Basics of Heart Failure

1. D R S R A V A N K U M A R G
A S S I S T A N T P R O F E S S O R
M R I M S
Heart Failure

3.  Coronary arteries - epicardium

4. Rotation of heart
 base rotates clockwise during systole
 apex rotates counterclockwise
 Subepicardial fibers wrapped around the left
ventricle (LV) in a left-handed helix
 Subendocardial fibers wrapped around the LV in a
right-handed helix.
 EF – Circumferential fibres – HFr EF
 Tissue Doppler – Longitudinal fibres - HFpEF

5. ECHO
 Anterior Structure – TTE
 Posterior Structure - TEE

6.  Heart failure (HF) is a complex clinical syndrome
resulting from structural and functional impairment
of ventricular filling or ejection of blood

7. Pressures in chambers
<7 <12
<25/7 <120/12
MPA 25/12 Aorta 120/80

8. Saturation in chambers

9. Symptoms Associated with HF
 Fatigue
 Shortness of breath at rest or during exercise
 Tachypnea
 Cough
 Diminished exercise capacity
 Orthopnea
 Paroxysmal nocturnal dyspnea
 Nocturia
 Weight gain/weight loss
 Edema (of extremities, scrotum, or elsewhere)
 Increasing abdominal girth or bloating
 Abdominal pain (particularly if confined to right upper quadrant)
 Loss of appetite or early satiety
 Cheyne-Stokes respirations (often reported by family rather than patient)
 Somnolence or diminished mental acuity

10. Physical Findings of Heart Failure
 Tachycardia
 Extra beats or irregular rhythm
 Narrow pulse pressure or thready pulse*
 Pulses alternans*
 Tachypnea
 Cool and/or mottled extremities*
 Elevated jugular venous pressure
 Dullness and diminished breath sounds at one or both lung bases
 Rales, rhonchi, and/or wheezes
 Apical impulse displaced leftward and/or inferiorly
 Sustained apical impulse
 Parasternal lift
 Third and/or fourth heart sound (either palpable and/or audible)
 Tricuspid or mitral regurgitant murmur
 Hepatomegaly (often accompanied by right upper quadrant discomfort)
 Ascites
 Presacral edema
 Anasarca*
 Pedal edema
 Chronic venous stasis changes

11. Drugs
 Cancer chemotherapy
 Diabetes drugs (e.g., thiazolidinediones)
 Clozapine
 Pseudoephedrine
 Hydroxychloroquine
 NSAIDs

12.  Pleural effusion if unilateral – Right Sided

14. Chest X ray
 Normal LA Pressure < 12 mm hg
 Cephalisation (13 to 18)
 Kerley lines (18 to 25)
 Pulmonary edema (> 25)

15. Cephalisation – increased perfusion to upper
lobes (Antler sign) 13-18 mm hg

16. Kerley lines (18 to 25 mm hg)
 Kerley's A lines - linear opacities extending from the
periphery to the hila, distention of anastomotic
channels between peripheral and central lymphatics
 Kerley's B lines (LA Pressure > 20 mm hg) -short
horizontal lines situated perpendicularly to the
pleural surface at the lung base, edema of the
interlobular septa
 Kerley's C lines - reticular opacities at the lung base,
representing Kerley's B lines en face.

18. pulmonary edema - “butterfly” pattern (> 25 mm
hg)

19. Prominent horizontal fissure

20.  Heart failure
 BNP ≥100 pg/mL
 NT-pro BNP ≥900 pg/mL
 Exclude heart failure
 BNP < 50 pg/mL
 NT-proBNP <300 pg/mL