Heart failure and its causes

1. Heart Failure
Khalid F AlHabib.MBBS.FRCPC
Cardiology Consultant
King Fahad Cardiac Centre
King Saud University
Saturday, May 11, 2024

2. Heart Failure: Outline
 Definition
 Causes
 Epidemiology
 Pathophysiology
 Clinical Assessment
 Management
 Prognosis

3. Heart Failure: Definition
 Complex syndrome in which abnormal
heart function results in, or increases the
subsequent risk of, clinical symptoms and
signs of low cardiac output &/or pulmonary
or systemic congestion.

4. CAUSES & FORMS

5. Systolic versus Diastolic HF

9. PREVALENCE & COST

10. The number of CHF patients will almost double
between the years 1990-2030, from these 3 million
cases of overt CHF to about 6 million.
Heart Failure: a major public health problem

11. Prevalence of HF
Increases with Age
US, 1988–1994
AHA. Heart Disease and Stroke Statistics—2004 Update
0
2
4
6
8
10
20–24 25–34 35–44 45–54 55–64 65–74 75+
Age (yr)
Population
(%)
Males
Females

12. Estimated Direct and Indirect Costs of HF in US
8%
8% 10%
7%
14%
53%
Hospitalization
$13.6
Lost Productivity/
Mortality*
$2.1
Home Healthcare
$2.1
Drugs/Other
Medical Durables
$2.7
Physicians/Other
Professionals
$1.8
Nursing Home
$3.5
*Lost future earnings of persons who will die in 2004, discounted by 3%
AHA. Heart Disease and Stroke Statistics—2004 Update
Total Cost
$25.8 billion

13. PATHOPHYSIOLOGY

20. CLINICAL EVALUATION

27. ACUTE VS. CHRONIC HEART FAILURE
FEATURE ACUTE HEART FAILURE
DECOMPENSATED CHRONIC HEART
FAILURE
CHRONIC HEART
FAILURE
Symptom severity Marked Marked Mild to moderate
Pulmonary edema Frequent Frequent Rare
Peripheral edema Rare Frequent Frequent
Weight gain None to mild Frequent Frequent
Whole-body fluid volume load No change or mild increase Moderate to marked increase Mild to marked increase
Cardiomegaly Uncommon Usual* Common*
Ventricular systolic function Reduced, normal, or
hypercontractile
Reduced* Reduced*
Wall stress Elevated Markedly elevated Elevated
Activation of sympathetic nervous system Marked Marked Mild to marked
Activation of renin-angiotensin-aldosterone
system
Often increased Marked Mild to marked
Reparable, reversible causative lesion(s) Common Occasional Occasional
*Patients with diastolic heart failure may have little to no cardiomegaly and normal systolic function.
Clinical and pathophysiological characteristics of the two major categories of unstable heart failure (acute heart failure and decompensated chronic heart failure) are compared
with those of chronic heart failure.
Adapted from Leier CV: Unstable heart failure. In Colucci WS (ed): Heart Failure: Cardiac Function and Dysfunction. 2nd ed. In Braunwald E (series ed): Atlas of Heart Diseases,
vol 4. Philadelphia, Current Medicine, 1999, pp 9.1–9.17.

30. A, Pulmonary blood flow redistribution. Enlargement of the upper lobe vessels is seen in a patient with ischemic
cardiomyopathy and elevated pulmonary venous pressure. B, Pulmonary interstitial edema. The vessels are indistinct
and enlarged, and peribronchial cuffing is present. C, Pulmonary alveolar edema in a patient with congestive
cardiomyopathy. The central perihilar distribution of edema, termed “bat wing” edema, is typical of pulmonary alveolar
edema caused by cardiovascular or fluid overload (uremic). D, Preferential right upper lobe distribution of pulmonary
edema in a 65-year-old man with mitral regurgitation. E, Right pleural effusion and residual right upper and bilateral
lower lobe edema in a patient with acute mitral regurgitation.

32. MANAGEMENT

36. PROGNOSIS

38. Causes of Hospital Readmission for
Congestive Heart Failure
17%
Other
19%
Failure to Seek
Care
16%
Inappropriate Rx
Rx Noncompliance
24%
Diet Noncompliance
24%
Annals of Internal Medicine 122:415-21, 1995
Over 2/3 of HF Hospitalizations Preventable

39. Prognosis with Heart Failure: More “Malignant” Than Cancer !
0
10
20
30
40
50
60
70
80
90
100
0 1 2 3 4 5 6 7 8 9 10
Survival
%
Women
Men
AHA, 1998 Heart and Statistical Update
NCHS, National Center for Health Statistics
Survival after the onset of congestive heart failure in Framingham Heart Study subjects
Ho Circulation 1993;88:107-115
Years
Overall
5-year mortality 50%

40. In Summary..