Heart Failure presentation with all the basic information of the disease.

1. Heart FailurePRESENTATION BY MRMWSK

2. OBJECTIVES
• Increase awareness of heart failure
• Define the aetiology of heart failure
• Address unmet needs that deserve to be investigate heart failure
• Discuss the management of heart failure
• Establish a multidisciplinary approach for the treatment of heart
failure
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3. HEART FAILURE
▪ Heart failure can be defined as an abnormality of cardiac structure or function
leading to failure of the heart to deliver oxygenated blood at a adequate rate with
the requirements of the metabolizing tissues, even with normal filling pressures
(or only at the outflow of increased filling pressures).
▪ TERMINOLOGY used to describe Heart Failure types:
▪ Related to EF: HFrEF (reduced ejection fraction: EF<40%)
HFmEF (mildly impaired ejection fraction: EF 40%-49%)
HFpEF (preserved ejection fraction: EF ≥50%)
▪ Related to time-course: New onset, transient, chronic
▪ Related to progression: Acute, stable, worsening
▪ Related to location: Left heart, right heart, combined
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4. STAGES OF HEART FAILURE
Based On Structure And Damage To Heart
Stage A At high risk for HF, but without structural or functional abnormality
No signs or symptoms
Stage B Developed structural heart disease strongly associated with
development of HF, but without signs or symptoms
Stage C Symptomatic HF associated with underlying structural heart
disease
Stage D Advanced structural heart disease and marked symptoms of HF at
rest, despite maximal medical therapy
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5. FUNCTIONAL CLASSIFICATION OF HEART FAILURE
Based On Symptoms Or Physical Activity
Class I No limitation of physical activity. Ordinary physical activity does not cause
undue fatigue, palpitation or dyspnoea
Class II Slight limitation of physical activity. Comfortable at rest, but ordinary
physical activity results in HF symptoms
Class III Marked limitation of physical activity. Comfortable at rest, but less than
ordinary activity results in HF symptoms
Class IV Symptoms of HF present at rest. If any physical activity is undertaken,
discomfort is increased
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6. AETIOLOGY OF HEART FAILURE
HEART
FAILURE
VALVULAR HEART DISEASE
• Mitral
• Aortic
• Trisuspid
• Pulmonary
MYOCARDIAL DISEASE
• Coronary artery disease
• Hypertension
• Cardiomyopathy
ENDOCARDIAL DISEASE
• With/without hypereosinophilia
• Endocardial fibroelastosis
PERICARDIAL DISEASE
• Constrictive pericarditis
• Pericardial effusion
HIGH OUTPUT STATES
• Anaemia
• Sepsis
• Thyrotoxicosis
• Paget‘s disease
• Arteriovenous fistula
ARRHYTHMIA
• Tachyarrhythmia
• Atrial
• Ventricular
• Bradyarrhythmia
• Sinus node dysfunction
CONDUCTION DISORDERS
• Atrioventricular block
VOLUME OVERLOAD
• Renal failure
• Iatrogenic (e.g. post-
operative fluid infusion
CONGENITAL
HEART DISEASE
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7. PATHOPHYSIOLOGY OF HEART FAILURE
ELECTRICAL
INSTABILITY
REDUCTION of EF
Injury to
myocytes due
to myocardial
infarction or
other cause
NEUROHUMORAL
IMBALANCE
VENTRICULAR
REMODELING
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8. SIGN & SYMPTOMS OF HEART FAILURE
The diagnosis of HF can be difficult, especially in the early stages
Symptoms Signs
Typical More specific
Breathlessness Elevated jugular venous pressure
Orthopnoea Hepatojugular reflux
Paroxysmal nocturnal dyspnoea Third heart sound (gallop rhythm)
Reduced exercise tolerance Laterally displaced apical impulse
Fatigue, tiredness, increased time to
recover after exercise
Cardiac murmur
Ankle swelling 8

9. COMORBIDITIES IN HEART FAILURE
COPD
Gout
Hyperlipidaemia
Iron deficiency
Renal
dysfunction
Diabetes mellitus
Anaemia
Cachexia
Obesity
Comorbidities in
patients with HF
Hypertension
Angina
Depression
Sleep disturbance
Cancer
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10. TREATMENT OF HEART FAILURE
Therapy goals
Treat hypertension
Encourage smoking cessation
Treat lipid disorders
Encourage regular exercise
Discourage alcohol intake,
illicit drug use
Control metabolic syndrome
Drugs
ACEIs or ARBs in appropriate
patients for vascular disease
or diabetes
STAGE A
At high risk for HF, but
without structural heart
disease or
symptoms of HF
Structuralheartdisease
STAGE B
Structural heart disease,
but without signs or
symptoms or HF
Therapy goals
All measures under
Stage A
Drugs
ACEIs or ARBs in
appropriate
patients
β-blockers in appropriate
patients
Devices in selected
patients
Implantable defibrillators
STAGE C
Structural heart disease
with prior or current
symptoms of HF
DevelopmentofsymptomsofHF
Therapy goals
All measures under Stages A&B
Dietary salt restriction
Drugs for routine use
Diuretics for fluid retention
ACEIs
β-blockers
Drugs in selected patients
Aldosterone antagonists
ARBs
Digitalis
Hydralazine/nitrates
Devices in selected patients
Biventricular pacing
Implantable defibrillators
RefractorysymptomsofHFatrest
STAGE D
Refractory HF requiring
specialized interventions
Therapy goals
Appropriate measures under
Stages A, B, C
Decision re: appropriate level
of care
Options
Compassionate end-of-life
care/hospice
Extraordinary measures
Heart transplant
Chronic inotropes
Permanent mechanical
support
Experimental surgery or drugs10

11. THANK YOU
IN THIS COMPULSORY LIFE HARDWORKING
IS MANDATORY TO GET FULL MARKS OF
SUCCESS
#QuoteByMrMWSK