Heart failure is defined as the heart's inability to pump enough blood to meet the body's needs. It can be caused by conditions that impair the heart muscle or overload it. Heart failure is classified based on location (right, left, or both ventricles), timing (acute or chronic), and pumping ability (systolic or diastolic). Signs and symptoms include dyspnea, fatigue, fluid retention, and reduced exercise tolerance. Treatment involves lifestyle changes, medications to relieve symptoms and improve pumping ability, and treating the underlying cause.
2. Heart failure Definition ‘Failure of the heart to maintain a cardiac output sufficient to meet the metabolic demands of the body’ Physiology Cardiac Output = Heart Rate X Stroke Volume - Latter is dependent on: Preload = Left ventricular end diastolic volume i.e. amount of stretch of left ventricle = volume overload Afterload = Total peripheral resistance = pressure overload Contractility = Capacity of myocardium to 'respond to' preload and afterload
3. Heart failure A)Classification:New York Heart Association Functional Classification Class I: no limitation is experienced in any activities; there are no symptoms from ordinary activities. Class II: slight, mild limitation of activity; the patient is comfortable at rest or with mild exertion. Class III: marked limitation of any activity; the patient is comfortable only at rest. Class IV: any physical activity brings on discomfort and symptoms occur at rest.
4. Heart failure B)Classification of heart failure: 1.Right heart failure 2.Left heart failure 3.Biventricular failure C) Classification of heart failure: 1.Acute heart failure 2.Chronic heart failure
5. Heart failure D) Heart failure is often classified as either systolic or diastolic. 1.Systolic heart failure means,heart muscle cannot pump, or eject, the blood out of the heart very well. 2.Diastolic heart failure means, heart's pumping chamber does not fill up with blood.
6. Heart failure Causes: Valve heart disease - approximately 10% of cases.Aorticstenosis can cause left ventricular hypertrophy due to chronic excessive afterload. Aortic or mitral regurgitation, ASD, VSD and tricuspid incompetencecause excessive preload.
7. Heart failure Causes: Heart failure secondary to myocardial disease:Coronary heart disease (myocardial infarction (MI) and ischaemia, arrhythmias, e.g. atrial fibrillation, heart block) Hypertension (increased vascular resistance, often with left ventricular hypertrophy ) Cardiomyopathies
11. Heart failure Local change in heart: Chamber enlargement Myocardial hypertrophy Increased heart rate
12. Heart failure Clinical feature: Dyspnoea and fatigue (may limit exercise tolerance). Fluid retention (may cause pulmonary or peripheral oedema). Patients do not necessarily have both, and either may dominate at any one time. In addition, patients may be depressed or complain of drug-related side-effects.
13. Heart failure Clinical feature: When the left ventricle is failing (LVF): dyspnoea, poor exercise tolerance, fatigue, orthopnoea, paroxysmal nocturnal dyspnoea (PND), nocturnal cough or wheeze. Right ventricular failure: (RVF) peripheral oedema (up to thighs, sacrum, abdominal wall), abdominal distension (ascites), nausea, anorexia, facial engorgement, pulsation in neck and face (tricuspid regurgitation), epistaxis.
14. Heart failure Clinical feature: The patient may look ill and exhausted, with tachypnoea, cool peripheries, peripheral ± central cyanosis. There may be a tachycardia at rest, low systolic BP, a displaced apex (LV dilatation) or RV heave (pulmonary hypertension)and a raised JVP.
15. Heart failure Clinical feature: On auscultation there may be a gallop rhythm or murmurs of mitral or aortic valve disease; wheeze , pleural effusions, tender hepatomegaly – pulsatile in tricuspid regurgitation, with ascites and often extensive peripheral oedema. The peak expiratory flow rate may be reduced but, if it is < 150 litres/min, suspect COPD or asthma.
16. Right Heart Failure Causes: Secondary to LVF LD-CB VHD- MS Congenital heart disease- ASD,VSD Pulmonary embolism Myocarditis MI
23. Heart failure Management in acute case:LVF/PE Bed rest in propped up position O2 inhalation Inj:morphine 10 mg iv Frusemide 40-80 mg iv Glyceryltrinitrate Dubutamine 2.5-10 μg/kg/min Aminophylline 250-500 mg infused over 10 mins
