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Heart Failure

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24 views9 pages

Heart Failure

Uploaded by

mmparmar2903
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
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Heart Failure

Introduction

Heart failure (HF) is a clinical syndrome in which the heart is unable


to pump sufficient blood to meet the body's metabolic demands or is
able to do so only at the expense of elevated filling pressures. It is a
complex condition characterized by a variety of symptoms, including
shortness of breath, fatigue, and fluid retention, and can lead to
significant morbidity and mortality if not effectively managed.

Classification of Heart Failure

Heart failure can be classified based on the ejection fraction (EF)


into two categories:

1. Heart Failure with Reduced Ejection Fraction (HFrEF): EF < 40%,


typically due to systolic dysfunction.

2. Heart Failure with Preserved Ejection Fraction (HFpEF): EF ≥


50%, usually associated with diastolic dysfunction.

Etiology of Heart Failure

The causes of heart failure can be divided into two broad


categories:
1. Primary Causes: Directly affect the heart muscle.

Ischemic heart disease (coronary artery disease, myocardial


infarction).

Hypertension (leading to left ventricular hypertrophy and diastolic


dysfunction).

Cardiomyopathies (dilated, hypertrophic, restrictive).

Valvular heart disease (e.g., mitral regurgitation, aortic stenosis).

Arrhythmias (e.g., atrial fibrillation, ventricular tachycardia).

2. Secondary Causes: Conditions that exacerbate or contribute to


heart failure.

Renal failure.

Thyroid disease.

Chronic pulmonary disease (e.g., COPD).

Anemia.

Obesity.
Pathophysiology of Heart Failure

The pathophysiology of heart failure involves a combination of


reduced cardiac output, elevated filling pressures, and
neurohormonal activation:

1. Decreased Cardiac Output: The heart fails to pump blood


effectively, leading to systemic hypoperfusion and organ
dysfunction.

2. Elevated Left Ventricular Filling Pressures: The inability of the


heart to pump effectively leads to blood congestion in the left
atrium and pulmonary circulation, causing pulmonary edema and
respiratory symptoms.

3. Neurohormonal Activation: The body compensates for decreased


cardiac output by activating several mechanisms:

Renin-Angiotensin-Aldosterone System (RAAS): Causes sodium and


water retention, increasing blood volume.

Sympathetic Nervous System: Increases heart rate and


contractility but also leads to vasoconstriction.

Natriuretic Peptides: Elevated levels of BNP (B-type natriuretic


peptide) are seen in response to increased ventricular wall stress,
helping to reduce fluid overload but can become overwhelmed in
severe HF.
4. Cardiac Remodeling: Chronic heart failure leads to changes in the
heart's structure and function, including ventricular dilation and
hypertrophy.

Clinical Features of Heart Failure

1. Symptoms:

Dyspnea: Shortness of breath, especially on exertion or at rest


(orthopnea, paroxysmal nocturnal dyspnea).

Fatigue and Weakness: Due to poor perfusion of vital organs.

Edema: Peripheral swelling (legs, ankles) and ascites due to fluid


retention.

Decreased Exercise Tolerance: Inability to perform daily activities.

2. Signs:

Tachycardia: Elevated heart rate as a compensatory mechanism.

Elevated Jugular Venous Pressure (JVP): Indicative of right-sided


heart failure or fluid overload.
Pulmonary Rales: Due to pulmonary edema.

S3 Gallop: Indicates increased filling pressures.

Hepatomegaly and Ascites: In right-sided heart failure due to


congestion.

Cold Extremities and Cyanosis: In severe cases, due to poor


peripheral perfusion.

Diagnosis of Heart Failure

1. Clinical History and Physical Examination: Identification of


symptoms such as dyspnea, fatigue, and edema, as well as signs like
elevated JVP, rales, and S3 gallop.

2. Laboratory Tests:

B-type Natriuretic Peptide (BNP): Elevated levels suggest heart


failure, particularly in acute cases.

Electrolytes, Renal Function: To assess for fluid overload or renal


dysfunction.

Thyroid Function: Hypothyroidism or hyperthyroidism can contribute


to heart failure.
3. Imaging:

Echocardiography: Gold standard for assessing ventricular function,


ejection fraction, and valve function.

Chest X-ray: Can show signs of pulmonary congestion (e.g.,


cardiomegaly, pulmonary edema).

4. Electrocardiogram (ECG): To identify arrhythmias or ischemic


changes.

5. Cardiac MRI: For detailed assessment of myocardial structure


and function, especially in cases of cardiomyopathy.

Management of Heart Failure

The goals of treatment are to relieve symptoms, improve quality of


life, and reduce mortality.

1. General Measures:

Lifestyle Changes: Sodium and fluid restriction, weight reduction,


smoking cessation, and regular exercise.
Patient Education: Monitoring symptoms, adherence to medications,
and understanding signs of worsening heart failure.

2. Pharmacologic Therapy:

Angiotensin-Converting Enzyme Inhibitors (ACEi) / Angiotensin


Receptor Blockers (ARBs): Reduce afterload, prevent remodeling,
and improve survival.

Beta-blockers: Decrease heart rate, reduce workload on the heart,


and improve long-term survival.

Diuretics: Furosemide (loop diuretics) to reduce fluid overload and


alleviate symptoms of pulmonary and peripheral edema.

Aldosterone Antagonists: Eplerenone or spironolactone to reduce


fluid retention and improve outcomes.

SGLT2 Inhibitors: Recent evidence supports their use in heart


failure with reduced ejection fraction (HFrEF).

Digoxin: For symptom control in atrial fibrillation and HF.

Vasodilators: Nitroglycerin and hydralazine in certain patients to


reduce preload and afterload.
3. Device Therapy:

Implantable Cardioverter Defibrillators (ICD): In patients at high


risk of sudden cardiac death.

Biventricular Pacemaker (CRT): In patients with heart failure and a


wide QRS complex to improve synchrony and reduce hospitalizations.

4. Surgical Management:

Coronary Artery Bypass Grafting (CABG): For patients with coronary


artery disease and heart failure.

Valve Surgery: For patients with valvular heart disease contributing


to heart failure.

Heart Transplantation: In end-stage heart failure when all other


treatment options fail.

Complications of Heart Failure

1. Arrhythmias: Particularly atrial fibrillation, which worsens heart


failure symptoms.
2. Acute Pulmonary Edema: Life-threatening complication requiring
immediate management.

3. Renal Dysfunction: Due to poor perfusion and the use of diuretics.

4. Cardiogenic Shock: In severe cases, where there is insufficient


cardiac output.

5. Thromboembolism: Particularly in patients with atrial fibrillation.

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