Simple diagrammatic representation for all levels of Medical education

1. HEART
FAILURE
Dr. Shinjan Patra
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Heart Failure
• Also called pump failure
• It describes the clinical syndrome that
develops when the heart can’t maintain an
adequate Cardiac output, or can do so
only at the expense of an elevated filling
pressure.

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Etiology
1.Depressed Ejection Fraction(<40%)
 Coronary artery diseases
 Chronic pressure overload
 Chronic volume overload
 Dilated cardiomyopathy
 Toxin induced damage
Arrhythmia’s

4. Etiology
2. Preserved Ejection Fraction(>40%)
 Pathologic hypertrophy
 Restrictive cardiomyopathy
 Aging
 Fibrosis
 High output states(metabolic disorders,
chronic anaemia etc)
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5. Pathophysiology &
complications
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9. Effect
Adapted from Forrester, Am J Med 1978
Nohria et al. JACC 2003; 41:1797-804
Dry and Warm
Dry and Cold
Wet and Warm
Wet and Cold
Increasing Congestion / PCWP
Increasing
Perfusion/
Cardiac Output
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Classification
• Left/right/biventricular
• Diastolic/systolic
• Acute/chronic

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Left- Sided Heart Failure
Tissue hypoxia occurs because heart is unable
to efficiently pump blood along with pulmonary
congestion.
CLINICAL features of pulmonary congestion:
Dyspnea Orthopnea & PND
Basal crepitations
Pleural effusions

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Left-Sided Heart Failure
• Improper perfusion leads to
– Weakness
– Fatigue
– Dizziness
– Confusion
– Oliguria & renal failure
– Abdominal pain & fullness
– Death

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Right-Sided Heart Failure
• Manifestations include:
– Distended neck veins
– Hepatomegaly (liver engorgement)
– Hepatojugular reflux
– Ascites
– Dependent edema
– Weight: the most reliable indicator of fluid gain
or loss

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Investigations
• Laboratory assessment-
CBC,electrolytes,BUN,S/U/Cr.
• DM, dyslipidemia, thyroid status
assessment
• ECG(assess LV status & prior MI)
• Chest X-ray
• Echocardiography
• Biomarkers(BNP & N-terminal pro-BNP
BNP >100 pg/ml suggests heart failure)

19. Treatment Strategies
• Treatment of symptoms
• Treatment of etiology/precipitating factors
• Improvement of Pumping action of heart
• Preventing remodeling of Heart
• Improvement of life style
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20. Symptoms correction
• Propped up position
• Moist O2 inhalation
• Rest
• Diuretics
• Vasodilators(NTG,nitroprusside,Nesiritide)
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22. Improving Pumping Action
• Inotropic
agents(digitalis,dobutamine,Milrinone)
• Vasoconstrictors(dopamine,epinephrine)
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24. Preventing Myocardial
Remodeling
• ACE inhibitors/ARB’s
• B-blockers
• Aldosterone antagonists
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30. Thank you
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