Heart Failure

Heart Failure

1. Definition

   • Clinical syndrome, that is, a recognizable pattern of signs and symptoms.
   • ‘Cardiomyopathy’ is a term, itself with widely differing definitions, that describes features of structural and functional heart muscle dysfunction.
   • Occurs in patients who, because of an inherited or acquired abnormality of cardiac structure and/or function.
     • Heart cannot pump enough blood to meet the body's needs, it develop a constellation of clinical symptoms and signs.

2. Epidemiology

   • More than 20 million people affected.
   • Affects 6–10% of people over age 65.
   • HF is lower in women than in men.
   • HF is thought to be increasing, in part because current therapies for cardiac disorders, such as myocardial infarction (MI).

3. Etiology

   • Depressed Ejection Fraction (<40%)
     • Coronary artery disease
     • Hypertension
     • Nonischemic dilated cardiomyopathy
     • Chronic volume overload
   • Preserved Ejection Fraction (>40–50%)
     • Pathologic hypertrophy
     • Restrictive cardiomyopathy
   • Pulmonary Heart Disease
   • High-Output States

4. Pathophysiology

   • Heart failure with reduced ejection fraction (HEFF)
     • Systolic heart failure
       • Left ventricle contracts little and empties inadequately.
   • Heart failure with preserved ejection fraction (HFpEF):
     • Diastolic heart failure
       • Filling of the left ventricle is affected, resulting in an increase in the end-diastolic pressure of the left ventricle.

5. Clinical manifestations

   • Cardinal symptoms: fatigue and shortness of breath.
   • Early stages of HF: dyspnea
   • Orthopnea
   • Paroxysmal Nocturnal Dyspnea
   • Cheyne-Stokes respiration

6. Diagnosis

   • Routine laboratory testing:
   • Chest X-ray
   • Assessment of LV function
   • Biomarkers
   • Exercise testing

7. Treatment

   • Driving
   • ACE inhibitors
   • BETA Blockers
   • Mineralocorticoids
   • Diuretics
   • If channels inhibitors
   • Angiotensin II Receptor Antagonists