Heart Failure: DR Kaem Shir Ali

HEART FAILURE
• Heart failure: A complex syndrome resulting from any

structural or functional cardiac disorder that impairs the
ability of the heart to pump sufficient blood to meet all of
the metabolic needs of the body systems.
• It is commonly termed congestive heart failure (CHF)

since symptoms of increase venous pressure are often
prominent.
• It is a common end point for many diseases of

cardiovascular system.
Statistics
• The American heart association estimates that approximately
4.7 million Americans have heart failure.
• There are approximately 400,000 new cases noted each year.
• About 40,000 Americans die from heart failure every year.
• The incidence increases to 10 in every 1000 after the age of

65.
• Risk of death is 5-10% annually in patients with mine

symptoms and increase to as high as 30-40% annually in
patients with advanced disease.
Causes of heart failure
Main causes:
 Ischaemic heart disease (35–40%)
 Cardiomyopathy (dilated) (30–34%)
 Hypertension (15–20%)
Other causes:
 Cardiomyopathy (undilated): hypertrophic, restrictive
(amyloidosis, sarcoidosis)
 Valvular heart disease (mitral, aortic, tricuspid)
 Congenital heart disease (ASD, VSD)
 Alcohol and drugs (chemotherapy – trastuzumab, imatinib)
 Hyperdynamic circulation (anaemia, thyrotoxicosis,
haemochromatosis, Paget’s disease)
 Right heart failure (RV infarct, pulmonary
hypertension, pulmonary embolism, (COPD))
 Tricuspid incompetence
 Arrhythmias (atrial fibrillation, complete heart block,
the sick sinus syndrome)
 Pericardial disease (constrictive pericarditis,
pericardial effusion)
 Infections (Chagas’ disease), e.g. myocarditis
Factors aggravating heart failure
• Myocardial ischemia or infarction.

• Dietary sodium excess.
• Arrhythmias.
• Medication noncompliance.
• Excess fluid intake.
• intercurrent illness (e.g. infection)
• Condition associated with increased metabolic demand(e.g. pregnancy,
thyrotoxicosis, excessive physical activity)
• Alcohol.
• Administration of drug with negative inotropic properties or fluid
retaining properties(e.g. NSAIDs, corticosteroids)
• Obesity
Forms of heart failure
 Systolic failure : inability of the ventricle to contract normally,
resulting in ↓cardiac output. Ejection fraction (EF) is <40%. Causes:
IHD, MI, cardiomyopathy.
 Diastolic failure :inability of the ventricle to relax and fill normally,

causing ↑filling pressures. EF is >50%. Causes: constrictive
pericarditis, tamponade, restrictive cardiomyopathy and it’s
common in elderly ,women.
 Acute failure : sudden onset of symptoms, usually following an acute

onset of a new illness – symptoms may appear over several hours ,
or decompensation of chronic heart failure characterized by
pulmonary and/or peripheral oedema with or without signs of
peripheral hypoperfusion.
 Chronic failure: Develops or progresses slowly (symptoms may
take years to become apparent). Venous congestion is common
but arterial pressure is well maintained until very late.
 Left side failure : left ventricle is hemodynamically overloaded

and /or weakened resulting in Dyspnoea, poor exercise tolerance,
fatigue, orthopnoea, paroxysmal nocturnal dyspnoea (PND),
nocturnal cough (±pink frothy sputum), wheeze (cardiac ‘asthma’),
nocturia , cold peripheries, weight loss, muscle wasting.
 Right side failure : abnormality primarily affecting right ventricle

(reduction in effective right ventricular output for given right
atrial pressure and cause increase jugular venous pressure and
hepatic congestion)
• Low output HF: cardiac output at rest <2.2 L/min per m²
(lower limit of normal) and fails to increase normally with
exertion. (presents with evidence of systemic vasoconstriction
such as cold , paler , or cyanotic extremities. Pulse pressure is
low)seen after MI , hypertension , dilated cardiomyopathy .
• High output HF: cardiac output > 3.5 L/min per m² or upper
limit of normal (before development of HF). Seen in
thyrotoxicosis, pregnancy , anemia , Paget's disease , beriberi
and ateriovenous fistulas ,with underlying heart disease .
 Forward Failure : inadequate cardiac output that
leads to diminished perfusion of vital organs
leading to ischemia , brain mental confusion
,skeletal muscles weakness , kidneys sodium and
water retention.
 Backward failure : due to damming of blood into

venous system such as lung congestion in LVF and
congestion of liver , spleen and other areas in RVF
Clinical feature of heart failure
Symptoms of heart failure are :

