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Heart failure
Heart failure is a complex clinical syndrome that results from structural or functional impairment of the heart's ability to pump blood effectively. It can develop when the heart fails to pump enough blood to meet the body's needs. Mortality from heart failure is high, with 50% of patients dying within 5 years of diagnosis. Common risk factors include hypertension, diabetes, and atherosclerotic disease. Management involves controlling risk factors and using medications like ACE inhibitors, beta blockers, diuretics, and aldosterone antagonists depending on the stage of heart failure.
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Heart failure
- 1. Heart Failure Case Presentation& Topic Review By: Bushra AL Asaor, Pharm D intern, Al Maarefa college. Supervised by: Pharm D. Salah Zouein .
- 2. Mortality: Absolute mortality rates: 50% within 5 years of diagnosis. 22% in 1-year after hospitalization. 10.4% in 30-day after hospitalization. 2013 ACCF/AHA Guideline for the Management of Heart Failure
- 3. Outline: 1. Definition 2. Classification 3.Clinical symptoms 4. Risk factors 5. Body adaptation mechanism 6. HF stages 7. Management 8. Case review
- 4. Definition: HF isa complex clinical syndrome that results from any structural or functional impairment of ventricular filling or ejection of blood. Heart failure develops when the heart, via an abnormality of cardiac function (detectable or not), fails to pump blood at a rate commensurate with the requirements of the metabolizing tissues or is able to do so only with an elevated diastolic filling pressure
- 5. Classifications: DescriptionEF%Classification Systolic HF≤ 40HFwith reduced ejection fraction (HFrEF) Diastolic HF50≤HF with preserved ejection fraction (HFpEF) Normal EF :55-70%
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- 7. Risk factors: Hypertension Diabetes Mellitus Metabolic Syndrome Atherosclerotic Disease Obesity Dyslipidemia 2013 ACCF/AHA Guideline for the Management of Heart Failure
- 8. Body adaptation toheart failure: 1. Cardiac Hypertrophy 2. Congestion of chambers 3. Activation of Renin Angiotensin Pathway 4. Pulmonary (Left Side) or Systemic (Right Side) Venous Congestion. 5. Dilutional Hyponatremia 6. Increased Sympathetic Activity( Vasoconstriction, Tachycardia, contractility 7. Endothelin release( Vasoconstriction) 8. Reduced Nitric Oxide production. 9. Bradycardia. 2013 ACCF/AHA Guideline for the Management of Heart Failure
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- 10. Management: Therapeutic alternatives: ACEi. ARB. Beta Blocker. Aldosterone antagonist. Nitrate hydralazine. Digoxin. Loop diuretic.
- 11. HF management Stage A *Control risk factors * ACE For MI or DM * Statin in dyslipidemia Stage B ICMP+ post MI +LVEF≤30+GFS ICD Recent or history of MI ± rEF ACE or ARB B blocker * Structural abnormality without MI Treat HTN Stage C Stage D * Effective B Blocker in HF: Metoprolol SR, Bisoprolol, Carvedilol 2013 ACCF/AHA Guideline for the Management of Heart Failure
- 12. HF management Stage A Stage B Stage C ACEior ARB& BB + Omega 3 Persistently symptomatic despite TX + ARB Or Digoxin If AA add (Nitrate hydralazine ) 1- EF ≤35 & crcl≥30ml/min & K<5meq/dl 2- EF≤40 & acute MI & symptom or DM Aldosterone antagonist Volume overload Loop diuretic Stage D 1- Fluid restriction(1.5- 2L/d). 2- Inotropes for cardiogenic shock 3-Cardiac transplantation. 4-Diuretic if overload. 5- IV NG or Nitroprusside if dyspnea without hypotension. 2013 ACCF/AHA Guideline for the Management of Heart Failure