Heart Failure

Ceri Davies
Consultant Cardiologist
Barts and the London NHS Trust

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 Definition
Epidemiology
Descriptive terms
Pathophysiology
Causes
Signs and symptoms
Investigations
Treatment

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 Definition
Epidemiology
Descriptive terms
Pathophysiology
Causes
Signs and symptoms
Investigations
Treatment

3
 Definition (1)

Heart is unable to generate a cardiac output

sufficient to meet the demands of the body
without an increased filling pressure

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 Definition (2)

European Society of Cardiology

Symptoms of heart failure and
Objective evidence of cardiac dysfunction
(systolic or diastolic) and if in doubt
Response to treatment

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 Definition
Epidemiology
Descriptive terms
Pathophysiology
Causes
Signs and symptoms
Investigations
Treatment

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 The problem
Prevalence 0.4 - 2%
Increases rapidly with age
Average age 74 years
Poor prognosis

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 Source:
www.heartstats.org

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 Source:
www.heartstats.org

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 A
B
C
D
E
F

Source:
www.heartstats.org

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Which letter represents breast
cancer?
0% 0% 0% 0% 0% 0%

1.A
2.B Answer
Now

3.C
4.D 8

5.E
6.F
1 2 3 4 5 6

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 Source:
www.heartstats.org

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 Definition
Epidemiology
Descriptive terms
Pathophysiology
Causes
Signs and symptoms
Investigations
Treatment

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Descriptive terms

Acute vs chronic
Systolic vs diastolic
Right vs left
Low output vs high output

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 Definition
Epidemiology
Descriptive terms
Pathophysiology
Causes
Signs and symptoms
Investigations
Treatment

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Pathophysiology

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18
19
 Normal Normal
stroke stroke
volume volume

CHF CHF

preload afterload

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 Definition
Epidemiology
Descriptive terms
Pathophysiology
Causes
Signs and symptoms
Investigations
Treatment

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 Aetiology
IHD

DCM

HT

Drugs - alcohol, chemotherapy

Infection - viral, Chagas

Metabolic - hypothyroidism, haemochromatosis

Post partum

Infiltrative - amyloid, sarcoid

Valve disease

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 Definition
Epidemiology
Descriptive terms
Pathophysiology
Causes
Signs and symptoms
Investigations
Treatment

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 Symptoms
SOB
On exertion (or at rest)
Orthopnoea
Paroxysmal nocturnal dyspnoea
Tiredness
Depression
Palpitations
Peripheral oedema
Gout

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 Symptom assessment

NYHA classification
Class I: No symptoms
Class II: Symptoms on exertion
Class III: Symptoms on minimal
exertion
Class IV: Symptoms at rest

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 Signs
May be very little

Raised JVP

3rd heart sound

Pulmonary crackles

Hepatomegaly

Peripheral or sacral oedema

[Cachexia]

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 Investigations
Routine bloods
FBC
U/Es
Glucose
LFTs
TFTs
Cholesterol
Ferritin
Uric acid
Immunoglobulins and PEP
BNP
Viral titres

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ECG

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What does the ECG show?
0% 0% 0% 0%

1.RBBB
2.LBBB
3.Normal
4.STEMI

1 2 3 4

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CXR

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ECHO

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 Investigations
Others
Cardiac catheterisation
Holter monitoring
Lung function tests
Cardiopulmonary exercise testing
Perfusion imaging
Cardiac MR

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 Definition
Epidemiology
Descriptive terms
Pathophysiology
Causes
Signs and symptoms
Investigations
Treatment

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Acute pulmonary oedema
Medical emergency
Easy to recognise
High flow O2
Morphine + anti-emetic
IV GTN
Furosemide if fluid overloaded
May need ventilatory support

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 Chronic heart failure

Basic principles
Prevent HF
Maintenance or improvement in symptoms
Increased duration of life

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 Nurses
Hospital

Community

Occupational therapy
Physiotherapists
Psychologists
Social workers
Doctors
GP

HF specialist

Interventional cardiology

Electrophysiologists

Renal physicians

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 Treatment
Remove exacerbating treatments
Drug therapy
Start with low doses and gradually increase
Device therapy
Surgical therapy
Exercise training
Palliation

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 Drugs

ACE-inhibitors
Angiotensin II receptor antagonists
-blockers
Aldosterone antagonists
Diuretics

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40
 Is this.?

1.AF 0%
2.SR
3.VT
4.VF

1 2 3 4

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Devices

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 Surgery

Valve surgery
Revascularisation
Transplantation
Assist devices
Mechanical hearts
Stem cells

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 Summary

Heart failure is a common cardiological problem

Long list of aetiologies
Final pathophysiological pathway the same
Treatments address neurohormonal activiation

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