This document provides an overview of heart failure, including its definition, epidemiology, etiology, pathophysiology, classification, signs and symptoms, diagnosis, and treatment. Heart failure is defined as when the heart is unable to pump enough blood to meet the body's needs. It affects about 3-20 cases per 1000 people and is increasing in prevalence. Causes include intrinsic pump failure, increased workload on the heart, and impaired filling of cardiac chambers. Treatment involves pharmacological therapies like ACE inhibitors, beta blockers, diuretics, as well as non-pharmacological approaches like diet modification and exercise.

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2. Presented to
Dr. Smreen Hassan
Presented by
Group :03
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3. Muhammad Asif Sami.
Sidra Akbar.
Fatima Rahat Ali.
Kanwal Mehboob.
Soorath Bhatti.
Maria Rehman.
Zainab Hassan.
Batch:04 (DPT)
Institute: D.I.R.S(Dewan University)
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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.
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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.
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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.
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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
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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).
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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
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12. decreased cardiac output
Decreased Left ventricular ejection
fraction
Elevated Left and Right ventricular end-
diastolic pressures
May have normal LVEF
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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.
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14. Coronary Artery Disease
50% idiopathic (at least 25% familial)
9 % mycoarditis (viral)
Ischemic heart disease, perpartum,
hypertension, HIV, connective tissue
disease, substance abuse, doxorubicin
Hypertension
Valvular Heart Disease
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15.  Hypertension
 Coronary artery disease
 Hypertrophic obstructive cardiomyopathy
(HCM)
 Restrictive cardiomyopathy
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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
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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.
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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.
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21. Lab Analysis
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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
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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)
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24. PHARMACOLOGICAL
TREATMENT
 Drugs used in CCF:
 Cardiotonic drugs: Cardiac glycosides
(digitalis, digoxin,digitoxin.
 Vasodilators: ACE-I, ARBs, Na- nitroprusside,
nitroglycerine, prazosine.
 Diuretics: Thiazides, loop diuretics, K+ sparing
diuretics.
 Miscellaneous:
 Aldosterone antagonist; spiranolactone.
 Β blockers: Carvedilol, metoprolol.
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25. 1. Loop diuretics
2. ACE inhibitor
3. Beta blockers
4. Digoxin
5. Hydralazine, Nitrate.
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26. Loop diuretics
 Lasix(furosemide)
 Hydrochlorothiazide(HCTZ)
 Spironolactone
 These inhibit reabsorption
of Na+ into the kidneys
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27. Decrease the body’s retention of salt and water
Reduces blood pressure
Probably will be on potassium
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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
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29. Prevent the production of the chemicals that causes
blood vessels to narrow
Resulting in blood pressure decreasing and the
heart pumping easier
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31. Calcium Channel Blockers:
Nifedipine
Diltiazem
Verapamil
Amlodipine
Felodipine
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32. Mechanism of Action
Used to dilate blood vessels
Used mostly with CHF in the presence
of ischemia
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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
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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
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37. Dosing:
Hydralazine
 Started at 25 mg , titrated up to 100 mg po TID
Isosorbide dinitrate
 Started at 40 mg
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38. Mechanism of Action:
Widens the blood vessels, therefore allowing more
blood flow
Relaxation of smooth muscle
Widens blood vessels
Lowers systolic blood pressure
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39. Given to
patients with HF
to control
symptoms such
as fatigue,
dyspnea,
exercise
intolerance.
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40. Mechanism of Action:
Digoxin
Lanoxin
Increases the contractility of the heart 
increasing the cardiac output
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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
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43. Newer drugsfor heartfailure
Vasopeptidaseinhibitors:
Omapatrilat
Nesiritide
Omecamtiv mecarbil: selective cardiac
myosin activator
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44. Goals of Management
 Improve oxygenation, ventilation
 Decrease venous return to heart
 Decrease cardiac work, O2 demand
 Improve cardiac output by
 Reducing afterload
 Increasing myocardial
contractility
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47. Some examples of aerobic exercises are walking,
jogging, running, aerobic dancing, cycling,
stepping, cross country skiing, swimming, arm
cycle ergometry, etc.
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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.
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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."
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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.
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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
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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 .
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56. (www.heartfoundation.org)
(www.hffonf.org)
(www.heart failure.com)
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC48653
99/
by JMSC
(www.jan.wvu.edu/media/Heart
Failure.htm)
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