Heart Failure

By

Dr. Tharwat Wagdy Hussien

Ass.
Ass. Prof.of
Prof.of Hematology
Hematology &
& Internal
Internal
Medicine
Medicine
Medical
Medical Academy
Academy

 What

is Heart Failure?

The heart is not pumping as well as it

should
Usually, the heart has been weakened by
an underlying condition
Blocked arteries
Heart attack
High blood pressure
Infections
Heart valve abnormalities

 Heart failure can involve the left

or right side of the heart or both
Usually the left side is affected
first
Heart failure occurs when either
side of the heart cannot keep up
with the flow of blood.

 What is Left Heart Failure?

Involves the left ventricle (lower
chamber) of the heart

Systolic failure

The heart looses its ability to contract

or pump blood into the circulation

Diastolic failure

The heart looses its ability to relax

because it becomes stiff
Heart cannot fill properly between each
beat

 Systolic and diastolic heart

failure are treated with different
types of medications
In both types, blood may back up
in the lungs causing fluid to leak
into the lungs (pulmonary edema)
Fluid may also build up in tissues
throughout the body (edema)

 What

is Right Heart Failure?

Usually occurs as a result of left

heart failure
The right ventricle pumps blood to
the lungs for oxygen
Occasionally isolated right heart
failure can occur due to lung
disease or blood clots to the lung
(pulmonary embolism)

What Causes Heart Failure?

Health conditions that either damage
the heart or make it work too hard:
1-Coronary artery disease
2-Heart attack
3-High blood pressure
4-Abnormal heart valves
5-Heart muscle diseases
(cardiomyopathy)
6-Heart inflammation (myocarditis)

 7- Congenital heart defects

8- Severe lung disease
9- Diabetes
10-Severe anemia
11-Overactive thyroid gland
(hyperthyroidism)
12-Abnormal heart rhythms

 1-Coronary artery disease

Cholesterol and fatty deposits build up
in the hearts arteries
Less blood and oxygen reach the heart
muscle
This causes the heart to work harder
and occasionally damages the heart
muscle

 2-Heart attack
An artery supplying blood to the heart
becomes blocked
Loss of oxygen and nutrients damages
heart muscle tissue causing it to die
Remaining healthy heart muscle must
pump harder to keep up

 3-High blood pressure

Uncontrolled high blood pressure doubles a
persons risk of developing heart failure
Heart must pump harder to keep blood
circulating
Over time, chamber first thickens, then gets
larger and weaker

 4-Abnormal heart valves

5-Heart muscle disease
Damage to heart muscle due to
drugs, alcohol or infections

6-Congenital heart disease

7-Severe lung disease

 8-Diabetes
Tend to have other conditions that
make the heart work harder

9-Obesity
Hypertension
High cholesterol

 10-Severe anemia
Not enough red blood cells to carry oxygen
Heart beats faster and can become overtaxed
with the effort

11-Hyperthyroidism

Body metabolism is increased and overworks

the heart

12-Abnormal Heart Rhythm

If the heart beats too fast, too slow or

irregular it may not be able to pump enough
blood to the body

Signs and Symptoms of Heart Failure

1- Shortness of Breath (dyspnea)
WHY?
Blood backs up in the pulmonary veins because the
heart cant keep up with the supply an fluid leaks into
the lungs

SYMPTOMS
Dyspnea on exertion or at rest
Difficulty breathing when lying flat
Waking up short of breath

 2-Persistent Cough or Wheezing

WHY?
Fluid backs up in the lungs

SYMPTOMS
Coughing that produces white or pink blood-tinged
sputum

 3-Edema
WHY?
Decreased blood flow out of the weak heart
Blood returning to the heart from the veins backs
up causing fluid to build up in tissues

SYMPTOMS
Swelling in feet, ankles, legs or abdomen
Weight gain

 4-Tiredness, fatigue
WHY?
Heart cant pump enough blood to meet needs of
bodies tissues
Body diverts blood away from less vital organs
(muscles in limbs) and sends it to the heart and
brain

SYMPTOMS
Constant tired feeling
Difficulty with everyday activities

 5- Lack of appetite/ Nausea

WHY?
The digestive system receives less blood causing
problems with digestion

SYMPTOMS
Feeling of being full or sick to your stomach

 6- Confusion/ Impaired thinking

WHY?
Changing levels of substances in the blood (
sodium) can cause confusion

SYMPTOMS
Memory loss or feeling of disorientation
Relative or caregiver may notice this first

 7- Increased heart rate

WHY?
The heart beats faster to make up for the loss in
pumping function

SYMPTOMS
Heart palpitations
May feel like the heart is racing or throbbing

New York Heart Association (NYHA)

Functional Classification

Class

% of
Symptoms
patients

35%

No symptoms or limitations in ordinary physical

activity

II

35%

Mild symptoms and slight limitation during

ordinary activity

III

25%

Marked limitation in activity even during minimal

activity. Comfortable only at rest

IV

5%

Severe limitation. Experiences symptoms even at

rest

Treatment Options
The more common forms of heart failure
cannot be cured, but can be treated
Lifestyle changes
Medications
Surgery

 I-

Lifestyle changes

1- Stop smoking
2- Loose weight
3- Avoid alcohol
4- Avoid or limit caffeine
5- Eat a low-fat, low-sodium diet
6- Exercise

 7- Reduce stress
8- Keep track of symptoms and weight
and report any changes or concern to
the doctor
9- Limit fluid intake
10-See the doctor more frequently

II- Medications used to treat Heart

Failure:
1-ACE Inhibitors
Cornerstone of heart failure therapy
Proven to slow the progression of heart
failure
Vasodilator cause blood vessels to expand
lowering blood pressure and the hearts work
load

 2- Diuretics (water pills)

Prescribed for fluid build up, swelling or
edema
Cause kidneys to remove more sodium and
water from the bloodstream
Decreases workload of the heart and edema
Fine balance removing too much fluid can
strain kidneys or cause low blood pressure

 3- Potassium
Most diuretics remove potassium from the
body
Potassium pills compensate for the amount
lost in the urine
Potassium helps control heart rhythm and is
essential for the normal work of the nervous
system and muscles

 4- Vasodilators
Cause blood vessel walls to relax
Occasionally used if patient cannot
tolerate ACE
Decrease workload of the heart

 5- Digitalis preparations
Increases the force of the hearts
contractions
Relieves symptoms
Slows heart rate and certain irregular
heart beats

 6- Beta-blockers
Lower the heart rate and blood pressure
Decrease the workload of the heart

7- Anticoagulant (coumadin)

Used in patients at risk for developing blood

clots in the blood vessels, legs, lung and
heart
Used in irregular heart rhythms due to risk of
stroke

 III- Surgery and other Medical

Procedures
Not often used in heart failure unless there is a
correctable problem
Coronary artery bypass
Angioplasty
Valve replacement
Defibrillator implantation
Heart transplantation
Left ventricular assist device (LVAD)