heart failure systolic heart failure

1. HEART
FAILURE
• DR. DUA QASIM
• DR. AYESHA JUMAN
• DR. FAISAL BHATTI

2. HEALTHY H VS HF

3. DEFINITION
A “complex clinical syndrome that
results from any structural or
functional impairment of
ventricular filling(diastole) or
ejection of blood (systole) ”.

4. TYPES OF HF
SYSTOLOLIC HEART FAILURE VS DIASTOLIC HEART
FAILURE
ACUTE HEART FAILURE VS CHRONIC HEART
FAILURE
LEFT SIDE HEART FAILURE VS RIGHT SIDE HEART
FAILURE AND BIVENTRICULAR FAILURE (CCF)
LOW OUTPUT VS HIGH OUTPUT FAILURE
FORWARD VS BACKWARD FAILURE

5. SYSTOLIC VS DIASTOLIC
DYSFUNCTIONS

6. MECHANISM OF HF

7. MECHANISM OF
SYSTOLIC HF

8. Table 4. Classification of HF by LVEF
8
Type of HF According to
LVEF
Criteria
HFrEF (HF with
reduced EF)
 LVEF ≤40%
HFimpEF (HF with
improved EF)
 Previous LVEF ≤40% and a follow-up measurement of
LVEF >40%
HFmrEF (HF with
mildly reduced EF)
 LVEF 41%–49%
 Evidence of spontaneous or provokable increased LV
filling pressures (e.g., elevated natriuretic peptide,
noninvasive and invasive hemodynamic measurement)
HFpEF (HF with
preserved EF)
 LVEF ≥50%
 Evidence of spontaneous or provokable increased LV
filling pressures (e.g., elevated natriuretic peptide,
noninvasive and invasive hemodynamic measurement)

9. CAUSES
MainCauses
Ischemic heart
disease (70-
80%)(most common)
Cardiomyopathy (Dilated) (30–34%)
Hypertension (15–20%)

10. 1: MYOCARDITIS
2: INFILTRATIVE DISEASE(HAEMOCHROMATOSIS
SARCOIDOSIS AMYLODOSIS)
3: INFECTIVE AGENT
4: METABOLIC DISORDER
5: VALVULAR HEART DISEASE
6: ATRIAL FIBRILLATION
7: ANEMIA THYTOXICOSIS

11. CAUSES

12. CLASSIFICATION
AHA STAGES AND NYHA FUNCTIONAL CLASSIFICATION

13. Table 3. Stages of
HF
13
Stages Definition and Criteria
Stage A: At Risk for HF At risk for HF but without symptoms,
structural heart disease, or cardiac
biomarkers of stretch or injury (e.g., patients
with hypertension, atherosclerotic CVD,
diabetes, metabolic syndrome and obesity,
exposure to cardiotoxic agents, genetic
variant for cardiomyopathy, or positive
family history of cardiomyopathy).

16. Figure 1.
ACC/AHA
Stages of
HF
16
The ACC/AHA
stages of HF are
shown.
ACC indicates
American College
of Cardiology;
AHA, American
Heart Association;
CVD,
cardiovascular
disease; GDMT,
guideline-
directed medical
therapy; and HF,
heart failure.

17. CLINICAL FEATURES
Symptoms:
Exertional dyspnea
Orthopnea
Paroxysmal nocturnal dyspnea
Fatigue.
Signs:
Cardiomegaly
3rd & 4th heart sounds
Elevated JVP
Tachycardia
Hypotension
Bi-basal crackles
Pleural effusion
Ankle edema
Ascites

18. CLINICAL
PRESENTATION

19. FRAMINGHAM
CLASSIFICATION
MAJOR CRITERIA MINOR CRITERIA
-Ankle edema
-Dyspnea on the exertion
-Hepatomegaly
-Nocturnal cough
-Pleural effusion
-Tachycardia (pulse > 120
beats per minute)
-Acute pulmonary edema
-Cardiomegaly
-Hepatojugular reflux
-Neck vein distention
-Paroxysmal nocturnal
-dyspnea/orthopnea

20. INVESTIGATIONS
Blood tests:
CBC
LFTs
Urea, Electrolytes
Cardiac enzymes in acute HF
BNP
Thyroid function
Chest X-ray: Look for
Cardiomegaly
Pulmonary congestion with upper lobe diversion
Kerley B lines
Pulmonary edema

21. ECG
• Look for ischemia
• Hypertrophy
• Arrhythmia
ECHOCARDIOGRAPHY
• Cardiac chamber dimension
• Systolic & diastolic function
• Regional wall motion
abnormalities
• Valvular Heart Disease
• Cardiomyopathies

22. FURTHER
INVESTIGATION
Single photon-emission CT (SPECT)/positron emission
tomography
CMR (cardiac MRI):
Assess viability of dysfunctional myocardium
Cardiac catheterization
Diagnose ischemic heart failure (& suitability for
revascularization)
Measurement of pulmonary artery pressure & Left ventricular
end-diastolic pressure

23. LIFESTYLE
MODIFICATION
Education
Explanation of nature of disease, treatment and self-help strategies
Diet
Good general nutrition and weight reduction for the obese
Avoidance of high-salt foods and added salt, especially for patients with severe congestive heart failure
Alcohol
Moderation or elimination of alcohol consumption. Alcohol- induced cardiomyopathy requires abstinence
Smoking
Cessation
Exercise
Regular moderate aerobic exercise within limits of symptoms
Vaccination
Consider influenza and pneumococcal vaccinatio

38. 4 aldosterone antagonists
Side effects:
1 Hyperkalemia
2 Gynaecomastia
3 Dry Mouth
4 Muscle Weakness
5 Confusion, Nausea, Vomiting
APLERENONE: Alternative to spironolectone in
painfull gynaecomastia.

47. JAZAKALLAH

48. “IF YOU WANT TO SHINE LIKE A
SUN, FIRST BURN LIKE A SUN!”
THANK YOU✨