The document discusses updated guidelines for the diagnosis and treatment of heart failure. It defines heart failure and outlines its global prevalence, noting that over 23 million people worldwide have the condition. Diagnostic tests discussed include echocardiograms, EKGs, blood tests and imaging. Heart failure is classified based on its onset, affected chambers, and clinical severity. Treatment involves pharmacological optimization as well as procedures like revascularization, valve surgery, implantable cardioverter-defibrillators and cardiac resynchronization therapy.

1. UPDATE OF HEART
FAILURE GUIDELINES
Dr. Mohamad Ashraf MD, PhD
Consultant cardiology and director of heart
failure program PSCCH

2. Definition of HF
 Heart failure can be defined as an abnormality
of cardiac structure or function leading to
failure of the heart to deliver oxygen at a rate
commensurate with the requirements of the
metabolizing tissues, despite normal filling
pressures.

4. Scope of the problem
 Heart failure (HF) is a chronic syndrome
characterized by significant physical,
psychological and social burdens, resulting in
poor quality of life.
 It is a chronic and progressive clinical
syndrome associated with increased neuro-
hormonal activity and multiple organ
dysfunction.
 HF is a major public health issue, with 23
million cases worldwide.

5.  The American Heart Association (AHA) estimates that
5.7 million Americans older than 20 years have HF
based upon 2007-2010 data, representing an annual
cost of $34.4 billion annually.
 The incidence of HF ranges between 1% and 19.3 per
1,000 person-years in older adults ≥65 years
 The extrapolated prevalence of HF in Saudi Arabia is
455,222 cases and the estimated incidence is 32,200
cases annually (Health Grades Inc., 2012).
 A study by Albackr et al. (2013) showed that 20% of the
patients who were admitted to Saudi hospitals with
acute coronary syndrome (ACS) had HF.

6.  HF has negative impacts on all aspects of
patients’ physical, social, psychological,
emotional and spiritual well-being.
 HF patients have difficulties in performing
activities of daily living; suffer from economic,
sexual and psychosocial problems; and
encounter troubles in social and professional
relationships.

9. Classification of heart failure
 According to the onset:
 Acute heart failure
 Chronic heart failure.
 According to failed chamber:
 Left sided heart failure
 Right sided heart failure
 According to the clinical state:
 Compensated HF
 Decompensated HF

11. Functional classes of HF

12. Stages of HF

16.  Blood tests. Your doctor may take a blood sample to look for signs
of diseases that can affect the heart. He or she may also check for a
chemical called N-terminal pro-B-type natriuretic peptide (NT-
proBNP) if your diagnosis isn't certain after other tests.
 Chest X-ray. X-ray images help your doctor see the condition of
your lungs and heart. Your doctor can also use an X-ray to diagnose
conditions other than heart failure that may explain your signs and
symptoms.
 Electrocardiogram (ECG). This test records the electrical activity
of your heart through electrodes attached to your skin. It helps your
doctor diagnose heart rhythm problems and damage to your heart.
 Echocardiogram. An echocardiogram uses sound waves to
produce a video image of your heart. This test can help doctors see
the size and shape of your heart along with any abnormalities. An
echocardiogram measures your ejection fraction, an important
measurement of how well your heart is pumping, and which is used
to help classify heart failure and guide treatment.

17. Diagnostic tests in HF
 ECG
 Echocardiography
 Chest X ray
 Stress test and cardiopulmonary exercise.
 Cardiac computerized tomography (CT) scan.
 Magnetic resonance imaging (MRI).
 Coronary angiogram and right heart cath.
 Myocardial biopsy.

18.  Lab tests:
 Natriuretic peptide (ANP, BNP, ..
 CBC
 Renal function
 Liver function
 Glucose and HbA1c
 Serum Na and K
 Thyroid function
 Lipid profile

25. Non pharmacological treatment of
HF
 Coronary revascularization (PCI and CABG).
 Valve surgery
 ICD:
 Primary and secondary prevention
 CRT:
 Is recommend for symptomatic patients with HF
in sinus rhythm with QRS ≥ 130 ms and LBBB
QRS morphology with EF ≤ 35% despite OMT in
order to improve symptoms and reduce morbidity
and mortality.
 LVAD: