Cardiac (Heart) Failure

CARDIOVASCULAR DISEASES
CARDIAC (HEART) FAILURE
1
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
Afflicts 10 out of every 1,000 people over age 65 in the
United States - (Statistics from American Heart association - 2002)
In India
20% of hospital admissions among persons older than 65
45% annual mortality in severe symptomatic heart failure
What Is HF ?
The heart does not pump efficiently, not able
to move as much blood as it should pump
with each beat
Not maintain adequate cardiac output
Organs in the body do not get enough oxygen

rich blood that they need to work well
Causes of Cardiac (Heart) Failure
Elevated filling pressure
(Metabolic demand like exercise / stress)
Clinical syndrome
(All forms of heart disease can lead to failure)
4
The most common clinical causes of HF
HF is a syndrome, so always possible for one or more

underlying cause!
Ischemic heart disease ~ 40 percent

Dilated cardiomyopathy ~ 30 percent
Primary valvular heart disease ~ 15 percent
Hypertensive heart disease ~ 10 percent
Other ~ 5 percent
Specific Causes & Mechanisms
Ventricular outflow obstruction (Pressure overload)
Ventricular inflow obstruction
Ventricular volume overload
Impaired Ventricular function
6
Cardiac Output
Preload
- Volume and pressure of blood entering in ventricle at
end of diastole
After load
- At end of systole
(Arterial resistance)
Myocardial contractility
Cardiac Failure
- Increases 3
7
Symptoms
8
Affects Peripheral Circulation
Impaired renal perfusion
- Salt / water retention
- Oedema
- Aldosteronism
Neuro-hormonal activation
- Activation of sympathetic nervous system
- Activation of renin-angiotensin system
- Peripheral vascular resistance
9
ACE Angiotensin Converting Enzyme, ADH Anti Diuretic Hormone, Aldosterone Steroid
hormone that balances the Na, K, Ca levels, Sympathetic Stimulating Nerves 10
11
Types of Heart Failure
Acute / Chronic heart failure
Left / Right / Biventricular heart failure
Forward & Backward heart failure
Diastolic & Systolic dysfunction
High Output failure
12
Acute / Chronic heart failure
Acute Myocardial infarction
Chronic Progressive valvular heart disease
Compensatory changes in heart includes hypertrophy,

chamber enlargement, increased heart rate
Common in persons with pulmonary embolism, increased

metabolic demand, pregnancy, thyrotoxicosis, anaemia
FACTORS AGGRAVATING:
- Reduction on therapy
- Fluid retaining drugs (Corticosteroids)
- Stress
- Arrhythmia
- Infection & illness 13
Left / Right / Biventricular heart failure
Due to cardiac myopathy ischaemic heart diseases
Left Heart: Right Heart:

LA, LV, Mitral valve, Aortic RA, RV, Tricuspid valve,
valve Pulmonary valve
Decrease output & increase Decrease output & increase
pressure pressure
Leads to pulmonary Due to multiple pulmonary
congestion, Pulmonary emboli, pulmonary valvular
oedema, pulmonary stenonis
hypertension
14
Signs & Symptoms
Left-Sided Heart Failure Right-Sided Heart Failure
Dyspnea
Unexplained cough Lower extremity edema
Pulmonary crackles Liver enlargement
Low oxygen saturation Anorexia
Third heart sound Abdominal pain
Reduced urine output Nausea
Altered digestion Weight gain
Dizziness and light- Weakness
headedness
Confusion
Restlessness and anxiety
Fatigue and weakness
Forward & Backward heart failure
Forward Inadequate cardiac output
Backward Normal output, but more salt and water retention

