HEART FAILURE

Definition
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 blood.

Heart Failure Types

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

Contd..
Left Heart Failure:
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)

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)

Causes:
Health conditions that either damage the heart or
make it work too hard
Coronary artery disease
Heart attack
High blood pressure
Abnormal heart valves
Heart muscle diseases (cardiomyopathy)
Heart inflammation (myocarditis)

Causes contd..
Congenital heart defects
Severe lung disease
Diabetes
Severe anemia
Hyperthyroidism
Abnormal heart rhythms

Causes contd:
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

Causes contd:
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

Causes contd:
Abnormal heart valves
Heart muscle disease
Damage to heart muscle due to drugs, alcohol or
infections

Congenital heart disease

Severe lung disease

Causes Contd:
Diabetes
Tend to have other conditions that make the
heart work harder
Obesity
Hypertension
High cholesterol

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

Hyperthyroidism
Body metabolism is increased and overworks the
heart
Abnormal Heart Rhythm
If the heart beats too fast, too slow or irregular it

RISK FACTORS:
Myocardial ischemia or infract
Dietary sodium excess
Excess fluid intake
Medication noncompliance
Arrhythmias
Infection
Conditions associated with increased metabolic demand (eg
pregnancy, thyrotoxicosis, excessive physical activity)
Administration of drug (eg. NSAIDs, corticosteroids)
Alcohol
Smoking

Signs and Symptoms

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

Signs and Symptoms contd..

Persistent Cough or Wheezing
WHY?

Fluid backs up in the lungs

SYMPTOMS

Coughing that produces white or pink

blood-tinged sputum

Signs and Symptoms contd..

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

Signs and Symptoms contd..

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

Signs and Symptoms contd..

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

Signs and Symptoms contd..

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

Signs and Symptoms contd..

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

MANAGEMENT:
To improve symptoms and quality of life
To decrease likelihood of disease progression
To reduce the risk of death and need for
hospitalisation

Treatment Options:
The more common forms of heart failure cannot
be cured, but can be treated

Lifestyle changes
Medications
Surgery

LIFE STYLE CHANGES:

Stop smoking
Loose weight
Avoid alcohol
Avoid or limit caffeine
Eat a low-fat, low-sodium diet
Exercise

Lifestyle changes
Reduce stress
Keep track of symptoms and weight and report
any changes or concern to the doctor
Limit fluid intake
See the doctor more frequently

HF Therapy
(Reduced LVEF with Symptoms)

Recommended Therapies:
Drug therapy for all patients
Diuretics for fluid retention
ACEI
Beta-blockers
Drug therapy for selected patients
Aldosterone Antagonists
Digitalis
Exercise Testing and Training

Medications used to treat Heart Failure

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

Medications used to treat Heart Failure

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

ACE Inhibitors: physiologic

benefits
Arteriovenous Vasodilatation
pulmonary arterial diastolic
pressure
left ventricular end-diastolic
pressure
systemic vascular resistance
systemic blood pressure
maximal oxygen uptake (MVO2)

ACE Inhibitors: physiologic

benefits
LV function and cardiac output
renal, coronary, cerebral blood
flow
No change in heart rate or
myocardial contractility
no neurohormonal activation

Guidelines to ACE Inhibitor Therapy

Contraindications
Renal artery stenosis
Renal insufficiency (relative)
Hyperkalemia
Arterial hypotension
Cough
Angioedema

Medications

Diuretics:
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

Diuretics
Indicated in patients with symptoms of
heart failure who have evidence of fluid
retention
Enhance response to other drugs in heart
failure such as beta-blockers and ACE
inhibitors

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

Medications:
Beta-blockers
Lower the heart rate and blood pressure
Decrease the workload of the heart
BLOOD THINNERS (COUDIMINE)
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

Treatment options:
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)

Surgical
Therapy
Revascularization
Valve repair,
replacement
Ventricular remodeling
Cardiomyoplasty

Surgical Therapy
Intra-aortic balloon pump (IABP)
Ventricular assist device (VAD)
o
o

Temporary therapy
Destination therapy

Heart transplant
Total artificial heart