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HEART FAILURE
What is Heart Failure?
 The clinical syndrome where the cardiac is not sufficient
enough to fulfill the body’s requirement.
 Even if it does, it is at the expense of elevated ventricular
filling pressure.
Systolic versus diastolic heart failure
Systolic failure: Inability of the ventricles to contract that results
in decreased cardiac oitput. Ejection fraction is less than 40
percent.
 Causes: IHD, MI, Cardiomyopathy
Diastolic failure: Inability of the ventricles to relax and fill
normally causing filling pressures. Ejection fraction more than 50
percent.
 Causes: constrictive pericarditis, cardiac tamponade,
restrictive cardiomyopathy.
Left sided versus Right versus failure
 May occur independently or together. (Known as congestive
cardiac failure)
 Left ventricular failure symptoms: Patient looks restless,
agitated and has cold, clammy skin. Dyspnea, orthopnea,
paroxysmal nocturnal dyspnea, nocturnal cough(pink frothy
sputum), wheeze, pulmonary edema
 Right ventricular failure symptoms: Pitting edema (From
thighs, sacrum, abdominal wall), ascites, hepatomegaly
 Raised JVP in both.
Other causes of heart failure:
 Ventricular outflow obstruction: HTN, Aortic stenosis,
Pulmonary HTN
 Ventricular inflow obstruction: Mitral stenosis,
Tricuspid stenosis
 Ventricular volume overload: Ventricular septal defect,
Mitral regurgitation, aortic regurgitation
 Arrythmias: Atrial fibrillation, Tachycardi
Conditions that aggravate or
precipitate heart failure
 MI
 Arrythmias
 Inappropriate reduction of drug
 Administration of a drug
 Pulmonary embolism
Complications
 Renal failure
 Hypokalemia
 Hyperkalemia
 Impaired liver function
 Arrythmias
Investigations:
 Chest Xray: May show abnormal distension of pulmonary
veins, vasculature of lung fields becomes more prominent.
Interstitial edema causes thickened interlobular septa
and dilated lymphatics. (Kerley B lines)
Pleural effusion can be observed in lungs.
 Echo: To rule out any valvular diseases.
 Urea, Creatinine and electrolytes
 Complete blood picture
 Brain Natriuretic peptide is elevated in heart disease. More than
500 pg/ml confirms HF with dyspnea
 ECG
Management
 Risk factor management
 Patient education
 Treatment: Non Pharmacological
 Treatment: Pharmacological
 When to refer?
Risk factor management
 Manage blood pressure or any other vascular
disease
 Manage diabetes
Patient education
 Very important for successful management
 Emphasis of being compliant as far as
medications are concerned
Non Pharmacological treatment
 Lifestyle modifications
 Encourage exercise
 Salt and fluid restriction
Pharmacological treatment
Diuretic:
 Loop diuretic: Furosemide 5-10 mg/hr
 Potassium sparing diuretic: Spironolactone or eplerenone
ACE Inhibitors:
 Enalapril 2.5 mg daily starting dose
ARBs:
 Losartan: 25mg daily dose
Neprilysin Inhibitors:
 Sacubitril. Can be used in combination with ARB Valsartan
Vasodilators:
 Venodilators such as nitrates
 Arteriodilators such as hydralazine
Betablockers:
 Bisoprolol 1.25 mg daily starting dose
Digoxin to provide rate control in patients with atrial fibrillation
Surgical intervention:
 Defibrillators in arrythmic patients
 Resynchronization devices in patients with
Coronary Artery Diseases
 Cardiac transplantation in patients with
cardiomyopathies
 Coronary revascularization in patients with
CAD
Heart failure

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Heart failure

  • 2. What is Heart Failure?  The clinical syndrome where the cardiac is not sufficient enough to fulfill the body’s requirement.  Even if it does, it is at the expense of elevated ventricular filling pressure.
  • 3. Systolic versus diastolic heart failure Systolic failure: Inability of the ventricles to contract that results in decreased cardiac oitput. Ejection fraction is less than 40 percent.  Causes: IHD, MI, Cardiomyopathy Diastolic failure: Inability of the ventricles to relax and fill normally causing filling pressures. Ejection fraction more than 50 percent.  Causes: constrictive pericarditis, cardiac tamponade, restrictive cardiomyopathy.
  • 4.
  • 5. Left sided versus Right versus failure  May occur independently or together. (Known as congestive cardiac failure)  Left ventricular failure symptoms: Patient looks restless, agitated and has cold, clammy skin. Dyspnea, orthopnea, paroxysmal nocturnal dyspnea, nocturnal cough(pink frothy sputum), wheeze, pulmonary edema  Right ventricular failure symptoms: Pitting edema (From thighs, sacrum, abdominal wall), ascites, hepatomegaly  Raised JVP in both.
  • 6.
  • 7.
  • 8. Other causes of heart failure:  Ventricular outflow obstruction: HTN, Aortic stenosis, Pulmonary HTN  Ventricular inflow obstruction: Mitral stenosis, Tricuspid stenosis  Ventricular volume overload: Ventricular septal defect, Mitral regurgitation, aortic regurgitation  Arrythmias: Atrial fibrillation, Tachycardi
  • 9. Conditions that aggravate or precipitate heart failure  MI  Arrythmias  Inappropriate reduction of drug  Administration of a drug  Pulmonary embolism
  • 10. Complications  Renal failure  Hypokalemia  Hyperkalemia  Impaired liver function  Arrythmias
  • 11. Investigations:  Chest Xray: May show abnormal distension of pulmonary veins, vasculature of lung fields becomes more prominent. Interstitial edema causes thickened interlobular septa and dilated lymphatics. (Kerley B lines) Pleural effusion can be observed in lungs.
  • 12.
  • 13.  Echo: To rule out any valvular diseases.  Urea, Creatinine and electrolytes  Complete blood picture  Brain Natriuretic peptide is elevated in heart disease. More than 500 pg/ml confirms HF with dyspnea  ECG
  • 14.
  • 15. Management  Risk factor management  Patient education  Treatment: Non Pharmacological  Treatment: Pharmacological  When to refer?
  • 16. Risk factor management  Manage blood pressure or any other vascular disease  Manage diabetes
  • 17. Patient education  Very important for successful management  Emphasis of being compliant as far as medications are concerned
  • 18. Non Pharmacological treatment  Lifestyle modifications  Encourage exercise  Salt and fluid restriction
  • 19. Pharmacological treatment Diuretic:  Loop diuretic: Furosemide 5-10 mg/hr  Potassium sparing diuretic: Spironolactone or eplerenone ACE Inhibitors:  Enalapril 2.5 mg daily starting dose ARBs:  Losartan: 25mg daily dose
  • 20. Neprilysin Inhibitors:  Sacubitril. Can be used in combination with ARB Valsartan Vasodilators:  Venodilators such as nitrates  Arteriodilators such as hydralazine Betablockers:  Bisoprolol 1.25 mg daily starting dose Digoxin to provide rate control in patients with atrial fibrillation
  • 21. Surgical intervention:  Defibrillators in arrythmic patients  Resynchronization devices in patients with Coronary Artery Diseases  Cardiac transplantation in patients with cardiomyopathies  Coronary revascularization in patients with CAD