Download Congestive Heart Failure (CHF)

Congestive Heart Failure
Symptoms & signs
BY : DR.F.Sahebjamee
Cardiologist
Heart Failure Incidence and
Prevalence
♥ Prevalence
Worldwide – 22 million
United States – 5 million
♥ Incidence
Worldwide – 2 million new cases year
United States – 500,000 new cases year
2 Types of Heart Failure
Systolic Dysfunction
Diastolic Dysfunction
♥ The heart becomes
♥ Chambers don’t fill up
so less blood goes to the
lungs and body
(Contraction) 2/3 of Patients
weak and enlarged
♥ The weakened heart
muscle can’t contract
♥ Not enough blood is
pumped from the
chambers
(Relaxation)
♥ Stiff heart muscle can’t
relax
♥ Not enough blood fills
the chambers
Symptoms and signs of heart failure
1. forward failure:
symptoms result from inability of the heart to pump enough
blood to the periphery (from left heart), or to the lungs (from
the right heart)
a) forward failure of left heart:- muscle weakness, fatigue,
dyspepsia, oliguria....
 general mechanism: tissue hypoperfusion
b) forward failure of right heart: - hypoperfusion of the
lungs  disorders of gas
exchange
- decreased blood supply
to the left heart
2. backward failure:
– symptoms result from inability of the heart to accept
the blood comming from periphery and from lungs
a.
backward failure of left heart:
– increased pulmonary capillary pressure  dyspnea
and tachypnoea, pulmonary edema (cardiac asthma) 
 arterial hypoxemia and hypercapnia....
b. backward failure of right heart:
– increased pressure in systemic venous system 
 peripheral edemas, hepatomegaly, ascites nocturnal diuresis....
New York Heart Association
Functional Classification
Class I
No symptoms with
ordinary activity
Class II
Slight limitation of
physical activity
results in fatigue,
shortness of breath,
chest pain or
irregular heart beat
New York Heart Association
Functional Classification
Class III
Marked limitation of
physical activity.
Comfortable at rest,
but less than ordinary
physical activity results
in fatigue, irregular
heart beat, pain or
shortness of breath
Class IV
Unable to carry out any
physical activity
without discomfort
All symptoms in class
III even at rest
Systolic Heart Failure by NYHA Class
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 2009
unNatural History of Heart Failure
10
75
Survival Rate
Hospitalizations
50
1
25
.1
0
I
II
III
IV
Hospitalizations / year
Annual Survival Rate
100
Advanced Heart Failure
N=200,000
age 65 (50%)
# of meds (9)
# hosp (5)
$$$ (12 billion)
Mortality (50%/yr)
Rx???
Deceased
NYHA CLASS
Adapted from Bristow, MR Management of Heart Failure, Heart Disease: A Textbook of
Cardiovascular Medicine, 6th edition, ed. Braunwald et al.
Symptoms and Mortality
80
REM ATCH
% Mortality
Class IV
CONSENSUS-I
60
Class II-III
Class III-IV
40
Class I
20
PROM ISE
VHeFT-I
SOLVD-Rx
SAVE
SOLVD-pre
0
0
20
40
Months
60
Early Symptoms of Heart
Failure
♥ A weight gain or loss of 2 or more
pounds in 1 day, or 4 pounds in 1 week
♥ Confusion, restlessness or lightheaded
♥ A feeling of fullness or bloating in
your stomach
♥ Cough, shortness of breath, swelling
♥ Fatigue, lose of appetite, or nausea
Urgent Symptoms of Heart
Failure
♥ Increased shortness of breath while resting or
trouble sleeping
♥ Waking up suddenly at night due to difficulty
breathing
♥ A need to sleep sitting up or a need for more pillows
than usual
♥ A fast irregular heart beat, a racing heart that makes
you feel dizzy, or like you are going to pass out
♥ Coughing up pink frothy mucus
DYSPNEA
Abnormally uncomfortable awareness of
breathing
Dyspnea after strenous activity- NORMAL
INDIVIDUAL
Dyspnea after moderate activity –
DECONDITIONED INDIVIDUAL
Dyspnea becomes abnormal only if it
occurs at rest or at a level of activity not
expected to cause dyspnea
DIFFERENTIAL DIAGNOSIS OF
DYSPNEA
PULMONARY
- Reactive airways disease
- COPD
- pulmoary edema
- pulmonary hypertension
- infection
- pulmonary embolism
- pleural diseases
- interstitial lung disease
DIFFERENTIAL DIAGNOSIS OF
DYSPNEA
CARDIAC
-ischemic heart dsease
- right sided heart failure
- arrhythmias
- dilated cardiomyopathy
- hypertrophic cardiomyopathy
- valve stenosis and regurgitation
ACUTE DYSPNEA
Sudden development of dyspnea
- pulmonary embolism
- pneumonia
- airway obstruction
- Spontaneous pnumothorax
- Pulmonary Edema
CHRONIC DYSPNEA
Symptom progress slowly or gradual
- HEART FAILURE
- COPD(chronic obstructive pulmonary disease)
DYSPNEA
INSPIRATORY DYSPNEA- obstruction in
upper airway
EXPIRATORY DYSPNEA- obstruction of
lower respiratory tract
EXCERTIONAL DYSPNEA- left ventricular
failure or COPD
FUNCTIONAL DYSPNEA- dyspnea at
rest and not during activity
ORTHOPNEA
Inability to breath comfortably when lying
Severe pulmonary venous congestion is
the cause of orthopnea
Usually seen in advance heart failure were
resting pulmonary venous pressure is
elevated
PAROXYSMAL NOCTURNAL
DYSPNEA
Interstitial or intera alveolar pulmonary
edema
Secondary to ventricular failure
Symptom starts 2-4 hours after sleeping,
patient arise from sleep feeling short of
breath
Symptom ameliorated by sitting on the
side of bed and take about 15-30 min
Measuring Jugular Venous Pressure