Heart Failure

dr. Niva W
Introduction

Heart failure (HF) is a major and growing

public health problem in the United States

Approximately 5 million patients in this

country have HF, and over 550 000
patients are diagnosed with HF for the first
time each year1

1. Hunt SA, Abraham WT, Chin MH, Feldmen AM, Francis GS, Ganiats TG, et al. Guidelines
for Diagnosis and Management Hear Failure in Adult. Circulation 2009;119;e391-e479.
Definition of Heart Failure
Heart failure is a complex clinical syndrome that
can result from any structural or functional cardiac
disorder that impairs the ability of the ventricle to fill
with or eject blood1

HF is a syndrome in which the patients should

have the following features: symptoms of HF,
typically shortness of breath at rest or during
exertion, and/or fatigue; signs of fluid retention
such as pulmonary congestion or ankle swelling;
and objective evidence of an abnormality of the
structure or function of the heart at rest (Table 3) 2

1 . Hunt SA, Abraham WT, Chin MH, Feldmen AM, Francis GS, Ganiats TG, et al. Guidelines for
Diagnosis and Management Hear Failure in Adult. Circulation 2009;119;e391-e479.
2. Dickstein K, Solal AC , Filippatos G , McMurray JJV, Ponikowski R, ilson PAP, Stromberg
A, Veldhuisen DJV, Atar D. Et al. Guidelines for the diagnosis and treatment
2. Dickstein K, Solal AC , Filippatos G , McMurray JJV, Ponikowski R, ilson PAP, Stromberg
A, Veldhuisen DJV, Atar D. Et al. Guidelines for the diagnosis and treatment
of acute and chronic heart failure European Heart Journal (2008) 29, 23882442.
2. Dickstein K, Solal AC , Filippatos G , McMurray JJV, Ponikowski R, ilson PAP, Stromberg
A, Veldhuisen DJV, Atar D. Et al. Guidelines for the diagnosis and treatment
of acute and chronic heart failure European Heart Journal (2008) 29, 23882442.
 Descriptive Terms in Heart Failure

High output
Preload VS
VS Low output
Forward
Afterload
CHF VS
Left sided Backward
VS
Right
sided
acute
Vs
chronic
 NYHA
functional
classification
ACC / AHA
stage of Heart
failure
 Acute VS Chronic Heart Failure
Acute heart failure
is defined as a short term or rapid change
in heart failure signs and symptoms
resulting in a need for urgent therapy.

Chronic heart failure

relatively more stable but symptomatic
condition3

3.oRourke RA, Walsh RA, Fuster V. Editors. Patophysiology of Heart failure.in : Hursts
The Heart. 12th ed. Singapore: Mc Graw Hill.2009.
2. Dickstein K, Solal AC , Filippatos G , McMurray JJV, Ponikowski R, ilson PAP, Stromberg
A, Veldhuisen DJV, Atar D. Et al. Guidelines for the diagnosis and treatment
of acute and chronic heart failure European Heart Journal (2008) 29, 23882442.
 Left Sided VS Right Sided Heart
Failure
Left Sided Heart Failure (or pump
failure)
is used clinically in reference to symptoms
and signs of elevated pressure and
congestion in the pulmonary veins and
capillaries
Right Sided Heart Failure
refers to symptoms and signs of elevated
pressure and congestion in the systemic
veins and capillaries3

3.oRourke RA, Walsh RA, Fuster V. Editors. Patophysiology of Heart Failure. 12 th ed.
Singapore: Mc Graw Hill.2009.
Congestive Heart Failure
features of circulatory congestion (fluid
retention)3

3.oRourke RA, Walsh RA, Fuster V. Editors. Patophysiology of Heart Failure. 12 th ed.
Singapore: Mc Graw Hill.2009.
Forward Failure VS Backward Failure
Forward Failure
refers to signs and symptoms of
decreasing cardiac output and tissue
hypoperfusion

Backward Failure
refers to signs and symptoms caused by
elevated right or left ventricle filling
pressure4

4. Longmore M, Wilkinson IB, Davidson EH, Foulkes A, Mafi AR. Heart failure basic
Concepts. In :Oxford Handbook of Clinical Medicine. 8th ed. New York: Oxford
University Press. 2010. p 128.
Preload VS Afterload
Preload
is term linked to the left and/or right atrial
pressures (often reflecting volume
overload)
Afterload
is term linked to the work of the
myocardium (often reflecting pressure
overload or high impedance)3

