Diagnosis and general management of heart failure

1. Diagnosis,
and Treatment of Chronic Congestive Heart
Failure
Dr Lázaro Nicanor Rodríguez González. MD. MSc.
Department of Internal Medicine .
Kimberley Hospital .
RSA.

2. Heart Failure
• Definitions
• Epidemiology
• Etiology and common triggers associated with decompensation
• Diagnosis
• Non-pharmacological measures
• Pharmacological treatment
• Electrical device therapies
• HF Surgical approaches

5. Symptomatic heart failure continues to
confer a worse prognosis
than the majority of cancers in USA,
with one-year mortality of
approximately 45 percent.

10. Left Ventricular Dysfunction
Systolic and Diastolic
• Symptoms
– Dyspnea on Exertion
– Paroxysmal Nocturnal
Dyspnea
– Tachycardia
– Cough
– Hemoptysis
• Physical Signs
– Basilar Rales
– Pulmonary Edema
– S3 Gallop
– Pleural Effusion
– Cheyne-Stokes Respiration

11. Right Ventricular Failure
Systolic and Diastolic
• Symptoms
– Abdominal Pain
– Anorexia
– Nausea
– Bloating
– Swelling
• Physical Signs
– Peripheral Edema
– Jugular Venous Distention
– Abdominal-Jugular Reflux
– Hepatomegaly

12. Modified Framingham clinical criteria for the diagnosis of
heart failure
Major
Paroxysmal nocturnal dyspnea
Orthopnea
Elevated jugular venous pressure
Pulmonary rales
Third heart sound
Cardiomegaly on chest x-ray
Pulmonary edema on chest x-ray
Weight loss 4.5 kg in five days in response to treatment of
presumed heart failure

13. Minor
Bilateral leg edema
Nocturnal cough
Dyspnea on ordinary exertion
Hepatomegaly
Pleural effusion
Tachycardia (heart rate 120 beats/min)
Weight loss 4.5 kg in five days
Modified Framingham clinical criteria for the diagnosis of
heart failure

14. Diagnosis
The diagnosis of heart failure requires that 2 major or 1 major and
2 minor criteria if they cannot be attributed to another medical
condition.
From Senni, M, Tribouilloy, CM, Rodeheffer, RJ, et al, Circulation 1998; 98:2282; ada pted from McKee, PA,
Castelli, WP, McNamara, PM, Kannel, WB. N Engl J Med 1971
Modified Framingham clinical criteria for the diagnosis of
heart failure

25. Reference Articles
1- Prakash C. Deedwania, MD, Enrique Carbajal, MDaEvidence based therapy for heart failure.
Med Clin N Am 96 (2012) 915–931
2-Heart Failure Society of South Africa (HeFSSA) perspective
on the European Society of Cardiology (ESC) 2012 chronic
heart failure guideline. S Afr Med J 2013;103(9 Suppl 2):661-667.
3-Carol Chen-Scarabelli, Et al. Dilemmas in end-stage heart failure. Journal of Geriatric
Cardiology (2015) 12: 57−65
4-Heart Failure Focused Update on Pharmacological Therapy. Yancy CW, et al.
Circulation. 2016;134:000–000.)
5-The Canadian Cardiovascular Society Heart Failure Companion: Bridging Guidelines
to Your Practice. Canadian Journal of Cardiology 32 (2016) 296-310
6-2016 ESC Guidelines for the diagnosis and
treatment of acute and chronic heart failure. European Heart Journal Advance Access
published May 20, 2016
7-2017 ACC/AHA/HFSA Focused Update of the 2013 ACCF/AHA Guideline for the
Management of Heart Failure