Heart failure is a structural and functional complex condition that needs to be understood by a physician hence adequate knowledge is needed. This slides provides understanding of heart failure, it's definition, classification/types,risk and precipitating factors, pathophysiology, clinical features (symptoms and signs), diagnosis/investigations, complications and management (both non pharmacological and pharmacological).

1. HEART FAILURE
NAWA.M.S.

2. OBJECTIVES
• Definition
• Epidemiology
• Classification/Types
• Causes
• Risk factors/precipitating factors
• Pathophysiology
• Clinical features
• Investigations
• Management

3. DEFINITION
• ACCF/AHA: complex clinical symdrome where they is strusctural or
functional impairment of ventricular filling or ejection and leads to
symptoms of fatigue and dyspnoea and cardinal of signs of heart
failure(peripheral pedal oedema and pulmonary rales/crepitations).
• WHO: a condition that develops when your heart is not pumping enough
blood for your body’s needs.
• EPIDEMIOLOGY
• Race: blacks have high risk of heart failure
• Sex: prevalence is greater in male than in females at age, 40 to
70 years,
• at age>75years- no sex predilectionis noted among patients

4. CLASSIFICATION/TYPES
• 1.) Heart failure with reduced ejection fraction(HFrEF):
• reduced ejection fraction <40%
• also known as systolic heart failure
• something is wrong with myocardial contraction(systole)
• ventricles are weak and can not eject a good amount of blood to the aorta
• less amount of blood is pumped than normal hence decreased stroke volume.
• 2.) Heart failure with preserved ejection fraction(HFpEF):
• preserved ejection fraction of >40%-50%
• also known as diastolic failure
• ventricles are thickened and stiff
• they is defective filling of ventricles.
• 3.)Heart failure with mildly reduced ejection fraction:
• ejection fraction of 40%-49%
• 4.)Heart failure with recovered ejection fraction:
• is heart failure with reduced ejection fraction whose ejection fracton improves after treatment.

8. CAUSES

10. RISK FACTORS
• Hypertension
• Coronary artery disease
• Advancing age
• Diabetes
• Obesity
• High serum cholesterol
• valvular disease

11. PRECIPITATING FACTORS

12. PATHOPHYSIOLOGY

14. CLINICAL FEATURES
• SYMPTOMS:
• 1.) Of congestion/left sided heart failure:
• exertional dyspnoea
• PND=awakening after 1 or 2 hours due to acute shortness of breath. relieves after 30 mins in upright position.
• orthopnoea=breathing difficulties in recumbent position. relieved by elevation of head by pillow.
• dyspnoea at rest
• non productive nocturnal cough
• 2.) Of systemic venous congestion/right sided heart failure
• weight gain
• lower extremity oedema
• abdominal bloating
• anorexia
• early satiety
• right upper quadrant pain
• in later stages: anarsca
• 3) Of reduced perfusion/low output syndrome
• fatigue and weakness particularly to lower extremities
• mental dullness,decreased affect
• confusion, in older patients.

15. • Other symptoms
• mood disturbances
• poor sleep nocturia
• oliguria
• SIGNS:
• 1.) Left sided heart failure
• Displaced PMI
• pathological s3-best heard at apex
• s4 gallop-heard best at lower sternal border
• crackles/rales at lung base
• dullness to percussion
• decreased tactile fremitus at lower lung fields
• increased intensity of p2(if pulmonary arterial hypertension)-heard over lower upper sternal border
• 2.) Right sided heart failure
• tender hepatomegaly, ascites
• right ventricular heaves
• peripheral pitting oedema, increased jugular venous distension.
• positive hepatojugular reflux

16. • 3.) Others
• exercise intolerance
• cheyne-stroke respirations
• hypotension
• tachycardia
• cyanosis of lips and nail beds
• cold and pale extremities
• diaphoresis
• diminished pulse pressure

18. DIAGNOSIS OF HEART FAILURE/INVESTIGATIONS
• Diagnosis of heart failure: 2 major or 1 major with 2 minors

20. • INVESTIGATIONS
• 1.) CHEST X RAY
• cardiomegaly
• kelly,s lines: A(longer) and B(shorter)
• pulmonary congetion-batwing haziness
• cephalization of veins
• bilateral pleural effusion

21. • 2.) ECG
• Left atrial enlargement
• arrythmias
• ventricular hypertrophy
• previous myocardial infarction
• 3.)ECHOCARDIOGRAPHY
• 4.)MRI
• 5.)EXERCISE TESTING:Treadmill or bicycle exercise testing is not routinely advocated for patients with
HF, but either is useful for assessing the need for cardiac transplantation in patients with advanced HF.
A peak oxygen uptake (vo2) <14 mL/kg per min is asso_x0002_ciated with a relatively poor prognosis.
Patients with a vo2 <14 mL/kg per min have been shown, in general, to have better survival when
transplanted than when treated medically.
• 6.) CARDIAC BIOMARKERS:
• a BNP>400pg/dl and NT pro-BNP>1000pg/dl=confirmation of heart failure
• no heart failure=BNP<100pg/dl and NT pro-BNP=<300pg/dl
• 7.) OTHERS: pulmonary arterybcatheterization,coronary angiogram, renal/thyroid function tests, full
blood count, lipid profile, blood sugar.

23. MANAGEMENT
• AIMS:
• to improve symptoms and quality of life
• to reduce disease progression
• to reduce risk of death and need for hospitalization
• 1.) NONPHARMACOLOGICAL
• A.) Diet: low salt(<4g/dl)/low fat/ eat lots of fruits and vegetabales as well
as high fibre containing diet and also limit water intake to 1,5liters.
• B.) Smoking cessation/ limit alcohol intake
• C.) Physical activity: exercise at least 30 mins aerobic exercise/brisk, walk
with 5days and ideally 7 days a week

24. • 2.) PHARMACOLOGICAL

28. REFERENCES
• DAVIDSONS PRINCIPLES AND PRACTICE OF MEDICINE(24TH EDITION) BY IAN
D. PENMAN, E’TAL..
• HARRISON’S PRINCIPLES OF INTERNAL MEDICINE(20TH EDITION) BY DR
FAUCI, E’TAL..
• KUMAR AND CLARK’S CLINICAL MEDICINE(10TH EDITION) BY PROFESSOR
DANE PARVEEN J KUMAR, E’TAL..
• STEP UP TO MEDICINE(5TH EDITION) BY STEVEN AGABEGI, E’TAL..
• DAVIDSON’S ESSENTIALS OF MEDICINE(2ND EDITION) BY J. ALASTAIRS INNES,
E’TAL..
• BOARD BASICS: AN ENHANCEMENT TO MKSAP 19

29. • THANK YOU
• NEXT SLIDE: PULMONARY OEDEMA, COR
PULMONALE/PULMONARY HYPERTENSION, ACUTE
DECOMPENSATED HEART FAILURE...