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.

1. Heart Failure
Dr Arindam Pande,
MBBS (Hons), MD, DM, FESC, FACC (USA)
Consultant Cardiologist,
Academic Coordinator: DNB Cardiology and PGDCC Training
Apollo Gleneagles Hospital, Kolkata

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Heart
Heart has four chambers -
Two Atrium(upper)
Two Ventricles(lower)

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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

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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?

6. Congestive Heart Failure
Congestion of pulmonary or systemic
circulation (backward failure)
Reduced output to body tissues (forward
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

9. Congestive Heart Failure
Left sided
Right sided
Biventricular

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

13. Left-Sided Heart Failure
Pulmonary
Signs/Symptoms

14. Left Heart Failure Symptoms
• Dyspnea on exertion
• Paroxysmal nocturnal dyspnea
• Orthopnea
• Fatigue, generalized weakness

15. Left Heart Failure Signs
• Anxiety, confusion, restlessness
• Persistent cough
• Pink, frothy sputum
• Tachycardia
• Tachypnea
• Noisy, labored breathing
• Rales, wheezing (“cardiac asthma”)
• Cyanosis (late)
• Third heart sound (S3)

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

18. Right Heart Failure Causes
Most Common Cause:
Left sided Heart Failure

19. Right Heart Failure Causes
• Others
• Chronic pulmonary hypertension (Idiopathic)
• COPD (cor pulmonale)
• Congenital Heart Disease
• Pulmonary embolism
• Right ventricular infarction

20. Right-Sided Heart Failure
Systemic
Signs/Symptoms

21. Right Heart Failure
Signs/Symptoms
• Tachycardia
• Jugular vein distension
• Pedal, pre-tibial, sacral edema
• Hepatomegaly
• Splenomegaly
Classic Triad of Right Ventricular Failure:
JVD, Hypotension, Clear Lungs

22. Right Heart Failure
Signs/Symptoms
• Anasarca (generalized edema)
• Fluid accumulation in body cavities
• Ascites
• Pleural effusion
• Pericardial effusion

23. Management of Heart Failure

24. Goals of Management
• Improve oxygenation, ventilation
• Decrease venous return to heart
• Decrease cardiac work, O2 demand
• Improve cardiac output by
• Reducing afterload
• Increasing myocardial contractility

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

28. Drug management in acute setings
• Nitroglycerin
• Furosemide (Lasix®) -
• Morphine Sulfate
• Dobutamine, Noradrenaline
• Bronchodilators (beta agonists)
• Digitalis

29. Long Term CHF Management
• Fluid minimization
• Diuretics (+ Potassium if non-potassium sparing)
• Diet restrictions
• Increase contractility
• Digitalis
• Blood pressure control
• ACE Inhibitors
• Betablockers
• ARNI
• Ivabradin
• Coronary artery perfusion
• Nitroglycerin

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.

31. THANKS
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