This document provides guidelines on the management of heart failure. It defines heart failure as resulting from any structural or functional impairment of ventricular filling or ejection of blood. The main manifestations are dyspnea, fatigue, and fluid retention. Heart failure is classified based on ejection fraction into HFrEF (reduced EF ≤40%) or HFpEF (preserved EF ≥50%). HFrEF is usually caused by conditions that weaken the heart muscle such as coronary artery disease or cardiomyopathy. HFpEF is often associated with hypertension and diastolic dysfunction. The guidelines also classify heart failure functionally and in stages to help determine treatment and prognosis.

1. Guidelines on management of
Heart Failure
Dr. Muhammad Arslan

2. In accordance with

3. Definition of HF
“HF is a complex clinical syndrome that results from
any structural or functional impairment of ventricular filling
or ejection of blood.”

4. Manifestations of HF
The cardinal manifestations of HF are dyspnea and
fatigue, which may limit exercise tolerance, and fluid
retention, which may lead to pulmonary and/or
splanchnic congestion and/or peripheral edema.
Because some patients present without signs
or symptoms of volume overload, the term
“heart failure” is preferred over “congestive
heart failure.”
Some patients have exercise intolerance but
little evidence of fluid retention, whereas
others complain primarily of edema, dyspnea,
or fatigue.

5. CLASSIFICATION
Of Heart Failure
On the Basis of
Ejection Fraction

6. HF With Reduced EF (HFrEF)
also referred to as Systolic HF
• HFrEF is defined as the clinical diagnosis of HF
AND EF ≤40%.
• In approximately half of patients with HFrEF,
variable degrees of LV enlargement may
accompany HFrEF.
• Coronary artery disease (CAD) with antecedent
myocardial infarction (MI) is the major cause of
HFrEF. Risk factors are Hypertension, Diabetes,
Metabolic syndrome and atherosclerosis.

7. Other causes are:
• Dilated Cardiomyopathy
– Idiopathic
– Familial
• Metabolic Cardiomyopathies
– Obesity Cardiomyopathy
– Diabetic Cardiomyopathy
– Thyroid disorders
– GH disorders
• Toxic Cardiomyopathies
– Alcoholic Cardiomyopathy
– Cocaine Cardiomyopathy
• Tachycardia Induced
Cardiomyopathy
• Infectious Cardiomyopathy
• Myocarditis
• AIDS
• Chaga’s disease
• Inflammatory Cardiomyopathy
• Hypersensitivity
• Rheumatlogical
• Peripartum Cardiomyopathy
• Amyloidosis
• Sarcoidosis
• Iron Overload
• Stress Cardiomyopathy

8. HF with Preserved EF (HFpEF)
also referred to as Diastolic HF
• Criteria proposed to define the syndrome of
HFpEF include
(a) clinical signs or symptoms of HF
(b) evidence of normal or preserved LVEF (≥50%)
(c) evidence of abnormal LV diastolic dysfunction
that can be determined by Doppler
echocardiography or cardiac catheterization
(a) Hypertension is the major causative factor.

9. a. HFpEF, borderline EF: 41 to 49 %
These patients fall into a borderline or intermediate group.
Their characteristics, treatment patterns, and outcomes
appear similar to those of patients with HFpEF.
b. HFpEF, improved EF: >40%
A subset of patients with HFpEF previously had HFrEF. These
patients with improvement or recovery in EF may be clinically
distinct from those with persistently preserved or reduced EF.
Further research is needed to better characterize these
patients.

10. of
Heart Failure
FUNCTIONAL
CLASSIFICATION

12. of
Heart Failure
STAGES

14. Comparing
FUNCTIONAL
Classification
with STAGES