Heart Failure

Heart Failure

1. Definition

   • Heart cannot pump enough blood to meet the body's needs

2. Epidemiology

   • Affects 6–10% of people over age 65.

3. Etiology

   • Depressed Ejection Fraction (<40%)
     • Coronary artery disease
     • Hypertension
     • Nonischemic dilated cardiomyopathy
       • Prior viral infection or toxin exposure
       • Genetic defects
       • Dilated cardiomyopathy associated with muscular dystrophies
     • Chronic volume overload
   • Preserved Ejection Fraction (>40–50%)
     • Pathologic hypertrophy
     • Restrictive cardiomyopathy
   • Pulmonary Heart Disease
     • Cor pulmonale
   • High-Output States
     • Metabolic disorders
     • Thyrotoxicosis
     • Nutritional disorders (beriberi)
     • Chronic anemia

4. Pathophysiology

   • Primary abnormality: Disorder of cardiomyocyte function, and changes in the turnover of collagen in the extracellular matrix.
     • Heart failure with reduced ejection fraction (HEFF) or systolic heart failure
       • Left ventricle contracts little and empties inadequately.
     • Secondary to: Myocardial infarction, myocarditis, and dilated cardiomyopathy
     • Heart failure with preserved ejection fraction (HFpEF) or diastolic heart failure
       • The filling of the left ventricle is affected = increase in the end-diastolic pressure of the left ventricle.
       • Compromised left ventricular relaxation, increased ventricular stiffness.

5. Clinical Manifestations

   • Fatigue
   • Shortness of breath
   • Pulmonary congestion
   • Reductions in pulmonary compliance
   • Orthopnea
   • Paroxysmal Nocturnal Dyspnea
   • Cheyne-Stokes respiration

6. Diagnosis

   • Routine laboratory testing
   • 12-lead ECG
   • Chest X-ray
   • Echocardiogram/Doppler
   • BNP and N-terminal pro-BNP
   • Exercise testing

7. Treatment

   • ACE inhibitors
   • Beta Blockers
   • Mineralocorticoids
     • Spironolactone
     • Eplerenone
   • Diuretics
   • Angiotensin II receptor Antagonist
   • If Channels Inhibitors
     • Ivabradine