3.oRourke RA, Walsh RA, Fuster V. Editors. Patophysiology of Heart Failure. 12 th ed.
Singapore: Mc Graw Hill.2009.
High -Ouput Heart Failure VS
Low -Output Heart Failure
High- Output High Failure
in this condition output is normal or
increased in the face of increasing needs.
Failure occurs when cardiac output fails to
meet these needs.
causes: anemia, pregnancy,
hyperthyroidsm
Low-Output High Failure
in this condition, cardiac output is
decreased and fails to increase normally
with exertion
 causes of low-output heart failure:
1. Pump failure
systolic and or diastolic HF, heart rate (
blockers, heart block, post MI)
2. Excessive preload
eg mitral regurgitation or fluid overload
3. Chronic excessive afteroad
eg aorta stenosis, hypertension4

4. Longmore M, Wilkinson IB, Davidson EH, Foulkes A, Mafi AR. Heart failure basic Concepts.
Classification by AHA or by NYHA

ACC / AHA stage of heart failure based on

structure and damage of heart muscle
NYHA functional classification based on
severity of symptoms and physical activity
2. Dickstein K, Solal AC , Filippatos G , McMurray JJV, Ponikowski R, ilson PAP, Stromberg
A, Veldhuisen DJV, Atar D. Et al. Guidelines for the diagnosis and treatment
of acute and chronic heart failure European Heart Journal (2008) 29, 23882442.
Aetiology of Heart Failure

2. Dickstein K, Solal AC , Filippatos G , McMurray JJV, Ponikowski R, ilson PAP, Stromberg

A, Veldhuisen DJV, Atar D. Et al. Guidelines for the diagnosis and treatment
of acute and chronic heart failure European Heart Journal (2008) 29, 23882442.
Diagnostic Tests in Heart Failure
ECG
Chest X-ray
Laboratory tests : complete blood count
(haemoglobin, leukocytes, platelets),
serum electrolytes, serum creatinine,
estimated glomerular filtration rate (GFR),
glucose, liver function tests, and urinalysis,
Natriuretic peptides, Troponins,
Neurohormonal markers
Echocardiography

2. ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure 2008
 Prognosis

Aetiologies
age
co-morbidities variation
outcomes

2. Dickstein K, Solal AC , Filippatos G , McMurray JJV, Ponikowski R, ilson PAP, Stromberg

A, Veldhuisen DJV, Atar D. Et al. Guidelines for the diagnosis and treatment of acute and
chronic heart failure European Heart Journal (2008) 29, 23882442.
Management

management

Non
pharmacological
pharmacological

2. Dickstein K, Solal AC , Filippatos G , McMurray JJV, Ponikowski R, ilson PAP, Stromberg

A, Veldhuisen DJV, Atar D. Et al. Guidelines for the diagnosis and treatment of acute and
chronic heart failure European Heart Journal (2008) 29, 23882442.
 Non
Pharmacological
pharmacological

- ACEI
Self-care -ARB
management - -Blockers
-Aldosterone
antagonists
- H-ISDN
- Digoxin AF
- Diuretics

2. Dickstein K, Solal AC , Filippatos G , McMurray JJV, Ponikowski R, ilson PAP, Stromberg A,

Veldhuisen DJV, Atar D. Et al. Guidelines for the diagnosis and treatment of acute and chronic
heart failure European Heart Journal (2008) 29, 23882442.
Acute Heart Failure
Definition

a rapid onset or change in the signs and

symptoms of HF, resulting in the need for
urgent therapy.
AHF may be either new HF or worsening
of pre-existing chronic HF2

2. ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure 2008
2. ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure 2008
2. ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure 2008
2. ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure 2008
2. ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure 2008
1.2009 Focused Update Incorporated Into the ACC/AHA 2005 Guidelines for the Diagnosis
and Management of Heart Failure in Adults
References
1.
Hunt SA, Abraham WT, Chin MH, Feldmen
AM, Francis GS, Ganiats TG, et al.
Guidelines for Diagnosis and Management
Hear Failure in Adult. Circulation
2009;119;e391-e479.
2.
Dickstein K, Solal AC , Filippatos G ,
McMurray JJV, Ponikowski R, ilson PAP,
Stromberg A, Veldhuisen DJV, Atar D. Et
al. Guidelines for the diagnosis and
treatment of acute and chronic heart
failure European Heart Journal (2008) 29,
23882442.
3.ORourke RA, Walsh RA, Fuster V. Editors.
Patophysiology of Heart Failure. 12th ed.
Singapore: Mc Graw Hill.2009.
4. Longmore M, Wilkinson IB, Davidson EH,
Foulkes A, Mafi AR. Heart failure basic
Concepts. In :Oxford Handbook of Clinical
Medicine. 8th ed. New York: Oxford
University Press. 2010. p 128.
THANK YOU