• Exertional dyspnea
• Orthopnoea
• Paroxysmal nocturnal dyspnea
• Acute pulmonary edema
• Abdominal symptoms
• Fatigue
Signs of heart failure are :
• Cardiomegaly
• Third and fourth heart sounds
• Elevated JVP
• Tachycardia
• Hypotension
• Bi-basal crackles
• Pleural effusion
• Peripheral ankle oedema
• Ascites
• Tender hepatomegaly
Framingham criteria for diagnosis of heart failure
Major criteria
• Paroxysmal nocturnal dyspnea
• Crepitation
• S₃ gallop
• Cardiomegaly (cardiothoracic ratio >50% on chest
radiography)
• Weight loss > 4,5kg in 5 days in response to treatment
• Increased central venous pressure (>16cmH₂o at right atrium)
• Neck distention
• Acute pulmonary oedema
• Hepatojugular reflex
Minor criteria
• Bilateral ankle oedema
• Dyspnoea on ordinary exertion
• Nocturnal cough
• Hepatomegaly
• Pleural effusion
• Tachycardia (heart rate ≥ 120/min)
• Decrease in vital capacity by ⅓ from maximum recorded.
• Diagnosis of CCF requires the simultaneous presence of at least 2

major criteria or 1 major criterion in conjunction with 2 minor
criteria.
New York Heart Association (NYHA) Functional
Classification of severity heart failure
Class I Heart disease present, but no undue dyspnoea from

ordinary activity.
Class II Comfortable at rest; dyspnoea on ordinary activities.
Class III Less than ordinary activity causes dyspnoea, which is

limiting.
Class IV Dyspnoea present at rest; all activity causes discomfort.

American College of cardiology (ACC)/ American Heart
Association(AHA) classification of heart failure by structural
abnormality
Stage A AT high risk if developing heart failure. No identified
structural or functional abnormality: no signs or
symptoms.
Stage B Developed structural heart disease that is strongly

associated with the Development of heart failure but
without signs and symptoms.
Stage C Symptomatic heart failure associated with underlying

structural heart disease.
Stage D Advanced structural heart disease and marked

symptoms of heart failure at rest despite maximal
medical therapy (refractory HF) .
Differential diagnosis
 pulmonary disease with dyspnea
 COPD
 Diffuse parenchymal lung disease
 Pulmonary vascular occlusive disease
 Disease of chest wall and respiratory muscles
Pericardial disease .
Liver disease.
Nephrotic syndrome
Protein losing enteropathy.
Investigations
• ECG
• Chest X-ray.
- cardiomegaly
- pleural effusion
- Bat’s wings appearance.
- Pneumonia
• Echo
• Cardiac biomarker
• RF test
• CBC
• Blood sugar
• Lipid profile.
• Serum Electrolyte
• B-type natriuretic peptide (BNP) > 400 pg/ml
• Thyroid function test
X-Ray in Left ventricular failure
Management
• Monitor fluid balance, daily weight (aim to lose 0.5–1 kg
daily), and daily urea and electrolytes.
• No-added-salt diet.
• Diuretics
• Angiotensin-converting enzyme (ACE) inhibitor,angiotensin II
receptor blocker can be used if ACE inhibitor not tolerated.
• Beta-blocker, eg bisoprolol, carvedilol or nebivolol, in patients
with stable NYHA II–IV symptoms. Only start when clinically
stable and euvolaemic.
• Spironolactone in patients with NYHA III–IV.
• Consider anticoagulation (AF and LV thrombus).
Complications
• AF.
• Ventricular tachycardia.
.
• Sudden death.
• Progressive heart failure.
• Renal impairment
Goals of treatment
• To improve symptoms and quality of life.
• To decrease likelihood of disease progression.
• To reduce the risk of death and need for
hospitalization
Thank you
Questions!!!!
End

Heart Failure: DR Kaem Shir Ali

Uploaded by

Copyright:

Available Formats

Heart Failure: DR Kaem Shir Ali

Uploaded by

Document Information

Original Title

Copyright

Available Formats

Share this document

Share or Embed Document

Sharing Options

Did you find this document useful?

Is this content inappropriate?

Copyright:

Available Formats

Heart Failure: DR Kaem Shir Ali

Uploaded by

Copyright:

Available Formats

HEART FAILURE

• Heart failure: A complex syndrome resulting from any

• It is commonly termed congestive heart failure (CHF)

• It is a common end point for many diseases of

• There are approximately 400,000 new cases noted each year.

• About 40,000 Americans die from heart failure every year.

• The incidence increases to 10 in every 1000 after the age of

• Risk of death is 5-10% annually in patients with mine

• Myocardial ischemia or infarction.

 Diastolic failure :inability of the ventricle to relax and ﬁll normally,

 Acute failure : sudden onset of symptoms, usually following an acute

 Left side failure : left ventricle is hemodynamically overloaded

 Right side failure : abnormality primarily affecting right ventricle

 Backward failure : due to damming of blood into

Symptoms of heart failure are :

• Diagnosis of CCF requires the simultaneous presence of at least 2

Class I Heart disease present, but no undue dyspnoea from

Class II Comfortable at rest; dyspnoea on ordinary activities.

Class III Less than ordinary activity causes dyspnoea, which is

Class IV Dyspnoea present at rest; all activity causes discomfort.

Stage B Developed structural heart disease that is strongly

Stage C Symptomatic heart failure associated with underlying

Stage D Advanced structural heart disease and marked

You might also like

Pfad - The Proxy pFad of © 2024 Garber Painting. All rights reserved.

• There are approximately 400,000 new cases noted each year.

• About 40,000 Americans die from heart failure every year.

• The incidence increases to 10 in every 1000 after the age of