Heart failure is a complex clinical syndrome characterized by impaired myocardial performance and progressive maladaptive neurohormonal adaptation. It can be systolic or diastolic in nature. Common causes include ischemia, cardiomyopathy, hypertension, and valvular disorders. Symptoms include dyspnea, orthopnea, fatigue, and ankle swelling. Diagnostic evaluation involves ECG, echocardiogram, blood tests, and cardiac catheterization. Management depends on whether the heart failure is acute or chronic, and involves treatments like oxygen, vasodilators, diuretics, beta blockers, ACE inhibitors, and device therapies like ICDs or CRT. Lifestyle changes like exercise and diet are also important.

1. HEART FAILURE
MD MASHIUL ALAM
MBBS MD
ASSISTANT PROFESSOR OF CARDIOLOGY, JIMCH

2. DEFINITION
Heart failure is a complex clinical syndrome characterized by impaired myocardial performance and
progressive maladaptive neurohormunal adaptation of cardiovascular and renal systems leading to
circulatory insufficiency and or congestion.

3. TERMINOLOGY
• Systolic heart failure EF <40%
• Heart failure with preserved ejection failure (HFpEF) EF >40%
• Congestive heart failure
• Right heart failure
• Acute heart failure/ Decompensated heart failure
• Acute LV failure (ALVF)/
• Chronic heart failure/ Compensated heart failure
• High out failure

8. PATHOPHYSIOLOGY
• Reduced ventricular contractility
• Ventricular outflow obstruction
• Inflow obstruction
• Volume overload
• Arrhythmia
• Diastolic dysfunction

10. MAJOR ORGANS INVOLVED

11. ETIOLOGY
• Ischemia
• Dilated cardiomyopathy – Viral or familial cause
• Myocarditis
• Hypertension and diabetic cardiomyopathy
• Peripartum cardiomyopathy
• Tachyarrhythmia induced cardiomyopathy HR >110 bpm
• Valvular disorders
• Nutritional deficiency/ Anaemia
• Infitratatiive disease

12. SYMPTOMS AND SIGNS
• Dyspnea
• Orthopnea
• PND
• Cheyne Stokes Respiration
• Fatigue
• Palpitation / syncope
• Anorexia and abdominal pain

14. PHYSICAL EXAMINATION
General examination
• Pulse
• BP
• JVP
• Oedema
Precordium
Abdomen

15. DIAGNOSTIC EVALUATION
• ECG
• ECHO
• CXR
• CBC, Metabolic profile, Thyroid function test, BNP
• CAG
• Endomyocardial biopsy
• CMR

17. MANAGEMENT
• Acute heart failure
Bed rest in propped up position
Maximizing oxygenation
Vasodilators
Diuretics
Inotropic therapy
Ultrafiltration
Temporary mechanical support

18. CHRONIC MEDICAL THERAPIES
ACE inhibitors
ARB
BB
Aldosterone receptor antagonists
Diuretics
Digoxin
Hydralazine and isosorbide mononitrate
Device therapy
Statin and antiplatelet , GTN?

19. CHRONIC NON MEDICAL THERAPY
• Patient education about diet, life style, smoking cessation , stope drinking
• Exercise training/ Cardiac rehabilitation

20. THANK YOU