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Heart failure
Heart failure (HF) is a clinical syndrome resulting from cardiac disorders affecting the ventricles' ability to fill or eject blood, with a higher incidence in older adults. It is classified into various types and stages to emphasize its preventability and progressive nature, with evaluations including symptoms and diagnostic tests. The Framingham criteria outline major and minor signs for diagnosing congestive heart failure.
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Heart failure
- 1. Approach to HEARTFAILURE Dr. Subroto Mandal, MD, DM Assistant Professor, Cardiology NRI Heart Centre & Research Institute
- 2. Definition of HeartFailure HF 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 blood. ACC/AHA Task force
- 3. “ Heart Failure”vs. “Congestive Heart Failure” Because not all patients have volume overload at the time of initial or subsequent evaluation, the term “heart failure” is preferred over the older term “congestive heart failure.”
- 4. Relatively common disorderThe incidence of HF approaches 10 per 1000 population after age 65 1-2 % at the age of 45-50yrs >10% at the age >75yrs At 40yrs age life time risk for HF 21%for men 20.3% for women 80% admission for HF > 65yrs old Cost of hospitalization for heart failure is twice that for all form of cancer and myocardial infarction combined PREVALENCE & INCIDENCE
- 5. CLASSIFICATION Forward VsBackward Rt. Vs Lt. sided HF Acute Vs Chronic HF Low Vs High output HF Systolic Vs Diastolic HF
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- 7. Stages of HeartFailure At Risk for Heart Failure: STAGE A High risk for developing HF STAGE B Asymptomatic LV dysfunction Heart Failure: STAGE C Past or current symptoms of HF STAGE D End-stage HF
- 8. Stages of HeartFailure Designed to emphasize preventability of HF Designed to recognize the progressive nature of LV dysfunction
- 9. Stages of HeartFailure COMPLEMENT, DO NOT REPLACE NYHA CLASSES NYHA Classes - shift back/forth in individual patient (in response to Rx and/or progression of disease) Stages - progress in one direction due to cardiac remodeling
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- 11. Rapid classification ofhemodynamic states
- 12. PRECIPITATING FACTORS INAPPROPRIATE THERAPY HIGH SALT INTAKE ARRYTHMIAS INFARCTION OR ISCHAEMIA PULMONARY EMBOLISM SYSTEMIC INFECTION PHYSICAL & EMOTIONAL STRESS INFECTIVE ENDOCARDITIS COMORBIDITY ( renal failure, sepsis) MYOCARDIAL DEPRESSANT DRUGS CARDIAC TOXINS HIGH OUTPUT STATES
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- 14. Evaluation of HFpatient
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- 17. RIGHT SIDED SYMPTOMSAbdominal Pain Nausea Constipation Anorexia Bloating Ascites SIGNS Peripheral edema Hepatomegaly JVD or JVP HJR LEFT SIDED DOE PND Orthopnea Tachypnea Cough Hemoptysis Bibasilar rales Pulmonary edema S3 gallop Pleural effusion Cheyne-Stokes respiration
- 18. COUGH Caused bypulmonary congestion Nonproductive cough in LVF (Dyspnea equivalent) Cough at recumbency (Orthopnea equivalent)
- 19. JVP Normal upperlimit of JVP are 4 cm from sternal angle TR V wave and Y descend are prominent Kussumal sign in constrictive pericarditis
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- 22. INVESTIGATIONS BNP ECGCXR ECHOCARDIOGRAPHY ( TTE, TEE) CARDIAC CATHETERIZATION MUGA SCAN, CT, MRI ANGIO ENDOMYOCARDIAL BIOPSY VIABILITY ASSESMENT (DSE, MRI, SPECT, PET scan) ARRYTHMIA WORK UP
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- 26. Dextrocardia – Acutepulmonary edema
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- 31. Mitral Stenosis PrePBMV Post PBMV
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- 42. Framingham Criteria forCongestive Heart Failure Major criteria: Paroxysmal nocturnal dyspnea Neck vein distention Rales Radiographic cardiomegaly Acute pulmonary edema S3 gallop Increased central venous pressure (>16 cm H2O at right atrium) Hepatojugular reflux Weight loss >4.5 kg in 5 days in response to treatment Minor criteria: Bilateral ankle edema Nocturnal cough Dyspnea on ordinary exertion Hepatomegaly Pleural effusion Decrease in vital capacity by one third from maximum recorded Tachycardia (heart rate>120 beats/min.)
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Editor's Notes
- #12 Figure 7-17. Rapid classification of hemodynamic states. Stevenson [42] popularized the concept of tailoring therapies to the hemodynamic status of patients. This approach can be coupled to a noninvasive diagnostic evaluation of patients admitted to the hospital with congestive heart failure with therapeutic approaches, perhaps directed by varying combinations of fluid retention states and peripheral organ perfusion. The two basic components outlined in this figure are, indeed, congestion (B and C) and low perfusion (C and D). Perhaps the most complex patient is the individual who is substantially volume overloaded with low flow states (D). These patients as well as those with simply low perfusion states are generally in cardiogenic shock. Signs and symptoms of congestion to review include orthopnea, paroxysmal nocturnal dyspnea, jugular venous distention, hepatomegaly, particularly with hepatojugular reflux, peripheral edema, presence of rales (remembering that they can be rare in chronic heart failure), and the Valsalva square wave blood pressure sign. Signs of low perfusion include a narrow pulse pressure, a sleepy or obtunded patient, periodic respirations, cool extremities, hypotension after angiotensin-converting enzyme inhibitor introduction, and renal dysfunction or a low serum sodium [42].
- #15 Figure 7-1. Specific goals of patient evaluation when heart failure is suspected. First, one must appropriately recognize the heart failure syndrome and differentiate heart and circulatory failure from problems that cause similar complaints and findings. Second, by staging the severity of heart failure, the clinician can establish prognosis with reasonable accuracy. This is important in the design of therapeutic protocols to treat certain aspects of the syndrome. Finally, identifying the primary etiology of myocardial dysfunction and determining the precipitating causes of decompensation are extremely important. The interplay of patient history, physical examination, laboratory tests, and specific diagnostic studies helps the clinician achieve these goals.