This document discusses heart failure (HF), including its definition, classification criteria, and treatment strategies. It describes HF as a condition where the heart's pumping function is inadequate to supply tissues' needs. It outlines the Framingham criteria for classifying HF and the American Heart Association's functional stratification. It also discusses various clinical presentations of HF and their characteristics and treatment objectives, such as acute pulmonary edema, acute coronary syndrome with acute HF, and right-sided HF. Throughout, it emphasizes using ACE inhibitors, beta-blockers, mineralocorticoid receptor antagonists, and other drugs as well as devices like pacemakers, defibrillators, and mechanical circulatory support depending on the severity and type of HF.

1. Francisco J. Chacón-Lozsán
MD student UCLA-Venezuela
European Society of Cardiology:
Heart Failure Association
Acute Cardiovascular Care Association
LinkedIn: http://ve.linkedin.com/in/chaconlozsanfrancisco
2013

2. Heart Failure (HF) Is a clinic condition which
the cardiac output in not adequate to supply
the tissue needs.

3. Framingham
Major Criteria
Minor Criteria
Major and minor criteria
•Orthopnea or nocturnal
paroxysmal dyspnea.
•Neck veins distension.
•Crackles.
•Cardiomegaly.
•Acute pulmonary edema.
•3 Cardiac murmur.
•CVP >6cmH2O
•Hepatic-Jugular reflux.
•Lower extremities
bilateral edema, nocturnal
cough or efforts dyspnea.
•Hepatomegaly
•Pulmonary vital capacity
reduced 50%
•HR>120/min
•Weigh loss >4,5Kg with
treatment.

5. AHA functional stratification of HF

6. Clinic presentation
Characteristics
Objectives
SBP >160mmHg
Pulmonary congestion without
systemic congestion. Many
with Ejection Fraction (EF)
preserved.
Objective: Volume
management. BP control.
Therapy: Vasodilator and loop
diuretics.
Normal BP or moderate high
BP (>160mmHg).
Gradual depression associated
to systemic congestion.
Radiologic pulmonary
congestion in patients with
advanced HF.
Objective: Volume
management.
Therapy: Vasodilator with or
without loop diuretics.
Low BP (>90mmHg)
Related to low cardiac output
with depression of renal
function.
Objective: Cardiac output.
Therapy: Cardiac inotropic
with vasodilator properties,
consider digoxin, vasodilators
and mechanical assistance.
Cardiogenic Shock.
Fast, complicated with MI, fast
myocarditis, acute valvular
disease.
Objective: Rise pump
function.
Therapy: vasoactive drugs,
Inotropic and mechanical
assistance.

7. Presentación clínica
Características
Objetivos
Acute pulmonary edema.
Abrupt, impaired by severe
hyperventilation. Patient
responses fast to vasodilators
and diuretics.
Objective: Volume
management.
Therapy: Vasodilators,
diuretics, ventilation,
morphine.
ACS with acute HF
Many patients have sings and
symptoms of HF that get better
resolving ischemia.
Objectives: Thrombolysis,
plaque stabilization, ischemic
correction.
Therapy: Reperfusion by PCI,
lysis, nitrates, antipatelet
agents.
Isolated Right HF IC or
intrinsic RV failure or valvular
disease.
Rapid of gradual, primary or
secondary to HBP or RV
pathology.
Objective: BP management.
Therapy: Nitrates,
phosphodiesterase inhibitors,
endoteline inhibitors, RV MI
reperfusion, valvular surgery.
HF post cardiac surgery.
Can be caused by inadequate
myocardial protection resulting
in cardiac damage.
Objective: Volume
management, rise CO.
Therapy: Use diuretic or
fluids, inotropic, mechanical
assistance.

11. ACE inhibitor (candesartan preferably)
+Beta-Blocker
If NYHA II-IV add MRA (spironolactone)
+Ivabradine (If using BB HR>70/min)
Still NYHA II-IV: Consider Pacemaker
• If QRS > 0,12sec use resynchronization.
• If QRS < 0,12sec use Automatic Implantable Defibrillator.
If still NYHA II-IV add Digoxin.