3. From a hemodynamic perspective, HF is a disorder in which the
heart cannot pump blood to the body at a rate commensurate
with its needs, or can do so only at the cost of high filling
pressures
1
4. Definition
. HF is a complex clinical syndrome identified by presence of
current or prior characteristic symptoms, such as dyspnea and
fatigue with evidence of cardiac dysfunction as a cause of these
symptoms
abnormal left ventricular [LV] and/or right ventricular [RV] filling
and elevated filling pressures
4
5. The classification system that is most commonly used to quantify
the degree of functional limitation imposed by HF is one first
developed by the NYHA. This system assigns patients to one of
four functional classes, depending on the degree of effort needed
to elicit symptoms
5
Class I – Patients with heart disease
without resulting limitation of physical
activity. Ordinary physical activity does
not cause HF symptoms such as
fatigue or dyspnea
Class II – Patients with heart
disease resulting in slight
limitation of physical activity.
Symptoms of HF develop with
ordinary activity but there are no
symptoms at rest.
Class III – Patients with heart disease resulting
in marked limitation of physical activity.
Symptoms of HF develop with less than
ordinary physical activity but there are no
symptoms at rest.
Class IV – Patients with
heart disease resulting in
inability to carry on any
physical activity without
discomfort. Symptoms of
HF may occur even at rest.
6. 6
Stage A – At high risk
for HF but without
structural heart disease
or symptoms of HF.
Stage B – Structural
heart disease but
without signs or
symptoms of HF
Stage C – Structural heart
disease with prior or
current symptoms of HF
Stage D – Refractory HF
requiring specialized
interventions
7. ⬥ Heart failure with reduced
ejection fraction — HF with
reduced EF (HFrEF; LVEF ≤40
percent) is also known as
systolic HF or HF due to
systolic dysfunction.
.
Etiology
⬥ Heart failure with
preserved ejection fraction —
HFpEF is also known as
diastolic HF and refers to HF in
patients with an LVEF ≥50
percent or >50 percent [2].
7
9. Heart failure with preserved ejection fraction
⬥ HFpEF is characterized by a normal LVEF, normal LV end-diastolic
volume, and abnormal diastolic function, often with LV concentric
remodeling or hypertrophy, but sometimes with normal ventricular
geometry
9
10. 10
Diastolic dysfunction versus HFpEF —
Diastolic dysfunction and HFpEF are not synonymous terms !
Diastolic dysfunction indicates a functional abnormality of diastolic
relaxation, filling, or distensibility of the LV, regardless of whether the
LVEF is normal or abnormal and whether the patient is symptomatic or
not.
Thus, diastolic dysfunction refers to abnormal mechanical properties of
the ventricle.
HFpEF denotes the signs and symptoms of clinical HF in a patient with a
normal LVEF and LV diastolic dysfunction
11. Studies have shown that there is a third
group of patients with mid-range or
mildly reduced LVEF (HFmrEF; 41 to 49
percent) that seem to share features of
both HFrEF and HFpEF
Bring the attention of your
audience over a key concept
using icons or illustrations
11
12. Chamber remodeling
⬥ Patients with HFpEF often exhibit a
concentric pattern of LV remodeling and a
hypertrophic process that is characterized by
the following features
⬥ ●A normal or near-normal end-diastolic
volume.
⬥ ●Increased wall thickness and/or LV
mass.
⬥ ●An increased ratio of myocardial mass
to cavity volume.
⬥ ●An increased relative wall thickness
(RWT).
⬥ patients with HFrEF
typically exhibit a pattern
of eccentric remodeling
with:
⬥ an increase in end-
diastolic volume
⬥ an increase in LV mass
but little increase in wall
thickness
⬥ and a substantial
decrease in the ratio of
mass to volume and
thickness to radius. 12
16. 8 per 1000
at age 50 to 59 years
The prevalence in African-American populations is reported to be 25
percent higher than in White populations.
