Heart failure is a clinical syndrome characterized by symptoms like breathlessness and fatigue caused by structural or functional abnormalities in the heart that reduce cardiac output. It generally refers to congestive heart failure, which can result from systolic or diastolic dysfunction. Left-sided heart failure is usually due to conditions like ischemic heart disease or hypertension and causes pulmonary congestion and edema. Right-sided heart failure more often stems from left heart failure or primary pulmonary disorders, presenting as peripheral edema. Pulmonary heart disease, or cor pulmonale, involves enlargement and failure of the right ventricle in response to increased pulmonary pressures, commonly from lung diseases like COPD.

1. Heart failure ddx
MNUMS Ambaselmaa.B
Urantuguldur.B

4. DEFINITION OF HEART
FAILURE
HF is a clinical syndrome characterized by typical symptoms (e.g.
breathlessness, ankle swelling and fatigue) that may be
accompanied by signs (e.g. elevated jugular venous pressure,
pulmonary crackles and peripheral oedema) caused by a
structural and/or functional cardiac abnormality, resulting in a
reduced cardiac output and/ or elevated intracardiac pressures at
rest or during stress. ( ESC GUIDELINES 2016).

5. Heart failure generally is referred to as congestive heart failure
(CHF). CHF is the common end point for many forms of cardiac
disease and typically is a progressive condition that carries an
extremely poor prognosis.

6. Most cases of heart failure are due to systolic
dysfunction—inadequate myocardial contractile function,
characteristically a consequence of ischemic heart disease
or hypertension. Alternatively, CHF also can result from
diastolic dysfunction—inability of the heart to adequately
relax and fill, such as in massive left ventricular hypertrophy,
myocardial fibrosis, amyloid deposition, or constrictive
pericarditis. Indeed, heart failure in elderly persons,
diabetic patients, and women may be more commonly
attributable to diastolic dysfunction.

7. HF
• Right-Sided Heart Failure
• Left-Sided Heart Failure

8. • Left-sided heart failure is most commonly secondary to
ischemic heart disease, systemic hypertension, mitral or
aortic valve disease, or primary diseases of the myocardium;
symptoms are mainly a consequence of pulmonary
congestion and edema, although systemic hypoperfusion
can cause renal and cerebral dysfunction.
• Right-sided heart failure is due most often to left heart
failure and, less commonly, to primary pulmonary disorders;
signs and symptoms are related chiefly to peripheral
edema and visceral congestion.

13. Cor pulmonale
• Pulmonary heart disease, also known as cor pulmonale, is
the enlargement and failure of the right ventricle of
the heart as a response to increased vascular resistance (such
as from pulmonic stenosis) or high blood pressure in the
lungs.

14. The causes of pulmonary heart
disease (cor pulmonale) are the
following:
• Acute respiratory distress syndrome ARDS
• COPD
• Primary pulmonary hypertension
• Blood clots in lungs
• Kyphoscoliosis
• Interstitial lung disease
• Cystic fibrosis
• Sarcoidosis
• Obstructive sleep apnea (untreated)
• Sickle cell anemia
• Bronchopulmonary dysplasia (in infants)

17. symptoms
• Shortness of breath
• Wheezing
• Cyanosis
• Swell ankle
• Ascites
• Nocturia
• Jaundice
• Enlargement of the liver
• Raised jugular venous pressure (JVP)
• Third heart sound
• Intercostal recession
• Presence of abnormal heart sounds

18. Investigationsavailable to determinethe causeof
cor pulmonaleinclude thefollowing
• Chest x-ray – right ventricular hypertrophy, right atrial dilatation, prominent
pulmonary artery
• ECG – right ventricular hypertrophy, dysrhythmia, P pulmonale (characteristic
peaked P wave)
• P pulmonale
• Blood antibody tests
• Blood test to check for a substance called brain natriuretic peptide (BNP)
• Thrombophilia screen- to detect chronic venous thromboembolism (proteins C
and S, antithrombin III, homocysteine levels)
• CT scan of the chest, with or without an injection of a contrast fluid (dye)
• Echocardiogram
• Lung biopsy (rarely done)
• Measurement of blood oxygen by checking arterial blood gas (ABG)
• Pulmonary (lung) function tests
• Right heart catheterization
• Ventilation and perfusion scan of the lungs (V/Q scan)

19. Differential diagnosis
• The diagnosis of pulmonary heart disease is not easy as both
lung and heart disease can produce similar symptoms.
Therefore, the differential diagnosis should assess:
• Atrial myxoma
• Congestive heart failure
• Constrictive pericarditis
• Infiltrative cardiomyopathies
• Right heart failure (right ventricular infarction)
• Ventricular septal defect

20. treatment
• The goal of treatment is to control symptoms. It is important
to treat medical problems that cause pulmonary hypertension,
because they can lead to cor pulmonale.
• Blood thinners to reduce the risk of blood clots
• Medicines to manage heart failure symptoms
• Oxygen therapy at home
• A lung or heart-lung transplant, if medicine does not work

21. Important tips to follow:
• Avoid strenuous activities and heavy lifting.
• Avoid traveling to high altitudes.
• Get a yearly flu vaccine, as well as other vaccines, such as the
pneumonia vaccine.
• If you smoke, stop.
• Use oxygen if your doctor prescribes it.
• Women should not get pregnant.

23. • http://negdsen401.blogspot.com/2017/11/20-18.html
• https://www.slideshare.net/iqbaldar16/guideline-for-the-
management-of-heart-failure
• https://www.acc.org/~/media/Non-Clinical/Files-PDFs-Excel-
MS-Word-
etc/Tools%20and%20Practice%20Support/Quality%20Program
s/Heart%20Failure%20Roundtable%202016/Heart%20Failure
%20Guidelines/HFG%204%202016%20ESC.pdf?la=en
• http://mongolmed.mn/article/3056
• https://www.cfrjournal.com/articles/Treating-acute-heart-
failure-COPD
• Robbins 9th edition