This document provides information about heart failure including its definition, causes, symptoms, diagnosis, and treatment. Heart failure occurs when the heart is unable to supply sufficient blood to meet the body's needs. It can be caused by systolic or diastolic ventricular dysfunction, valvular abnormalities, or other cardiac or extracardiac issues. Common symptoms include dyspnea, fatigue, edema, and hepatomegaly. Diagnosis involves examinations like echocardiography and tests such as electrocardiograms and natriuretic peptide levels. Treatment focuses on managing symptoms, addressing the underlying cause, and may include medications like ACE inhibitors, beta-blockers, diuretics, and anticoagulants.

1. UNIVERSIDAD TECNICA DE MACHALA
ACADEMIC UNIT OF CHEMICAL
SCIENCES AND HEALTH
MEDICINE SCHOOL
ENGLISH
HEART FAILURE
STUDENTS
William Cruz
Kevin Herrera
TEACHER:
Mgs. Barreto Huilcapi Lina Maribel
CLASS:
EIGHTH SEMESTER ‘’A’’
Machala, El Oro
2018

2. HEART FAILURE
CONCEPT.-
It is defined as the situation in which the heart is unable to supply the metabolic
demands of the organism or, if it is achieved, it is at the expense of an increase in
ventricular filling pressures.
ETIOPATHOGENESIS:
 HF due to systolic ventricular dysfunction. When the HF is due to the
decrease in the heart's pump function, it is said to be secondary to systolic
dysfunction. Deficit of myocardial contractility.
 HF with preserved ventricular function.- May be secondary to diastolic
dysfunction; in this case there is an alteration of the ventricular distensibility
due to diastolic dysfunction. Alteration in ventricular relaxation that hinders
ventricular filling.
 Other causes of HF.- Valvular alterations, congenital malformations, tumors
or even certain rapid arrhythmias, pericardial affection, anemia, alterations of
the thyroid or certain hypovitaminosis.
 Extracardiac Causes. - Like the pericardial affection, the anemia, alterations
of the thyroid or certain hipovitaminosis.

3. PATHOPHYSIOLOGY
The first compensation mechanism consists of an increase in preload according to
Frank Starling's law, so that the greater volume of resistance and the increase in end-
diastolic pressure increase the strength of the contraction and the volume of ejection
of the next beat. The main symptom of left heart failure is the feeling of shortness of
breath (dyspnea) when making an effort. It is due to the accumulation of fluid in the
lung. When the disease worsens, dyspnea increases. Another symptom of left heart
failure is asthenia or fatigue, because not enough blood reaches the muscles. In right
heart failure the accumulation of blood in the veins throughout the body produces a
series of characteristic symptoms and signs. The veins of the neck, the jugular vein,
becomes more prominent (jugular engorgement). The liver fills with blood and gets
bigger (hepatomegaly). In the ankles and legs, the accumulation of liquid causes them
to swell (what is called edema).
In some cases ascites occurs, which is the accumulation of fluid in the peritoneal
cavity (a kind of cavity that surrounds the intestine and abdominal organs). In short,
the
natural history of congestive heart failure is that of a progressive worsening.
TRIGGERING FACTORS
Among these we have arrhythmias, infections, hta, pulmonary thromboembolism,
anemia, drugs, (MAI)
Forms of presentation.- The HF can be acute or chronic. Acute HF is defined as
having a rapid onset or worsening of symptoms that requires urgent treatment. The
most frequent causes are hypertensive crises, myocardial infarction, valvular rupture
(mitral or aortic) or myocarditis; Chronic HF, which follows a slower course and is
the most commonly observed, develops in patients with valvular heart disease,
cardiomyopathy, and long-standing ischemic or hypertensive heart disease.
 Acute HF.- Acute pulmonary edema is the most severe form of acute HF and
is due to the significant, usually sudden, rise in pulmonary capillary pressure.
 Chronic HF .- Usually associated with congestive signs that are
consequences of an isolated right ventricular failure or more often are
secondary to a left fault. It is important to note that when a patient with HF
due to left dysfunction develops right ventricular failure.
SINGS AND SYMPTONS

4. The clinical manifestations of HF result from disorders caused by the function of
other organs.
 Dyspnea: Translates the increase in effort required for breathing.
 Orthopnea: That is, dyspnea of decubitus.
 Paroxysmal nocturnal dyspnea. - Refers to episodes of acute dyspnea that
awaken the patient.
 Cardiac asthma.- It is the bronchoepasm secondary to the HF itself.
 Cough.- This cough is not productive.
 Nicturia.- The dream is interrupted by the need to urinate.
 Sweating.- In certain cases there is abundant sweating due to cutaneous
vasoconstriction.
 Fatigue or fatigue.- Depends on the reduction of cardiac output and
endothelial dysfunction that limits the flow to the extremities during exercise.
 Hepatalgia.- Hepatomegaly can produce pain in the right hypochondrium or
in the epigastrium.
FUNCTIONAL CLASSIFICATION OF THE CI:
The New York Heart Association (HYHA). - Established the functional classification
according to its limitations:
 Class 1.- There are no limitations. The usual physical activity does not
produce excessive fatigue, dyspnea or palpitations.
 Class 2.- Light limitations of physical activity. The patient does not have
symptoms at rest. The usual physical activity produces fatigue, dyspnea or
angina.
 Class 3.- Notable limitations of physical activity, although at rest there are no
symptoms, these manifest themselves with low levels of physical activity.
 Class 4.- Inability to carry out activities in the absence of symptoms. These
may be present even at rest.
COMPLEMENTARY EXPLORATIONS
 Radiological examination.- We can appreciate the size and configuration of
the cardiac silhouette, the presence of kerley lines.
 Laboratory tests.- Atrial Natriuretic peptide.
 Electrocardiogram.- There are no specific data although the pattern in these
patients is abnormal due to the severity of the underlying heart disease.

5.  Doppler.- Echocardiography is the basic technique to confirm and establish
the etiology of HF, as well as being useful in assessing the severity of
ventricular dysfunction. It allows to appreciate the anatomy and the cardiac
function with great fidelity and to distinguish between diastolic and systolic
dysfunction.
 Magnetic Resonance.- This technique allows the anatomical and functional
study of the heart with great precision.
 Holter Registration.- It is not useful for IC. It may be useful for detecting
episodes of asymptomatic paroxysmal atrial fibrillation or severe ventricular
arrhythmias.
TREATMENT
Perform general measures, such as exercise, suppress smoking, reduce weight (diet).
 Treatment of HF with ventricular dysfunction.- The drugs of choice are an
ACE inhibitor with a B-adrenergic blocker and a diuretic.
 Anticoagulant treatment.- It is reserved for patients with atrial fibrillation, in
patients with a history of previous embolism.
 Treatment of HF due to diastolic dysfunction. This may differ in some
aspects from that which is generally recommended to the patient with systolic
function deficit, as regards the etiology.
 Treatment of acute HF.- It has different forms of presentations in which it
includes acute pulmonary edema, de novo HF, decompensation of chronic HF
and cardiogenic shock, therefore the treatment will be oriented according to
the type of HF. presentation.
BIBLIOGRAPHY
E. Roig Minguell, 2016 "Heart failure". Valenti Farreras and C Rozman. Internal
Medicine Farreras / Rozman. Barcelona: Elsevier, 2016, pages 414 - 418