HEART FAILURE“pump failure”

DEFINITION

Heart failure is the inability of the heart to supply adequate blood flow and therefore oxygen delivery to the peripheral tissues and organs

EPIDEMIOLOGY Only cardiovascular disease with

increasing incidence and prevalance

due to Aging population Increased survival after MI--thrombolysis Improvement of medical and surgical

treatment

PATHOPYSIOLOGY Heart is a pump which works with the

lungs. It pumps blood from the heart to the lungs

to pick up oxygen. The oxygenated blood returns to the heart It then pumps blood out into the circulatory

system

CLASSIFICATION OF HEART FAILUREThis is based on:How rapid symptoms develop---acute HF ---chronic HFWhich ventricle is involved---right side HF ---left side HFOver all cardiac output---systolic HF ---diastolic HF

CLASSIFICATION ACCORDING TO ONSET OF SYMPTOMS:

Acute heart failure--characterized by a rapid onset of heart failure that may

occur following 1- MI 2-myocarditis 3-arrythmias 4- infection 5- PEIf it is not fatal may progress to chronic heart failure

Chronic heart failureThis results from the heart undergoing

adaptive responses to precipitating cause and this cardiac response leads to impaired function.

1- anemia2-thyrotoxicosis3-non compliance to medications4- diet—high salt

CLASSIFICATION ACCORDING TO OVER ALL CARDIAC OUTPUT

Systolic heart failure

The ventricle loses its ability to contract so the heart is unable to pump forcefully enough to get blood into the circulation.

Diastolic heart failure

The ventricle loses its ability to relax , the muscle are stiff so the heart is unable to fill with blood during resting cycle

CLASSIFICATION ACCORDING TO VENTRICLE INVOLVED

Left side heart failure This involves the left atrium, left ventricle,mitral

and aortic valve Patient presents with --- dyspnoe,orthopnoe and PND --- basal crepitations --- 3rd heart sound--gallop

Right side heart failure

This involves the right atrium, the right ventricle , the tricuspid and the pulmonary valve.

Patient usually does not present with dyspnoe , orhtopnoe or PND

Raised JVP Clear lung field Ascites Lower limb edema

ETIOLOGY Myocardial infarction Coronary artery disease Valvular heart disease Idiopathic cardiomyopathy Viral or bacterial cardiomyopathy myocarditis

ETIOLOGY cont. Pericarditis Arryhthmias Hypertension Thyroid disease Pregnancy Septic shock

ETIOLOGY cont. Toxins—anthracyclines

amphetamine

cocaine Metabolic---haemachromatosis

wilson,s disease

pheochromocytoma

SYMPTOMS

NYHA classification of dyspnoe Class 1—no shortness of breath {SOB} Class 11—SOB on severe exertion Class 111—SOB on mild exertion Class 1v---SOB at rest

SYMPTOMS cont.{ FACES} Fatigue Activity decrease Cough { specially supine,frothy red sputum Edema Shortness of breath { NYHA }

SIGNS Non productive cough Diffuse laterally displaced apex beat Raised JVP Hepatojugular reflex Hepatomegaly Resting tachycardia

Oliguria Crepitations Pleural effusion Pulses alternans { severe cases} S3 gallop Unexplained weight gain Ankle swelling Ascites

INVESTIGATION CBC U+E LFT Cardiac enzymes CXR ECG Echocardiogram

TREATMENT Diuretics Digoxin ACE inhibitors Vasodilators