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Dr SAMIR TAYFOUR
CONSULTANT CARDIOLOGIST

HAIL CARIAC CENTRE
KSA
normal

Pump failure
Causes of left ventricular
failure
• Volume over load:

Regurgitate valve
High output status

• Pressure overload:
• Loss ...








Forward Vs Backward
Rt. Vs Lt. sided HF
Biventricular HF
Acute Vs Chronic HF
Flash pulmonary edema
Low Vs H...
Ventricular remodeling after acute infarction

Ventricular Remodeling

Initial infarct

Expansion of infarct
(hours to day...
Framingham Criteria for Congestive Heart Failure
Major criteria:
Paroxysmal nocturnal dyspnea
Neck vein distention
Rales
R...
Class III
1.20 M
(25%)

Class IV
240 K
(5%)

Class I
1.68 M
(35%)

Class II
1.68 M
(35%)
AHA Heart and Stroke Statistical ...
Stages of Heart Failure
At Risk for Heart Failure:
STAGE A High risk for developing HF
STAGE B Asymptomatic LV dysfunction...
Stages of Heart Failure

• Designed to emphasize preventability of HF
• Designed to recognize the progressive
nature of LV...
NYHA functional classes2

ACC/AHA HF stages1

• High risk for developing HF
• No structural disease

A

Class I

Asymptoma...
The Progressive Development of
Cardiovascular Disease
Risk Factors

Endothelial Dysfunction
Atherosclerosis
CAD
Myocardial...
>65years

Leading cause of hospitalization
Number 1 Killer
5 years from diagnosis
only 50% alive
Evolving paradigms of heart failure progression.

De Keulenaer G W , and Brutsaert D L Circulation
2011;123:1996-2005
Copy...
Conceptual approaches to cardiac performance.

De Keulenaer G W , and Brutsaert D L Circulation
2011;123:1996-2005
Copyrig...
The heart failure spectrum.

De Keulenaer G W , and Brutsaert D L Circulation
2011;123:1996-2005
Copyright © American Hear...
The ventricle is a dissipative structure with emerging properties.

De Keulenaer G W , and Brutsaert D L Circulation
2011;...
Volume –
overload
hypertrophy

