulate the final clinical diagnosis and determine
the tactics and principles of treatment.
Professional orientation of students
CHF complicates the majority of cardiovascular diseases and is largely prediction of patient
notes and becoming a major factor in mortality. Timely treatment of the underlying disease may
prevent the development of CHF. Modern adequate treatment of the heart failure can improve
the prognosis and quality of life.
Basic knowledge and skills
№
Discipline
To be able to know
To be able to do
The anatomical structure of the heart
1
Anatomy
2
Histology
Structure and functioning myocardium
3
Biochemistry
Fundamentals of myocardial
metabolism and cardiac contraction
muscle
4
Pathophysiology
Mechanisms of heart failure, the role
of the kidneys and endocrine system
5
Propedevtika
internal diseases
Semiotics heart failure of different
stages and forms
Evaluate the clinical, instrumental
and laboratory tests
Plan for practical lesson
№
Elements of practical employments
1.
Verification of present's students
5
2.
Entrance control and his analysis
15
Time(minutes)
3. * Distributing patients for Supervision ( card or clinical tasks )
10
4. * Review patients or study of educational hospital chart
40
5.
Discussion of findings, formulation of previous diagnosis, determination of
methods of additional inspection of patient, interpretation of their results,
formulation of final diagnosis and plan of treatment
50
6.
Exercises with clinical formulations for solving clinical situation tasks
20
7.
Output control of knowledge and its evaluation
15
8.
Results and final assessment of knowledge and skills of students and tasks to
self- preparation for the next lesson
5
Note: * - in the case of patients absence in clinical, practice can be made in the form of
preparation and decision of situational tasks.
List of theoretical issues addressed in class
1. The main causes of heart failure .
2. Pathogenesis of disorders of the central and peripheral hemodynamics in various forms ( leftand right heart ). Systolic and diastolic dysfunction. The role of the kidneys and endocrine
factors.
3. Classification of CHF. Concept stage heart failure and functional class of the patient.
4. Features of clinical course and diagnosis of chronic left-and right heart failure of varying
degrees.
5. Methods of diagnosis , the value of instrumental methods.
6. Differential treatment based on the causes and stages of heart failure.
Methods of practical classes *
After reviewing the present teacher carries out writing the input control background knowledge
(added a set of 15 of tests in accordance with the number of students). Teacher carries out the
distribution of students for supervision of patients.
№
Task
1.
To provide
In a survey reveal:
supervision of
1. Symptoms of chronic
patients diagnosed circulatory disorders (clinical
with heart failure and more)
Instructions a student
2. Availability of the reasons
that led to the development of
heart failure
3. Characteristic changes in
heart failure echocardiography,
x-ray examination, in
laboratory data
Note teacher for students
Pay particular attention to:
• The existence of identified complaints
and objective data
• the disease, leading to heart failure,
quality of treatment of the underlying
disease
• the availability and duration of changes
in x-ray examination and
echocardiography
• determine the amount of tactics and
treatment of heart failure
Teachers work according to the plan of studies, spend the weekend at the end of the control
knowledge. Before the end of class the teacher sums up the results of his studies on the
assessment of each student and announce the topic of the next session.
Forms and methods of selfTests
1. Specify the most characteristic systolic dysfunction changes we have identified in
echocardiography:
A. Mitral valve insufficiency.
B. Reduced ejection fraction.
C. Increased heart cavities.
D. Thickening of the walls of the myocardium.
E. Reducing heart cavities.
2. Specify the most typical for left ventricular failure changes we have identified in X-ray study
of the chest cavity:
A. Cardiomegaly.
B. Increased vascular pattern.
C. The increase in the left ventricle.
D. The increase in the right ventricle.
E. The expansion of the aorta.
3. Which drug can most effectively reduce the degree of secondary hiperaldosteronemi in CHF.
A. Atenolol.
B. Veroshpiron.
C. Enalapril.
D. Consists of digoxin.
E. Furosemide.
Situational tasks
1. The patient, 53 years, engineer, complaining of shortness of breath at the slightest exertion ,
swelling of the legs, heaviness in the right upper quadrant, an attack of breathlessness at night. In
the 50 years suffered a myocardial infarction, 3 months began to notice shortness of breath, and a
year later - the swelling. Objectively: general condition - moderate. Cyanosis of lips, swelling of
the legs. The apical impulse is common, abnormal pulse determined in 5- 6th intercostal space 2
cm from the outside of the midclavicular line. Cardiac deaf. Heart rate - 100 per min. BP 140/90 mm Hg. Liver 4 cm below the right upper quadrant. Radiological findings: heart
extended to the left and down, determined paradoxical pulse. ECG - focal cicatricial changes in
the anterior wall of the left ventricle. Formulate a diagnosis. Identify tactics and treatments.
What is the prognosis of the patient?
2. Woman, age 45, for 15 years suffering from chronic glomerulonephritis. Blood pressure
within 200-180/105-110 mm Hg. Complained to the appearance of edema of the lower
extremities, weakness, shortness of breath during severe stress, night cough. The blood
creatinine - 160 mg/dL, albumin – 55 g/l. In urine daily proteinuria – 0,9 g/l. When
echocardiographic ejection fraction (EF) - 35 %. Specify the most likely diagnosis. Is there a
need for differential diagnosis? Your tactics in the management of patients.
Visual material
1. Tables and slides to the classification of heart failure.
2. Videotape of echocardiography heart in CHF.
3. Sets of radiographs, ECG.
4. Tests case studies.
Sources of information
Basic:
Therapy. Course of lectures. Simferopol. -2003.- 444p.
Additional:
1. Harrison's Principles of Internal Medicine 18th edition.
.org)
2. ESC Guidelines. Cardiovascular medicine. (Www.escardio.org / guidelines)
Individual Students Program topics
Explore:
• The main causes of heart failure.
• Pathogenesis of disorders of the central and peripheral hemodynamics in various forms (leftand right heart). Systolic and diastolic dysfunction. The role of the kidneys and endocrine
factors.
• Classification of CHF. Concept stage heart failure and functional class of the patient.
• Features of clinical course and diagnosis of chronic left-and right heart failure of varying
degrees.
• Methods of diagnosis, the value of instrumental methods.