Prevalence
66 per 1000
at ages 80 to 89 years
16
17. average survival hospitalization for a first episode of HF
the median survival was 2.3 years in men and 1.7
years in women
17
HFpEF appears to be associated with a better prognosis than HF due to systolic
dysfunction (annual mortality 8 to 9 versus 19 percent) in some reports
18. Drugs that should be avoided or used with caution in patients
with heart failure
18
Calcium channel
blockers
Some initial studies suggested
a possible deleterious effect of
calcium channel blockers in
patients with HF with reduced
ejection fraction (HFrEF),
Nonsteroidal anti-inflammatory drugs
is associated with
increased risk of
first occurrence or
exacerbation of HF
Aspirin
While patients with HF and
vascular disease may have
indications for aspirin use, the
risks and benefits of aspirin in
patients with HF but without
other indications are not well
established.
.
19. Drugs that should be avoided or used with caution in patients
with heart failure
19
Oral hypoglycemic
agents
Thiazolidinediones cause fluid
retention, which may
precipitate HF.
Patients with HF who
take metformin are at
increased risk of potentially
lethal lactic acidosis
Drugs that may cause
hyperkalemia
Patients with HFrEF are
treated with drugs that raise
serum potassium levels
potassium sparing diuretics
such
as amiloride and triamterene s
hould generally be avoided.
Antidepressants
cardiovascular side
effects (particularly
palpitations) are
common among
patients taking
TCAs.
20. Drugs that should be avoided or used with caution in patients
with heart failure
20
Natural" remedies and
supplements
ephedra (also called Ma
huang) is a plant source
of ephedrine that is contained
in some products promoted
for athletic performance
enhancement or weight loss.
Case reports suggest that
ephedra may cause HF and
left ventricular systolic
dysfunction
PDE-3 inhibitors
In patients with HFrEF, the chronic use of
oral PDE-3 inhibitors for inotropic therapy
was associated with increased mortality
Eg : Cilostazol : for the treatment of
intermittent claudication
Anagrelide is a PDE-3 inhibitor used in the
treatment of proliferative hematologic
disorders
PDE-5 inhibitors
These drugs are vasodilators
that can lower pulmonary and
systemic arterial pressure. the
use of PDE-5 inhibitors with
any form of nitrate therapy
(regular or intermittent) is
contraindicated
21. Drugs that should be avoided or used with caution in patients
with heart failure
21
TNF-alpha inhibitors
Tumor necrosis
factor-alpha
inhibitors may be
associated with new
onset or worsening
of pre-existing HF.
Antihistamines
Long QT syndrome has
been reported with some
second generation
antihistamines
Theophylline
During acute decompensation
of HF, theophylline serum
levels may increase, causing
toxicity. Tachycardia and atrial
arrhythmias may occur at
serum concentrations
considered therapeutic,
particularly among patients
with heart disease
28. CREDITS
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28
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31. TIMELINE
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Blue is the colour of
the clear sky and the
deep sea
Red is the colour of
danger and courage
Black is the color of
ebony and of outer
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Yellow is the color of
gold, butter and ripe
lemons
White is the color of
milk and fresh snow
Blue is the colour of
the clear sky and the
deep sea
Yellow is the color of
gold, butter and ripe
lemons
White is the color of
milk and fresh snow
Blue is the colour of
the clear sky and the
deep sea
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danger and courage
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1 3 5
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Blue is the colour of the
clear sky and the deep
sea
Red is the colour of
danger and courage
Black is the color of
ebony and of outer
space
Yellow is the color of
gold, butter and ripe
lemons
White is the color of milk
and fresh snow
Blue is the colour of the
clear sky and the deep
sea
34. BUSINESS MODEL CANVAS
34
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36. TEAM PRESENTATION
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Imani Jackson
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Blue is the colour of the
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Marcos Galán
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Blue is the colour of the
clear sky and the deep sea
Ixchel Valdía
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Blue is the colour of the
clear sky and the deep sea
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Blue is the colour of the
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