leading to pulmonary and systemic venous congestion
High output failure

Large Atrio Ventricular (AV) shunt, severe anaemia, thyrotoxicosis
16
Diastolic & Systolic heart failure
Diastolic Poor ventricular filling, High filling pressure,
Abnormal ventricular relaxation
Systolic Impaired myocardial contraction
17
Diagnostic Tests
Echocardiography to assess Radionuclide ventriculo-
ejection fraction (EF) graphy
Chest X-ray Ambulatory ECG
ECG monitoring (Halter
Cardiac stress test monitor)
Cardiac catheterization Pulmonary function tests
Cardiac computed Heart biopsy
tomography (CCT) scan or Exercise testing
magnetic resonance (6-minute walk)
imaging (MRI)
19
Other Diagnostic Tests
Medical history and physical exam
Brain natriuretic peptide (Na+, proteins) measurement
Lab tests: complete blood cell count, metabolic panel,

liver function studies and urine analysis
Other tests: Thyroid function tests and fasting lipid

profile
Non-pharmacologic treatment
Exercise training for stable HF patients, increased exercise
capacity -> decreased hospitalization rate, increased quality of
life, decreased symptoms.
Weight loss in obese patients
Dietary Na restriction ( 2 g/day)
Fluid and free water restriction ( 1.5 L/day)
Minimize medications known to have deleterious effects on
heart failure (negative ionotrops, NSAIDs, over-the-counter
stimulants)
Adequate Oxygen
Fluid removal (dialysis, thoracentesis, paracentesis)
Pharmacologic treatment
IV Vasodilators
- Nitroglycerine
- Nitroprusside
IV Inotropic agents
- Dopamine
- Dobutamine
- ACE inhibitors
IV Diuretics
- Furosemide
- Bumetanide
Surgical treatment
Coronary artery bypass grafting

(revascularization)
Percutaneous coronary intervention (Angioplasty)
Valve replacement surgery
Biventricular pacemaker
Heart transplantation
Left ventricular assist device (LVAD)
Drugs to avoid in HF patients
NSAIDs - Induce systemic vasoconstriction, counteract ACE

inhibitors, blunt the effects of diuretics.
Thiazolidinediones - Contribute to fluid retention. Should be

avoided in severe failure.
Metformin - Increased risk of lactic acidosis.
Cilostazole - (Phosphodiesterase (PDE) inhibitor) Increases

mortality.
Calcium channel blockers - (avoid Verapamil and Diltiazem)

Trials with amlodipine and felodipine showed a neutral effect
on mortality.
What should be done to prevent
Progression of the Disease?
Become Conscious of Lifestyle Choices!
Make Better Choices
Quit Smoking
Reduce Weight
Avoid Excess Alcohol and Drugs
Exercise
Take Medication
Immunization
Communicate with health care specialists and get
knowledge about your health
Treat high cholesterol, diabetes and irregular heart beat
Attention on salt intake, swelling and stress
Early Symptoms of Heart Failure
Can be Treated and Cured
A weight gain - 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

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What are the most common causes of heart failure?

What are the most common causes of heart failure?

What are some of the symptoms of heart failure?

What are some of the symptoms of heart failure?

CARDIOVASCULAR DISEASES

CARDIAC (HEART) FAILURE

Not maintain adequate cardiac output

Organs in the body do not get enough oxygen

HF is a syndrome, so always possible for one or more

Ischemic heart disease ~ 40 percent

Ventricular inflow obstruction

Ventricular volume overload

Impaired Ventricular function

Left / Right / Biventricular heart failure

Forward & Backward heart failure

Diastolic & Systolic dysfunction

High Output failure

Chronic Progressive valvular heart disease

Compensatory changes in heart includes hypertrophy,

Common in persons with pulmonary embolism, increased

Due to cardiac myopathy ischaemic heart diseases

Left Heart: Right Heart:

Backward Normal output, but more salt and water retention

High output failure

Brain natriuretic peptide (Na+, proteins) measurement

Lab tests: complete blood cell count, metabolic panel,

Other tests: Thyroid function tests and fasting lipid

Coronary artery bypass grafting

NSAIDs - Induce systemic vasoconstriction, counteract ACE

Thiazolidinediones - Contribute to fluid retention. Should be

Metformin - Increased risk of lactic acidosis.

Cilostazole - (Phosphodiesterase (PDE) inhibitor) Increases

Calcium channel blockers - (avoid Verapamil and Diltiazem)

A weight gain - Loss of 2 or more pounds

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