2. INTRODUCTION
Heart failure is the Pathophysiologic state in
which an abnormality of cardiac function is
responsible for the failure of the heart to pump
blood at a rate adequate to meet the
requirements of tissue or can do so only from
an elevated filling pressure.

3. TERMINOLOGIES
 Arrhythmia
 Systole
 Diastole
 Stenosis
 Peripheral resistance
 Vasoconstriction
 Preload
 Afterload

4. DEFINITION
Heart failure or cardiac
failure is the condition in
which the heart looses the
ability to pump sufficient
amount of blood to all parts
of the body. Heart failure
may involve RV/LV or both.

5. Acute
Chronic

6. CONGESTIVE HEART FAILURE
Results in accumulation of
fluid in lungs & other tissues
.when heart cannot pump out
blood , it remains in heart
resulting in dilatation of
chambers & accumulation of
blood in vessels resulting in
vascular congestion

7. ETIOLOGIES & RISK
FACTORS

9. High output cardiac failure
Viral infection
Heart damage
Acute decompensation
Primary causes
Precipitating causes
Primary genetic link
Gender difference

10. ANATOMY &
PHYSIOLOGY

11. Right
side
SEPTA
LEFT

15. CORONARY CIRCULATION

17. SYSTEMIC CIRCULATION

18. PROPERTIES OF CARDIAC CYCLE
Excitability
Rhythmicit
y
Conductivit
y
Contractilit

19. ACTIONS OF HEART
four
types
inotropic
chronotrpoic
bathmotro-
pic
dromotropic

20. HEART SOUNDS

21. PATHO-
PHYSIO
-LOGY

22. PATHOPHYSIOLOGY
Various sequences are—
Systolic failure
Diastolic failure
Mixed systolic & diastolic

23. PATHOPHYSIOLOGY
 Compensatory mechanism
- SNS activation
-Neurohormonal response
-Ventricular dilatation
-Ventricular hypertrophy.
 Counter regulatory mechanism

24. TYPES
LEFT
SIDED
HEART
FAILURE
RIGHT
SIDED

25. NYHA-FC & ACCF/AHA STAGES
NYHA-FC ACCF/AHA
STAGES
EXMPLES
STAGE-A
Patients at high
risk of
developing HF
without
structural heart
diseases or
symptoms of
HF
Systemic
HTN, CAD,
DM, cardio
toxic drug or
alcohol
abuse, family
H/O
cardiomyopat
hy

26. NYHA-FC & ACCF/AHA STAGES
NYHA-FC ACCF/AHA
STAGES
EXMPLES
CLASS-I
Pts with cardiac
diseases without
limitation of
physical activity,
ordinary
physical activity
does not cause
fatigue, dyspnea,
palpitation or
angina pain
STAGE –B
Patients who
have structural
heart disease
but have no
symptoms
LV
hypertrophy,
enlarged
dialated
ventricles,
asymptomatic
valvular heart
disease,
previous MI

27. NYHA-FC & ACCF/AHA STAGES
NYHA-
FC
ACCF/AHA STAGES EXMPLPES
CLASS-
II
STAGE-C
Patients who have
structural heart
diseases with currents
or prior symptoms
Dyspnea or
fatigue due to
LV dysfunction
CLASS -
III
Asymptomatic
patients who
are undergoing
treatment for

28. NYHA-FC ACCF/AHA
STAGES
EXMPLES
CLASS-IV
Patients with
cardiac disease
who cannot
carryout any
physical
activity without
symptoms,
symptoms may
be present at
rest
STAGE-D
People with
refractory heart
failure that
requires
specialized
interventions
Patient with
marked symptoms
at rest despite
medical treatment,
who cannot be
discharged from
hospital, who are
recurrently
hospitalized,
awaiting Heart
transplantation,
receiving I.V.
therapy for
symptomatic
relief

29. SIGNS & SYMPTOMS

30. CLINICAL INDICATORS:
Systemic congestion
Diminished systemic perfusion
Pulmonary congestion
Diminished pulmonary perfusion

31. DIAGNOSTIC EVALUATIONS
1. Physical examination
 Cardiovascular assessment
 Pulmonary assessment
 Integumentary assessment
 GI assessment

32. 2. LAB TESTS & OTHER PROCEDURES
 Transthoracic Doppler 2D echo.
 ECG
 EMB (Endomyocardial Biopsy).
 Cardiac catheterization.
 Chest X-Ray
 Exercise stress test.
 Nuclear cardiology
 Cardiovascular Imaging
 Cardiac CT
 Angiography.

33. Blood studies:
 Cardiac Biomarkers
 C-Reactive protein
 Cardiac Natriuretic Peptide
a. Atrial Natriuretic Peptide
b. b-type Natriuretic Peptide
c. c- type Natriuretic Peptide
 Serum lipids
 Lipoprotein associated phospholipase A2.

34. Others:
A. Electrolytes.
B. Kidney Function test
C. Liver Function test
D. Thyroid Function Test
E. Complete Blood Count

35. ALGORHYTHM
E.g. Framingham heart study
Major criteria Minor criteria
An enlarged heart on X-Ray.
S3 Gallop
Acute Pulmonary edema
Episodes of waking up from sleep
Gasping for air.
Crackles on Lung auscultation
CVP more than 16 cm oh H2O
Jugular venous distention
Weight loss of more than 4.5 kg in a 5
days.
Positive abdominojugular test
 Abnormally Fast
Heart more than 120
bpm.
Nocturnal cough

36. MANAGEMENT
BASED
ON
TYPES
3
CATEGORI
ES OF
TREATME
NT
PHARM
A-
COLOGI
C
SURGICA
L

38. 2. PHARMACOLOGIC INTERVENTION
 ACE Inhibitors.
 Loop diuretics
 Beta Blockers
 Digoxin
 Antianginal agents
 Ca channel Blockers
 Vasodilators

39. SURGICAL INTERVENTIONS
 Device therapy
 CABG
 Heart Valve Surgery
 Ventricular Restoration
 Extracorporeal membrane oxygenation
 Heart transplantation
 Total artificial heart

40. NURSING MANAGEMENT

41. HEALTH EDUCATION

42. RESEARCH
PROGNOSIS OF THE
DISEASE
CONCLUSION

43. JOURNAL ABSTRACT
1. ISOSORBIDE MONONITRATE IN HF WITH
PRESERVED EJECTION FRACTION
By-Margaret M. Redfield et.al
New England journal Of medicine,10th Dec,
2015.
2. Efficacy of safety of LCZ696 ( Sacubitril
Valsartan)
By Jhund S. Pradeep et.al
European Heart journal, Nov 2015

44. Q
U
I
Z

45. BIBLIOGRAPHY

46. T
H
A
N
K
Y
O
U