4. Introdution to Heart Failure..
Epidemiology of Heart Failure
Etiology of Heart Failure
Pathophysiology of Heart Failure.
Physiology of Hear Failure.
Classification of Heart Failure.
Sign & symptoms of Heart Failure.
Physical Examination.
Lab Analysis.
Non Pharamacological therapy .
Pharmacological Therapy.
Goals of Management.
General Life Style Advice.
4
5. In medical terms heart failure is defined as the
condition when heart is unable to pump enough
blood required for normal body functions.
Human body needs sufficient amount of oxygen which
is supplied by heart through blood. Heart failure is a
serious condition and needs immediate medical care.
5
6. Epidemiology
The incidence: 1 in 1000 population per year;
increasing by about 10% every year. In >85y
incidence is 10 cases per 1000.
The prevalence ranges from 3-20 cases per 1000
population, increasing to at least 80 cases per
1000 in people aged 75 years and over.
The male to female ratio is about 2:1.
The median age of presentation is 76 years.
6
7. Etiology
INTRINSIC PUMP FAILURE :
The important cause of heart failure is the weakening of ventricular
muscle due to disease so that the heart fails to act as an efficient
pump
Ischaemic heart disease (35-40%)
Cardiomyopathy (dilated) (30-34%)
INCREASED WORKLOAD ON THE HEART : It is due to either increased
pressure load or volume load
Increased pressure load
Hypertension
Chronic lung disease
Increased volume load
Severe anaemia
Hypoxia due to lung disease
IMPAIRED FILLING OF CARDIAC CHAMBERS:Cardiac failure may also result
from defects in filling of heart 7
8. PATHOPHISIOLOGY
Heart failure is associated with complex
neurohormonal changes including activation
of the renin angiotensin aldosterone system
and the sympathetic nervous system
8
9. Results from any structural or functional
abnormality that impairs the ability of the
ventricle to eject blood (Systolic Heart Failure) or
to fill with blood (Diastolic Heart Failure).
9
11. Stage A – High risk of HF, without structural heart
disease or symptoms
Stage B – Heart disease with asymptomatic left
ventricular dysfunction
Stage C – Prior or current symptoms of HF
Stage D – Advanced heart disease and severely
symptomatic or refractory HF
11
12. decreased cardiac output
Decreased Left ventricular ejection
fraction
Elevated Left and Right ventricular end-
diastolic pressures
May have normal LVEF
12
13. Seen with peripheral shunting, low-
systemic vascular resistance,
hyperthryoidism, beri-beri, carcinoid,
anemia
Often have normal cardiac output
Seen with pulmonary hypertension,
large RV infarctions.
13
17. Difficulty in breathing particularly on exertion such as
climbing stairs, walking and doing housework.
Legs, ankles and abdomen get swollen due to the
accumulation of water
A lethargic and weak feeling
17
18. Difficulty in sleeping
A feeling of breathlessness when lying down (lungs
get congested on lying down because of the back
damming effect). This condition is medically termed
as pulmonary edema. This condition is inevitable
since the patient can get collapsed anytime.
18
19. S3 gallop
Low sensitivity, but highly specific
Cool, pale, cyanotic extremities
Crackles or decreased breath sounds at bases (effusions) on lung
exam
Elevated jugular venous pressure
Lower extremity edema
Ascites
Hepatomegaly
Splenomegaly.
19
22. CBC
Since anemia can exacerbate heart failure
Serum electrolytes and creatinine
before starting high dose diuretics
Fasting Blood glucose
To evaluate for possible diabetes mellitus
Thyroid function tests
Since thyrotoxicosis can result in A. Fib,
and hypothyroidism can results in HF.
Iron studies
To screen for hereditary hemochromatosis as cause of
22
23. NON-PHARMACOLOGICAL
TREATMENT:
Revascularization
Biventricular pacemaker
Cardiac transplantation
Nutritional therapy
Diet/weight reduction recommendations-individualized
and culturally sensitive
Dietary Approaches to Stop Hypertension (DASH) diet
recommended
Sodium- usually restricted to 2.5 g per day
Potassium encouraged unless on K sparing diuretics
(Aldactone)
23
27. Decrease the body’s retention of salt and water
Reduces blood pressure
Probably will be on potassium
27
28. Improve survival in patients with all severities of
heart failure.
Begin therapy low and titrate up as possible:
Enalapril – 2.5 mg
Captopril – 6.25 mg
Lisinopril – 5 mg
28
29. Prevent the production of the chemicals that causes
blood vessels to narrow
Resulting in blood pressure decreasing and the
heart pumping easier
29
34. Certain Beta blockers (carvedilol, metoprolol,
bisoprolol) can improve overall and event free class
II to III HF, probably in class IV.
Contraindicated:
Heart rate <60 bpm
Symptomatic bradycardia
COPD, asthma
34
35. Mechanism of Action:
Useful by blocking the beta-adrengergic receptors of
the sympathetic nervous system, the heart rate and
force of contractility are decreased could actually
worsen CHF
35
41. NSAIDS
Can cause worsening of preexisting HF
Thiazolidinediones
Include rosiglitazone (Avandia), and pioglitazone (Actos)
Cause fluid retention that can exacerbate HF
Metformin
People with HF who take it are at increased risk of
potentially lethic lactic acidosis
41
47. Some examples of aerobic exercises are walking,
jogging, running, aerobic dancing, cycling,
stepping, cross country skiing, swimming, arm
cycle ergometry, etc.
47
49.
can be done with use of dumbbells, cuff and hand
weights, elastic bands, barbells, hand held blades,
Pilates table, punching bags, inflated balls,
stability balls, variable resistance exercise
machines ( BTE, cybex) etc.
49
52. regular aerobic physical activity, preferably at. least 2 to 3 times per
week for approximately 1 hour, while carefully keeping a regular heart
rate of 70% to 85% of the theoretic age-related maximum rate.
The American Heart Association recommends "Specifically, we
recommend a total of 30 minutes of moderate-intensity activities on
most days of the week and a minimum of 30 minutes of vigorous
physical activity at least 3 to 4 days each week to achieve
cardiovascular fitness."
52
53. General lifestyle advice
Education:Effective counselling of patients and family
emphasizing weight monitoring and dose adjustment of diuretics
may prevent hospitalization.
Obesity control:Maintain desired weight and body mass index.
Smoking: Smoking should be stopped, with help from anti-smoking
clinicsif
necessary.
Physical activity, exercise training and rehabilitation
Dietary modification: Large meals should be avoided and if
necessary weight reduction instituted. Salt restriction is necessary
and foods rich in salt or added salt in cooking and at the table
should be avoided.
53
54. y
Reducethe number
of sackson the
wagon
Limit the speed, thus
saving energy
Likethe carrot placed
in front
Inotrops
Increase the
efficiency
Vasodilators
blockers
Diuretics, ACEinhibitors
54
55. An imbalance in pump function in which the heart
fails to maintain the circulation of blood
adequately.
Diagnosis: ETT, Echo- cardiogram, Cardiac-
imaging, Angiography, Blood tests. Differential
diagnosis.
Treatment: Pharmacological (Nitrates, beta
blockers, calcium channels blockers.), Combination
therapy.
Non pharmacological treatment: Improving and
managing risk factors , surgery .
55