Normal heart

Pressure –
overload
Hypertrophy


BNP
 With chronic heart failure, atrial mycotes secrete increase
amounts of atrial natriuretic peptide (ANP) and brain...
•B-type BNP is secreted by the
ventricles in response to
increase in ventricular pressure
or volume stress
•The diagnostic...
Chf lecture dr samir tayfour (2) consultant cardiologist-KSA-cardiac centre Hail.
Chf lecture dr samir tayfour (2) consultant cardiologist-KSA-cardiac centre Hail.
Chf lecture dr samir tayfour (2) consultant cardiologist-KSA-cardiac centre Hail.
Chf lecture dr samir tayfour (2) consultant cardiologist-KSA-cardiac centre Hail.
Chf lecture dr samir tayfour (2) consultant cardiologist-KSA-cardiac centre Hail.
Chf lecture dr samir tayfour (2) consultant cardiologist-KSA-cardiac centre Hail.
Chf lecture dr samir tayfour (2) consultant cardiologist-KSA-cardiac centre Hail.
Chf lecture dr samir tayfour (2) consultant cardiologist-KSA-cardiac centre Hail.
Chf lecture dr samir tayfour (2) consultant cardiologist-KSA-cardiac centre Hail.
Chf lecture dr samir tayfour (2) consultant cardiologist-KSA-cardiac centre Hail.
Chf lecture dr samir tayfour (2) consultant cardiologist-KSA-cardiac centre Hail.
Chf lecture dr samir tayfour (2) consultant cardiologist-KSA-cardiac centre Hail.
Chf lecture dr samir tayfour (2) consultant cardiologist-KSA-cardiac centre Hail.
Chf lecture dr samir tayfour (2) consultant cardiologist-KSA-cardiac centre Hail.
Chf lecture dr samir tayfour (2) consultant cardiologist-KSA-cardiac centre Hail.
Chf lecture dr samir tayfour (2) consultant cardiologist-KSA-cardiac centre Hail.
Chf lecture dr samir tayfour (2) consultant cardiologist-KSA-cardiac centre Hail.
Chf lecture dr samir tayfour (2) consultant cardiologist-KSA-cardiac centre Hail.
Chf lecture dr samir tayfour (2) consultant cardiologist-KSA-cardiac centre Hail.
Chf lecture dr samir tayfour (2) consultant cardiologist-KSA-cardiac centre Hail.
Chf lecture dr samir tayfour (2) consultant cardiologist-KSA-cardiac centre Hail.
Chf lecture dr samir tayfour (2) consultant cardiologist-KSA-cardiac centre Hail.
Chf lecture dr samir tayfour (2) consultant cardiologist-KSA-cardiac centre Hail.
Chf lecture dr samir tayfour (2) consultant cardiologist-KSA-cardiac centre Hail.
Chf lecture dr samir tayfour (2) consultant cardiologist-KSA-cardiac centre Hail.
Chf lecture dr samir tayfour (2) consultant cardiologist-KSA-cardiac centre Hail.
Chf lecture dr samir tayfour (2) consultant cardiologist-KSA-cardiac centre Hail.
Chf lecture dr samir tayfour (2) consultant cardiologist-KSA-cardiac centre Hail.
Chf lecture dr samir tayfour (2) consultant cardiologist-KSA-cardiac centre Hail.
Chf lecture dr samir tayfour (2) consultant cardiologist-KSA-cardiac centre Hail.
Chf lecture dr samir tayfour (2) consultant cardiologist-KSA-cardiac centre Hail.
Chf lecture dr samir tayfour (2) consultant cardiologist-KSA-cardiac centre Hail.
Chf lecture dr samir tayfour (2) consultant cardiologist-KSA-cardiac centre Hail.
Chf lecture dr samir tayfour (2) consultant cardiologist-KSA-cardiac centre Hail.
Chf lecture dr samir tayfour (2) consultant cardiologist-KSA-cardiac centre Hail.
Chf lecture dr samir tayfour (2) consultant cardiologist-KSA-cardiac centre Hail.
Chf lecture dr samir tayfour (2) consultant cardiologist-KSA-cardiac centre Hail.
Chf lecture dr samir tayfour (2) consultant cardiologist-KSA-cardiac centre Hail.
Chf lecture dr samir tayfour (2) consultant cardiologist-KSA-cardiac centre Hail.
Chf lecture dr samir tayfour (2) consultant cardiologist-KSA-cardiac centre Hail.
Chf lecture dr samir tayfour (2) consultant cardiologist-KSA-cardiac centre Hail.
Chf lecture dr samir tayfour (2) consultant cardiologist-KSA-cardiac centre Hail.
Chf lecture dr samir tayfour (2) consultant cardiologist-KSA-cardiac centre Hail.
Chf lecture dr samir tayfour (2) consultant cardiologist-KSA-cardiac centre Hail.
Chf lecture dr samir tayfour (2) consultant cardiologist-KSA-cardiac centre Hail.
Chf lecture dr samir tayfour (2) consultant cardiologist-KSA-cardiac centre Hail.
Chf lecture dr samir tayfour (2) consultant cardiologist-KSA-cardiac centre Hail.
Chf lecture dr samir tayfour (2) consultant cardiologist-KSA-cardiac centre Hail.
Chf lecture dr samir tayfour (2) consultant cardiologist-KSA-cardiac centre Hail.
Chf lecture dr samir tayfour (2) consultant cardiologist-KSA-cardiac centre Hail.
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Chf lecture dr samir tayfour (2) consultant cardiologist-KSA-cardiac centre Hail.

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Heart failure ,definition,classification,stages,causes,symptoms
diagnosis.

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Chf lecture dr samir tayfour (2) consultant cardiologist-KSA-cardiac centre Hail.

