Heart failure occurs when the heart is unable to pump enough blood to meet the body's needs. It can develop when the heart muscle is damaged, such as from a myocardial infarction. There are two main types - left heart failure which causes blood to back up in the lungs, and right heart failure where blood backs up in the body. Symptoms depend on whether it is left or right heart failure, and include shortness of breath, fatigue, swelling, and coughing. Treatment focuses on reducing cardiac workload, increasing blood oxygen levels, and limiting fluid buildup through medications, oxygen therapy, and monitoring for arrhythmias.
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Atria – It collects blood from the body.
Ventricle- It supplies blood to the body
Right Ventricle supplies blood to lungs
Left Ventricle supplies blood into the
system for circulation
5. • In medical terms heart failure is defined as the
condition when heart is unable to pump enough
blood required for normal body functions.
• Human body needs sufficient amount of oxygen
which is supplied by heart through blood. Heart
failure is a serious condition and needs
immediate medical care.
What is Heart Failure?
7. 7
Cardiac structural abnormalities
occur as a result of injury and
remodeling
MI=myocardial infarction Konstam et al. J Am Coll Cardiol 2011;4:98–108
Cardiac injury
(e.g. MI)
Infarct zone
thinning and elongation
Spherical ventricular
dilation
Fibrous scar Myocyte hypertrophy
Increased Interstitial
collagen
Ventricle
8. LV=left ventricular
McMurray. N Engl J Med 2010;362:228–38; Francis et al. Ann Intern Med 1984;101:370–7; Krum, Abraham. Lancet 2009;373:941–55
The pathophysiology of chronic HF
HF symptoms
dyspnea, edema, fatigue
Progressive remodelling and
worsening of LV function
Morbidity and mortality
arrhythmias, pump failure
Hemodynamic alterations,
salt and water retention
These changes lead to systemic neurohormonal imbalance
Damage to cardiac myocytes and extracellular matrix leads to
changes in the size, shape and function of the heart (remodeling)
and cardiac wall stress
This may lead to fibrosis, apoptosis, hypertension, hypertrophy,
cellular and molecular alterations, myotoxicity
10. Left-Sided Heart Failure
• Left ventricle fails as effective pump
• Left ventricle cannot eject blood delivered
from right heart through pulmonary
circulation
• Blood backs up into pulmonary circulation
11. Left-Sided Heart Failure
• Increase pressure in pulmonary capillaries
forces blood serum out of capillaries into
interstitial spaces and alveoli
• Increase respiratory work and decrease gas
exchange occur
12. Left-Sided Heart Failure
• Common causes
• ACUTE MI
• especially if involves left ventricle
• Chronic hypertension
• Dysrhythmias
• especially tachydysrhythmias
16. Right-sided Heart Failure
• Right ventricle fails as effective pump
• Right ventricle cannot eject blood returning
through vena cavae
• Blood backs up into systemic circulation
17. Right Heart Failure
• Increased pressure in systemic capillaries
forces fluid out of capillaries into interstitial
spaces
• Tissue edema occurs
25. Management
• Sit patient up, dangle feet
• Do not lay flat
• Oxygen by non-rebreather mask
• Consider positive pressure ventilation
26. Management
• Consider intubation if:
• O2 saturation cannot be kept >90% on 100% O2
• PaO2 cannot be kept >60 torr on 100 % O2
• Patient displays signs of worsening cerebral hypoxia
• PaCO2 progressively increases
• Patient becoming exhausted
27. Management
• Monitor ECG
• Hypoxia, increased heart wall tension leads to
dysrhythmias
• IV NS TKO via microdrip or lock
• Limit Fluids
• If RVF only, fluid challenges to preload
30. If medication or other means fail to improve the
condition, left ventricular assist devices and / or
heart transplantation is opted.
For patients in cardiogenic shock, ECMO
(extracorporeal membrane oxygenator) therapy
is given to stabilize the condition temporarily.