Heart Failure Dima Lotfie13901022

• Heart failure is the pathophysiological state in which the heart fails to provide sufficient cardiac output to satisfy the metabolic needs of the body.

• Main causes include:1- Coronary artery disease 2- Hypertension 3- Valvular heart disease 4- Cardiomyopathy 5- Cor Pulmonale

Clinical classification • According to the course of disease:- Acute HF- Chronic HF• According to location:- Left side heart failure - Right side heart failure - Biventricular heart failure • According to function impaired:- Systolic failure - Diastolic failure

Systolic Diastolic

More prominent in men More prominent in women

Any age, typically 50-70 years Elderly

Depressed left ventricular EF (40% or lower)

Preserved or normal left ventricular EF (40% or higher)

Usually from coronary disease Due to LVH and chronic replacement by fibrous tissue.

Then/weak heart wall Thick/stiff heart wall

• Systolic heart failure (pumping problem): inability of the heart to contract enough to provide blood flow forwards

• Diastolic heart failure (filling problem): inability of the left ventricle to relax normally, resulting in fluid backing up into the lungs.

Systolic vs. diastolic

Symptoms: FACES• F: fatigue • A: activities limitation • C: chest congestion • E: edema • S: shortness of breath

On examination:

Systolic Diastolic

JVP distention Normal JVP

Peripheral edema Hypertension

S3 S4

Crackles Crackles

• The Framingham criteria for the diagnosis of heart failure consists of the concurrent presence of either 2 major criteria or 1 major and 2 minor criteria. • Major criteria include the following:- Paroxysmal nocturnal dyspnea- Weight loss of 4.5 kg in 5 days in response to treatment- Neck vein distention- Acute pulmonary edema- Hepatojugular reflux- S 3 gallop- Central venous pressure greater than 16 cm water- Circulation time of 25 seconds- Radiographic cardiomegaly- Pulmonary edema, visceral congestion, or cardiomegaly at autopsy.

• Minor criteria are as follows:- dry cough- Dyspnea on ordinary exertion- A decrease in vital capacity by one third the maximal value recorded- Pleural effusion- Tachycardia (rate of 120 bpm)- Bilateral ankle edema

Investigations • Complete blood count (CBC)• Urinalysis• Electrolyte levels• Renal and liver function studies• Fasting blood glucose levels• Lipid profile• Thyroid stimulating hormone (TSH) levels• B-type natriuretic peptide levels• N-terminal pro-B-type natriuretic peptide• Electrocardiography• Chest radiography

ECG• Systolic heart failure:- LBBB grade III - Old MI

• Diastolic heart failure:- Left ventricular hypertrophy