Download Heart failure

HEART FAILURE
“pump failure”
DEFINITION
Heart failure is the inability of the heart to
supply adequate blood flow and therefore
oxygen delivery to the peripheral tissues
and organs
EPIDEMIOLOGY
 Only cardiovascular disease with
increasing incidence and prevalance
due to
 Aging population
 Increased survival after MI--thrombolysis
 Improvement of medical and surgical
treatment
PATHOPYSIOLOGY
 Heart is a pump which works with the
lungs.
 It pumps blood from the heart to the lungs
to pick up oxygen.
 The oxygenated blood returns to the heart
 It then pumps blood out into the circulatory
system
CLASSIFICATION OF HEART FAILURE
This is based on:
How rapid symptoms develop---acute HF
---chronic HF
Which ventricle is involved---right side HF
---left side HF
Over all cardiac output---systolic HF
---diastolic HF
CLASSIFICATION ACCORDING TO ONSET OF
SYMPTOMS:
Acute heart failure
--characterized by a rapid onset of heart failure that may
occur following
1- MI
2-myocarditis
3-arrythmias
4- infection
5- PE
If it is not fatal may progress to chronic heart failure
Chronic heart failure
This results from the heart undergoing
adaptive responses to precipitating cause
and this cardiac response leads to
impaired function.
1- anemia
2-thyrotoxicosis
3-non compliance to medications
4- diet—high salt
CLASSIFICATION ACCORDING TO OVER
ALL CARDIAC OUTPUT
Systolic heart failure
The ventricle loses its ability to contract so
the heart is unable to pump forcefully
enough to get blood into the circulation.
Diastolic heart failure
The ventricle loses its ability to relax , the
muscle are stiff so the heart is unable to fill
with blood during resting cycle
CLASSIFICATION ACCORDING TO VENTRICLE
INVOLVED
Left side heart failure
 This involves the left atrium, left ventricle,mitral
and aortic valve
 Patient presents with
--- dyspnoe,orthopnoe and PND
--- basal crepitations
--- 3rd heart sound--gallop
Right side heart failure
This involves the right atrium, the right ventricle ,
the tricuspid and the pulmonary valve.
 Patient usually does not present with dyspnoe ,
orhtopnoe or PND
 Raised JVP
 Clear lung field
 Ascites
 Lower limb edema
ETIOLOGY
 Myocardial infarction
 Coronary artery disease
 Valvular heart disease
 Idiopathic cardiomyopathy
 Viral or bacterial cardiomyopathy
 myocarditis
ETIOLOGY cont.
 Pericarditis
 Arryhthmias
 Hypertension
 Thyroid disease
 Pregnancy
 Septic shock
ETIOLOGY cont.
 Toxins—anthracyclines
amphetamine
cocaine
 Metabolic---haemachromatosis
wilson,s disease
pheochromocytoma
SYMPTOMS
NYHA classification of dyspnoe
 Class 1—no shortness of breath {SOB}
 Class 11—SOB on severe exertion
 Class 111—SOB on mild exertion
 Class 1v---SOB at rest
SYMPTOMS cont.{ FACES}
 Fatigue
 Activity decrease
 Cough { specially supine,frothy red sputum
 Edema
 Shortness of breath { NYHA }
SIGNS
 Non productive cough
 Diffuse laterally displaced apex beat
 Raised JVP
 Hepatojugular reflex
 Hepatomegaly
 Resting tachycardia
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Oliguria
Crepitations
Pleural effusion
Pulses alternans { severe cases}
S3 gallop
Unexplained weight gain
Ankle swelling
Ascites
INVESTIGATION
 CBC
 U+E
 LFT
 Cardiac enzymes
 CXR
 ECG
 Echocardiogram
TREATMENT
 Diuretics
 Digoxin
 ACE inhibitors
 Vasodilators