HEART FAILURE

HEART FAILURE

1. DEFINITION

   • A key distinction that has led to persistent confusion in many discussions of the definition of HF is that between the concepts of ‘heart failure’ and ‘cardiomyopathy’
   • Heart failure (HF) occurs in patients who, because of an inherited or acquired abnormality of cardiac structure and/or function, resulting in heart cannot pump enough blood to meet the body's needs,
   • it develop a constellation of clinical symptoms (dyspnea and fatigue) and signs (edema and rales) that lead to frequent hospitalizations, a poor quality of life, and a shortened life expectancy.

2. EPIDEMIOLOGY

   • HF is a burgeoning problem worldwide, with more than 20 million people affected. The overall prevalence of HF in the adult population in developed countries is 2%.
   • HF prevalence follows an exponential pattern, rising with age, and affects 6–10% of people over age 65.
   • The overall prevalence of HF is thought to be increasing, in part because current therapies for cardiac disorders, such as myocardial infarction (MI), valvular heart disease, and arrhythmias, are allowing patients to survive longer.

3. ETIOLOGY

   • DEPRESSED EJECTION FRACTION (<40%)
     • Coronary Arytery Disease
     • Hypertension
     • Nonischemic Dilated Cardiomyopathy
       • Prior viral infection or toxin exposure
       • Genetic Defects
     • Chronic volume overload
   • PRESERVED EJECTION FRACTION (>40-50%)
     • Pathologic Hypert
     • Restrictive Cardiomyopathy
   • PULMONARY HEART DISEASE
   • HIGH-OUTPUT STATES
     • Metabolic Disorders
     • Thyrotoxicosis
     • Nutritional disorders
     • Chronic Anemia

4. PATHOPHYSIOLOGY

   • In heart failure, the heart may not supply the tissues with adequate blood to meet their metabolic needs, and the elevation of pulmonary or systemic venous pressure associated with this disease can promote congestion of the organs.
   • The primary abnormality may be a disorder of cardiomyocyte function, and changes may also occur in the turnover of collagen in the extracellular matrix
     • HEART FAILURE WITH REDUCED EJECTION FRACTION
       • It is also called systolic heart failure, where global systolic dysfunction of the left ventricle predominates. Here the left ventricle contracts little and empties inadequately.
     • HEART FAILURE WITH PRESERVED EJECTION FRACTION
       • Also called diastolic heart failure, here the filling of the left ventricle is affected, resulting in an increase in the end-diastolic pressure of the left ventricle

5. CLINICAL MANIFESTATIONS

   • ORTHOPNEA
     • is defined as dyspnea occurring in the recumbent position, is usually a later manifestation of HF than is exertional dyspnea. It results from redistribution of fluid from the splanchnic circulation and lower extremities into the central circulation during recumbency, with a resultant increase in pulmonary capillary pressure.
   • PAROXYSMAL NOCTURNAL DYSPNEA
     • is an acute episode of severe shortness of breath and coughing that generally occurs at night and awakens the patient from sleep, usually 1 or 3 h after the patient retires.
   • CHEYNE-STOKES RESPIRATION
     • Also referred to as periodic respiration or cyclic respiration, Cheyne-Stokes respiration is present in 40% of patients with advanced HF and usually is associated with low cardiac output.

6. DIAGNOSIS

   • ROUTINE LABORATORY TESTING
   • ELECTROCARDIOGRAM
   • CHEST X-RAY
   • BIOMARKERS
   • EXCERCISE TESTING

7. TREATMENT

   • DRIVING
   • ACE INHIBITORS
   • BETA BLOCKERS
   • MINERALOCORTICOIDS
   • DIURETICS
   • IF CHANNELS INHIBITORS

8. JAVIER LANDÁZURI A 7° MEDICINE "D" MEDICAL ENGLISH