  1. 1. Dr SAMIR TAYFOUR CONSULTANT CARDIOLOGIST HAIL CARIAC CENTRE KSA
  2. 2. normal Pump failure
  3. 3. Causes of left ventricular failure • Volume over load: Regurgitate valve High output status • Pressure overload: • Loss of muscles: Systemic hypertension Outflow obstruction Post MI, Chronic ischemia Connective tissue diseases Infection, Poisons (alcohol,cobalt,Doxorubicin) • Restricted Filling: Pericardial diseases, Restrictive cardiomyopathy, tachyarrhythmia
  4. 4.        Forward Vs Backward Rt. Vs Lt. sided HF Biventricular HF Acute Vs Chronic HF Flash pulmonary edema Low Vs High output HF Systolic Vs Diastolic HF
  5. 5. Ventricular remodeling after acute infarction Ventricular Remodeling Initial infarct Expansion of infarct (hours to days) Global remodeling (days to months) Ventricular remodeling in diastolic and systolic heart failure Normal heart Hypertrophied heart (diastolic heart failure) Dilated heart (systolic heart failur
  6. 6. Framingham Criteria for Congestive Heart Failure Major criteria: Paroxysmal nocturnal dyspnea Neck vein distention Rales Radiographic cardiomegaly Acute pulmonary edema S3 gallop Increased central venous pressure (>16 cm H2O at right atrium) Hepatojugular reflux Weight loss >4.5 kg in 5 days in response to treatment Minor criteria: Bilateral ankle edema Nocturnal cough Dyspnea on ordinary exertion Hepatomegaly Pleural effusion Decrease in vital capacity by one third from maximum recorded Tachycardia (heart rate>120 beats/min.)
  7. 7. Class III 1.20 M (25%) Class IV 240 K (5%) Class I 1.68 M (35%) Class II 1.68 M (35%) AHA Heart and Stroke Statistical Update 2001 Class I No limitations of physical activity Class II Slight limitations of physical activity Class III Marked limitations of physical activity Class IV Inability to carry out physical activities without discomfort and/or symptoms at rest
  8. 8. Stages of Heart Failure At Risk for Heart Failure: STAGE A High risk for developing HF STAGE B Asymptomatic LV dysfunction Heart Failure: STAGE C Past or current symptoms of HF STAGE D End-stage HF
  9. 9. Stages of Heart Failure • Designed to emphasize preventability of HF • Designed to recognize the progressive nature of LV dysfunction
  10. 10. NYHA functional classes2 ACC/AHA HF stages1 • High risk for developing HF • No structural disease A Class I Asymptomatic • Structural heart disease • No HF symptoms B Class II Symptomatic with moderate exertion • Structural heart disease • Prior or current HF symptoms C Class III Symptomatic with minimal exertion • Refractory end-stage HF D Class IV Symptomatic at rest requiring special interventions Hunt SA et al. J Am Coll Cardiol. 2001;38:2101–2113. 2 Criteria Committee of the New Year Heart Association. Nomenclature and Criteria for Diagnosis of Diseases of the Heart and Great Vessels. 7th ed. Boston: Little, Brown, 1973:286. 1 23
  11. 11. The Progressive Development of Cardiovascular Disease Risk Factors Endothelial Dysfunction Atherosclerosis CAD Myocardial Ischemia Coronary Thrombosis Myocardial Infarction Arrhythmia & Loss of Muscle Remodeling Ventricular Dilation Congestive Heart Failure Endstage Heart Disease
  12. 12. >65years Leading cause of hospitalization
  13. 13. Number 1 Killer
  14. 14. 5 years from diagnosis only 50% alive
  15. 15. Evolving paradigms of heart failure progression. De Keulenaer G W , and Brutsaert D L Circulation 2011;123:1996-2005 Copyright © American Heart Association
  16. 16. Conceptual approaches to cardiac performance. De Keulenaer G W , and Brutsaert D L Circulation 2011;123:1996-2005 Copyright © American Heart Association
  17. 17. The heart failure spectrum. De Keulenaer G W , and Brutsaert D L Circulation 2011;123:1996-2005 Copyright © American Heart Association
  18. 18. The ventricle is a dissipative structure with emerging properties. De Keulenaer G W , and Brutsaert D L Circulation 2011;123:1996-2005 Copyright © American Heart Association
  19. 19. Volume – overload hypertrophy Normal heart Pressure – overload Hypertrophy
  20. 20.  BNP  With chronic heart failure, atrial mycotes secrete increase amounts of atrial natriuretic peptide (ANP) and brain natriuretic pepetide (BNP) in response to high atrial and ventricular filling pressures  Usually is > 400 pg/mL in patients with dyspnea due to heart failure.
  21. 21. •B-type BNP is secreted by the ventricles in response to increase in ventricular pressure or volume stress •The diagnostic accuracy of BNP increases tremendously with inclusion of patients with HFPEF • BNP has reported sensitivity of 91% and specificity of 82% • BNP is developing into an exclusion test for heart failure however role of BNP for defining prognosis and monitoring of therapy still requires more investigation

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